Synapses Vol. 7 (2023)

SYNAPSES NATALIA CHALUPCZAK, CMS ’26 Untitled Cars whizz by. Two Toyotas nearly collide. No one cares for the lights anymore. Boots patter on a sidewalk darkened by the rain, the muddied soles staining the star-shaped slabs of granite stuck to the floor. God, the way people smile when they see the stars. Their eyes glimmer like their LED screens when they open Instagram. “It’s not real!” shouts a homeless man. “None of it’s real! Open your ears!” A rusty beard with a beanie shivers in a street corner. The beanie’s rib cage presses tightly against an almost see- through layer of skin. Those bulging eyes sit ripe to pop from their sockets, the antiquated lines clinging to them too weak to straighten themselves. “You liars!” he continues. “Hypocrites! It’s all a game, all to make you hurt!” A skirmish breaks out on the street. Watching the confrontation as if they should be munching on popcorn, a group of vegetative button-downs and overpriced shorts wait to cross. “Get off me!” yells a red t-shirt shoving away a pair of brown-splattered hands. Beanie’s long, bony fingers pull harder on the cotton, pull desperately the idle gazes that surround him. He reaches for red shirt’s baseball cap and snatches it. “Liars!” the beard shouts. “Hypocrites!” Little man lights up. The cattle cross. Red shirt never goes back to retrieve the cap. Now she’s a young woman with pink hair. She’s walking in the middle of the street. The wind of speeding cars blows the brightly colored strands away from her cheeks. Her dull eyes are fixed somewhere between the sky and the traffic ahead of her. She’s chanting poetic phrases in that peculiar dialect she learned from the joint in her hand. Her pupils dilate as she chuckles and fidgets with her fingers. Her arms extend, welcoming the lethal machines zooming inches away. Her eyebrows sit too sad to straighten themselves. Her pupils go gray. All she sees is gray, the cars, the buildings, herself. She sees herself on a stage, wearing a sequined gown. It glistens like those LED screens. Her pink hair jiggles against the pale curtains as she sings to a cheering crowd. She sees something in the distance and stops. The audience fades to dust. The stage, too, the excitement, the energy. A thought comes over her watery eyes: It’s all in my head, it always has been. She forces a final feeble smile. Her eyebrows raise a little more. She shakes. She closes her eyes and imagines she can fly. She’s an angel. But there’s no halo to be found, just that LED beam glowing from the inside. No clouds, just pot-putrid smoke that dances to the city, to the ringing phones, to the wailing white-powdered beards flailing aimlessly in their corners, and to the bleak black boots clacking against the slabs like fleets of funeral cars. She spreads her wings. A Toyota smashes into her existential embrace. She really can fly. Her joint is disfigured beyond recognition. Smoke continues to rise, but it’s hard to see in the rain, you barely even notice. Her body lays idle on the cold, wet concrete. She lays with the stars.­ ■ CHICAGO MEDICAL SCHOOL 51

SYNAPSES ERIC HANDLER, MD ’76, MPH Serendipity Life is full of surprising consequences separated by split moments in time. I did my pediatric residency training at Los Angeles County USC Hospital from 1976 to 1979. I was physically and mentally drained after completing it. Not knowing what I wanted to specialize in, I decided that I needed to completely recharge my batteries. So for the next five years, I worked part-time in pediatric private practice and part-time as a school physician, with the remainder of my time spent on the beach. Three to four times a week, I was at the beach from sunup to sundown enjoying the sand and the ocean, as well as friendships. During this five-year period, I was barely making ends meet financially and still had no idea what I wanted to do. One day, I bumped into a friend of mine who said that California Children Services was looking for a pediatrician to do examinations at developmental centers on severely disabled individuals. I thought to myself, Why in God’s name would I want to work with children who had limited communication and were functioning at an intellectual level of six months of age or less? During the conversation my friend said, “Oh, by the way, this job pays $50 per hour...” I said, “Where can I sign up?!” During my first day at the developmental center, one of the patients was a five-year-old girl who was severely physically disabled and had limited movement of her arms and legs. She could not communicate but was able to make grunting sounds. During the examination, I turned to her mother and said, “What beautiful nail polish your daughter has,” and then went back to the examination. The next thing I know, the child is grunting and stretching her arms so that I could better see her polished nails. From that moment on, I knew that my calling was to work with children who have developmental disabilities. My heart was with these children and their families. Towards the end of my five-year stint splitting my time between the clinic and the beach, I was set up on a blind date. On Memorial Day 1983, I called her (Jill) and asked if she had any plans for the night. We had spoken on the phone a few times previously, and since I had nothing planned, I felt I could reach out to see if she was in a similar situation. Much to my surprise, she said she was not busy, and we decided to go out for dinner. I can remember opening the door to her home and seeing her for the first time, thinking, Boy, she’s a pretty woman, and smiled. On the second date, I could picture her being my wife. Approximately four and a half weeks into our relationship, we visited my brother and his family in San Luis Obispo. While we were unpacking in our bedroom, I opened the window to let in some air. Jill looked at me and said, “Does this mean I’m going to have a chest cold for the rest of my life?” I thought this was a very strange comment, and turned to her and said, “You know it’s inevitable that we will get married, and when the time is right, I will ask you.” I then started thinking, Wouldn’t this be a great story to tell our children and friends if we were to get engaged in such a short period of time? So I turned to Jill and said, “Will you marry me?” She said yes, and three months later we were married. The trajectory of my life increased exponentially after marrying Jill. Still unsure of what I wanted to do with my life, and now being married, Jill suggested, “Why don’t you go for your Masters in Public Health?” That was a very curious thing for her to say, and I later realized that my mom was working behind the scenes to get me to go back to school, and was using my wife as a mouthpiece. Needless to say, I enrolled in UCLA’s Public Health program and received my MPH in 1984. During this time I was still working part-time jobs. One day, I was in the UCLA library waiting to take my final exam, and decided to look through one of the pediatric journals, which had a list of fellowships available to pediatricians across the nation. I noticed a pediatric rehabilitation fellowship at Rancho Los Amigos Hospital. After my final, I called the physician in charge of the fellowship and was told there was an opening. I applied for the position and was accepted in 1985. During my fellowship, I treated children with numerous debilitating diseases. I began to struggle with the question: What is the purpose of life? I felt like I had the weight of the world on my shoulders. After several weeks of trying to come up with an answer, I decided to table the issue. Five months later I was pumping gas, and, out of the blue, 52 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES the answer to that universal question appeared. I quickly wrote down the quote before I could forget. From that moment on, I felt a remarkable peace of mind. The Purpose of Life: To enhance our God-given gifts while discovering and exploring the gifts of others. We all have moments of serendipity. It is what we do with these moments that defines us!­ ■ ME L ISSA CH E N, MD, FACULTY Serenity Artist’s Statement: Inspired by the poem “The Peace of Wild Things” by Wendell Berry: “When despair for the world grows in me and I wake in the night at the least sound in fear of what my life and my children’s lives may be, I go and lie down where the wood drake rests in his beauty on the water, and the great heron feeds. I come into the peace of wild things who do not tax their lives with forethought of grief. I come into the presence of still water. And I feel above me the day-blind stars waiting with their light. For a time I rest in the grace of the world, and am free.” Oxford, Connecticut. CHICAGO MEDICAL SCHOOL 53

SYNAPSES NEAL KAUFMAN, MD ’75, MPH When Uncertain, Do—When Uncertain, Don’t? “When in doubt, don’t.” — Benjamin Franklin Medical treatment decisions can be divided into three patterns: for sure yes, for sure no, and maybe yes or maybe no. We wish that all decisions were easily yes or no, but that just isn’t possible. Treatment decisions are all-to-often someplace in between, requiring clinical judgment in the unique context of each patient. One factor which often doesn’t get the attention it deserves is the clinician’s and patient’s fundamental approach to decision-making with uncertainty. One key element relates to a person’s preference for accepting or rejecting an action if there is uncertainty. In other words, would you tend to decide yes or would you tend to decide no, when faced with conflicting but scientifically valid information leading to uncertainty? Most people don’t think about this decision-making element, but the innate preference underlies many decisions made under uncertainty. Perhaps an example will be helpful. Thirty-six months ago I was diagnosed with a relatively rare and serious condition called Amyloidosis. Amyloidosis refers to a group of disorders in which protein fibrils accumulate in certain organs, disrupt their tissue architecture, and impair the function of the effected organ. The clinical manifestations and prognosis vary widely depending on the specific type of the affected protein.1 I presented with nephrotic syndrome and was diagnosed with Immunoglobulin light-chain (AL) amyloidosis, which is the most common form of systemic amyloidosis, characterized by deposition of a misfolded monoclonal light- chain that is secreted from a plasma cell clone. Demonstrating amyloid deposits in a renal biopsy stained with Congo red and a bone marrow biopsy confirmed my diagnosis. The main way to monitor the impact of treatment is to follow the level of light chains in the blood and the amount of proteinuria. There are two very different approaches to treatment which have improved the outcomes for low- and intermediate- risk patients, but the prognosis for high-risk patients is still grave.2 Treatment approaches include: (1) novel agents similar to treatments for multiple myeloma (e.g., proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, thalidomide derivatives) and, (2) autologous stem cell transplantation used to eliminate the underlying plasma cell clone.3 During an autologous stem cell transplant, the patient’s stem cells are harvested, and their bone marrow is treated with a very powerful chemotherapy cocktail until it is wiped out. Then the patient’s own stem cells are transfused back into their blood.4 If all goes well, the stem cells repopulate the bone marrow and cure the disease. With AL Amyloidosis, the cure rate is about 50 - 60 percent.3 The transplant requires three weeks in complete isolation in the hospital, typically with significant pain, risk of infection and uncomfortable side effects. About 1-3 percent of recipients die without leaving the hospital. Full recovery takes four to six months.3 This treatment approach contrasts with continued chemotherapy with its less-than-ideal impact, and the risk of side effects from the treatment such as serious infection, deep vein thrombosis (DVT), and pulmonary embolism.2 After eighteen months of chemo/immunotherapy, my light chains had decreased, but not to hoped-for levels, and my proteinuria was somewhat improved. I was faced with the need to decide which of the two very different approaches was right for me. In my case, the chemo/immunotherapy was relatively easy on my body, with tolerable side effects and no significant complications. That made continued chemotherapy a viable option. Against that approach is the fact that the 54 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES longer I wait to have the transplant, the older I get, and the more likely I am to have a complicated course including a heightened risk of significant morbidity and mortality because of the transplant. I read everything I could find on the treatment options and outcomes in order to decrease the uncertainty of my choice. I spoke many times with my oncologist and got second and third opinions from experts in the field. All the doctors thought I should have the transplant. They believed either option could work, but even with the uncertainty and toxicity of the transplant, they concluded that a transplant was the better treatment option. With uncertainty, they all recommended yes to the transplant. This conclusion probably came not only from their approach to decision-making with uncertainty, but from their experience with transplants and perhaps the tendency to think that more treatment is better. They believed that an effective treatment should not be withheld except for valid medical reasons, and I had none. As patients are allowed to truly be part of a shared decision-making process, it is important to include the patient’s preference regarding decisions under uncertainty. The patient, and all those the patient brings into the decision- making process, must live with the decision the patient implements. Imagine the impact of a bad outcome with the chosen approach, especially when there was not unanimity of thought, which is the rule and not the exception. I approached the decision-making process from an assumption that with uncertainty one should do all that is possible to minimize the uncertainty. In my case, and in most cases, it wasn’t possible to eliminate most of the uncertainty. My condition is too rare, each person with the condition has a slightly different degree of organ damage, and the response to, and side effects from, the chemotherapy are unique for each person. With that reality, I went to my basic and lifelong approach to medical decision making with uncertainty: when uncertain, don’t say yes. So, I decided to not have the transplant. My final story is yet to be told. It has been eighteen months since I made my decision, and at this point it looks like not having the transplant is working well. While I can never know what it would have been if I had the transplant, my condition is slowing improving at a pace my doctor and I can accept. And, I feel empowered and at peace with my approach, since I was able to work through a difficult and important life-affirming decision with the help of my wife, family, friends, and doctors. References 1. Vaxmana,J. Recent Advances in the Diagnosis, Risk Stratification, and Management of Systemic Light-Chain Amyloidosis Acta Haematol 2019;141:93–106; DOI: 10.1159/000495455 2. Gertz,MA. Immunoglobulin light chain amyloidosis diagnosis and treatment algorithm. Blood Cancer Journal (2018)8:44. DOI 10.1038/s41408-018-0080-9 3. Sidiqi, MH. Transplantation for Light Chain Amyloidosis: Decreased Early Mortality Over Time. Journal of Clinical Oncology. Volume 36. Number 13. May 1,2018. p1323-1330;DOI: https://doi.org/10.1200/JCO.2017. 76.9554 4. Autologous Stem Cell Transplant: A Guide for Patients & Caregivers. © 2019 Memorial Sloan Kettering Cancer Center 1275 York Avenue, New York, NY 10065­ ■ CHICAGO MEDICAL SCHOOL 55

SYNAPSES LAURA LI, CMS ’25 Pyramid Artist’s Statement: There is fascination and wonder associated with symmetry. Sometimes we stop ourselves dead in our tracks to admire a room, or perhaps our gaze unconsciously lingers a few moments longer on an object. In any case, symmetry has influenced our perception of art, culture, beauty, and all aspects of life. Likewise, we catch ourselves feeling a tad bit uncomfortable with things that are not symmetrical, or things that are slightly-off. Some works of art capitalize upon this feeling, while others try to avoid causing discomfort. Here, we see the lobby found underneath the Louvre Museum pyramid in Paris. It is incredible to think that this awe-inspiring view only serves as the entrance into the museum itself, which holds thousands of incredible works of art. This fact can remind us to enjoy the beauty that is found everywhere around us, and not reserve it only for select places or moments. While others may only see a museum lobby that they must pass through to get to the artwork, we can choose to see a beautiful display of architecture and symmetry. Who knows what else we can appreciate? 56 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES MIRE K DUNDR, Ph D, FACULTY Is a Spider Web a Work of Art? Artist’s Statement: Some spider webs are incredibly intricate. Most people assume that web design is purely functional, but this is not always the case. Some spiders actively decorate their webs with different silk designs. The webs are shiny for a reason. Many insects have better visual perception in UV wavelengths of light. Spider webs are much more reflective in UV light, possibly attracting insects. The decorations may also resemble vegetation gaps where insects are more prone to fly. CHICAGO MEDICAL SCHOOL 57

SYNAPSES ABDULAZIZ AHMED, CMS ’24 Around the World Artist’s Statement: Chai? Cha? Or Te a? W h ateve r you pre fe r to c a l l i t, th e re i s n o d o u b t a b o u t h ow d e p e n d e n t we are on it. It is amazing how integrated it is in our lives throughout the world. Location: O ot y Te a Est ate, Tam il N adu , I n d i a . 58 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES WIL L IAM G RE E NFIE LD, MD, FACULTY Quitting Covid, Cautiously How long in the Bubble? It seems like forever One Blursday, another Stay home, avoid trouble Take shots from Doc Fauci Mask up when you’re out That little jab ouchie Keeps SARS from your snout Just physics and chemistry An un-alive entity ‘Tis hard not to personalize This treacherous enemy One death, tragedy One million, statistic Avoiding this malady Is just realistic But many sans reason Dared Fate’s sad decree Fake News! They held fast to Lies, foolishly Science has conquered So much of the onslaught But earth’s Mother Nature May have us, well, fair caught So have we now finished This scourge, at its end? No, we’re not done with Nor the future portend But open the shutters Breathe air unimpeded Be brave, take your risks But heed — Caution still needed! ■ CHICAGO MEDICAL SCHOOL 59

SYNAPSES ALEX YOON, CMS ’26 M1 Treading CMS till my last TTAGGG run out, Influence medfluencers till they give me their clout Shot of influenza ‘cause your boy be ill Never need a plan B like I’m taking the pill, ‘Cause I’m chill, Buddha with the mind of steel But turn rappers to cadavers if it’s a matter of skill And don’t need blank checks, we need them dank decks Two years pre and then we moving directly next Onto the steth, the short coat, no flex, Get up out of bed, we baking the bread, Animal like fauna, temperature like sauna Stopping pulses when reaching the heart like vena cava, Row, sink, or float Lot of creatures in the fold but only one goat Everybody’s got a mountain to climb, Everybody slips and falls sometimes, Feel the pressure but it mold diamond from coal, Take cover when we about to blow, ‘cause When I spit, the vicinity get hypertensive Drop a bar and the building start to get disruptive No one out my class stunting, we were born champions Caduceus on the belly when we came out of the amnion, Yeah, keep the mental steady A fish out in the sea, I’m just M1 treading. ■ 60 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES QAIS DIHAN, CMS ’24 M3s Hanging On Artist’s Statement: Even in the most arduous circumstances, persistence always prevails. Valley of Fire, Nevada. CHICAGO MEDICAL SCHOOL 61

SYNAPSES NEHA BASTI, CMS ’25 Untitled During my M1 year, I joined the Global Genes RARE Compassion Program. This program pairs medical students with four rare disease patients over the course of eight months. During each “rotation,” we had the opportunity to speak with our patient partner to learn more about the rare disease experience, directly from someone who has lived through it. The following are my reflections from participating in this program. *All names have been changed for patient privacy.* ***** My intention to join the RARE Compassion Program stemmed from my grandmother who had scleroderma. She passed away in 1985 at the age of 37. As a child, I was always searching for details about her life, knowing very little about her other than the name of her disease. I once overheard a relative mention that she loved to sing and hum while preparing meals for my mother and her two siblings. While such a common thing, I always took great pride in that similarity between us — it helped me see her as a person beyond someone who had passed away from a rare illness. Due to the volume of content covered in the pre-clinical years of medical school, it is easy to get detached from the realities of disease. Like other rare conditions that are skimmed over, scleroderma was relegated to a few bullet points at the end of one of my lectures. At that moment, I truly felt detached from the humanity of the rare disease experience. I joined the RARE Compassion Program because I hoped to better understand the tangible steps future physicians like myself could take to advocate for the rare disease community. I wanted to learn about the lived experience of rare disease patients on a deeper level than what I could glean from a textbook. Ultimately, it is the people, and their stories, that stick with us and drive us to be better doctors. During my first rotation, I met M. She is a talented musician with a witty sense of humor and a knack for telling it like it is. Her diagnostic odyssey lasted ten years until she was diagnosed with Behçet’s Disease, an inflammatory disorder causing painful ulcers that can affect various organ systems. Behçet’s Disease can seem invisible because patients look “fine” at first glance, yet they often are struggling with severe pain. M shared with me stories of how her need for pain medications, which are essential for her to function, was questioned because physicians did not think she looked “sick.” During our conversations, we spoke about the impact of adverse childhood events, the challenges of accessing disability, and the frustrations of navigating life when the abilities of your physical body are constantly at odds with your intentions and desires. After we said goodbye, my eyes would well up with tears as I scrambled to click the “end meeting” button. Each time, I was moved and frustrated by the many barriers impacting her daily life. My discussions with M serve as a reminder that while physicians care for rare disease patients during a fifteen- minute appointment or a three-hour surgery, ultimately, a patient is left to deal with the day-to-day realities of their disease all alone. Even scheduling our meetings together was difficult as M would often not be feeling well enough to take our calls. While seemingly minor, these scheduling conflicts challenged me to reflect on my biases and how they could disguise legitimate issues as inconveniences. We are quick to label a no-show as non-committal or a patient’s frustration as non-cooperativeness, yet those could be signs of larger problems. As a future physician, I must look past the “first glance” and identify the many invisible barriers, from individual to institutional, that rare disease patients are fending off. My patient partners had countless stories of how the healthcare system had let them down. I wondered, how can I, as a single future physician working within the vast health system, make a difference in the life of a rare disease patient? In a sea of illnesses, some common and many rare, is it possible to know everything? I wanted to learn about the tangible steps I could take as a future doctor to better serve rare disease patients. “Do you have stories of positive experiences with any of your physicians?” I asked R on an afternoon Zoom call during my second rotation. 62 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES R smiled and told me the story of her daughter’s neurologist. R’s daughter presented with a febrile seizure at a young age. Her workup, from the EEG to MRI, was normal. Even though their neurologist did not know what was going on, he advocated for R to get a second opinion. He even repeatedly called the local children’s hospital to ensure R’s daughter was able to see one of their specialists. It was this specialist who diagnosed R’s daughter with Dravet Syndrome. After learning of his patient’s diagnosis, the neurologist connected R with the Dravet Syndrome Foundation, which later became a significant source of guidance for R as she faced a challenging new chapter in her daughter’s life. The connection with a community of parents also navigating this illness helped R learn about everything from therapeutic dietary modifications to research trials to sign up for. “It was a really small thing the neurologist did,” R said, “but it helped me immensely.” I asked this question to all of my patient partners throughout the RARE Compassion Program. To my surprise, this theme persisted: the most memorable physicians were the ones who stuck by them throughout their journey. One of my patient partners referred to her healthcare team as like an extended family — people who were in it for the long haul. At the end of one rotation meeting, a panelist reminded us, “As their doctor, it is your duty to walk beside your patient, even when you don’t know what is going on.” As a medical student, it feels embarrassing to say “I don’t know.” It seems like knowing everything is part of our job description. The RARE Program taught me that, for physicians, reaching the limits of one’s knowledge is not a dead-end. It is a fork in the road, an opportunity for the physician to support their patients in other ways — such as advocating for them to get a second opinion, researching their symptoms further, or through connecting them with patient support groups. These are the steps I will take when caring for my future patients. It was my third patient partner, L, who helped me understand the necessity of clinical trials to the rare disease population. Our first interaction was through email; she sent a video about her sons who live with a lysosomal storage disorder called aspartylglucosaminuria (AGU). L is a fervent advocate for patients with AGU. She often joined our calls in a huff after a grueling meeting advocating for clinical trials. L has a science background, which was abundantly clear to me during our first call where she filled the Zoom chat with links to articles on gene therapy and animal models. She applied that background to pushing for research, from raising awareness to advocating for AGU-affected families around the world. Our conversations were the first time I truly grasped how essential clinical trials are to the rare disease population. I thought back to R who firmly stated “research” when I asked her what her source of hope is in her journey as a Dravet Syndrome caretaker. “My daughter has to spend her life with this,” she said. “So, I try everything to make sure there are better [therapeutic and diagnostic] options in the future.” Prior to the RARE Program, I considered research to be primarily an academic endeavor, pushing the needle forward but only at a snail’s pace. After speaking with my patient partners, I was reminded of how they have had to become experts in their own right, often having to be the ones to explain their bodies to the people wearing white coats. I now appreciate how critical a role clinical research can play in expanding the scientific awareness about rare conditions to lead to more effective therapies and improved outcomes. It is imperative for me, as a future doctor, to support rare disease research, whether that is through attending rare conferences, keeping up to date with developments in the literature, or leading clinical research on rare pathologies. My medical school professors remind us to avoid referring to patients by their disease and instead opt to say a person living with that disease (for example, a person living with diabetes). A rare condition can consume so much of a person’s life. It can become something that the healthcare system defines rare condition patients by, as if it is listed as their name in their chart. This is why I value patients’ stories. They share the nuances of a person, the essential qualities that get left off the EMR. Rare patients are so much more than their disease. They are a teenager who enjoys bowling with his friends. CHICAGO MEDICAL SCHOOL 63

SYNAPSES They are a musician who attends concerts every chance she gets. They are a woman who loves to sing while she cooks dinner for her three kids. These are the people and the stories that will stick with me. ■ AB HINAV BIRDA, CMS ’24 Macrophage Surrounded by Bacteria Artist’s Statement: This digital artwork is an abstract representation of the cellular interactions between immune cells and bacteria. The fine details and striking colors used in the artwork draw attention to the constant battle within our bodies as our immune system works to maintain our health. The use of digital art software (Nightcafe) adds a modern and dynamic element to the portrayal of this microscopic struggle. Digital artwork with assistance from AI software. 64 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES BARRY H. EPSTEIN, MD ’64 Haiku Regarding the State of Medicine in 2023 A series of haiku on the state of medicine in 2023, and a solution. There is a problem Medicine has gotten sick Focus is money. No time for patients Ten minutes is just enough Order a C.T. Don’t ask the questions How are your kids doing now? Get an M.R.I. Where are the teachers? It takes much time to listen Lab tests are simple. We need empathy Connections with our patients Caring and respect. ■ CHICAGO MEDICAL SCHOOL 65

SYNAPSES DIMA ARBACH , MD, FACULTY Wishes If I could, my daughter From that story, I’d take you out And show you the beauty of the world Distract you with toys And protect you with all I have I will give you dreams In a spring that doesn’t sleep For every year you get older If I could, my daughter I’d sing to you until you fall asleep And light up your night with moon and stars I’d hold the storm with my own hands And hide you inside my heart From tomorrow and yesterday, pictures of places From memories and scars If I could, my daughter, not look in the mirror Not see me in you And not see you in me. ■ 66 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES CONNOR HASZTO, CMS ’23 As Below So Above Artist’s Statement: This photograph was taken in Oakland, Pennsylvania, specifically in Panther Hallow. Panther Hallow is a 5-minute walk from the University of Pittsburgh campus. It is a dense forest that is strikingly different from the busy city streets. This area of the hallow depicts an interesting composition of nature and a large steel bridge unifying a great divide. I found the mixture to be a reflection of our relationship with the world; we are both something apart and separate from nature. CHICAGO MEDICAL SCHOOL 67

SYNAPSES CHRISTIAN ARCELONA, CMS ’26 Creative Spark Artist’s Statement: “Creative Spark” is an emotive and thought-provoking piece of art that explores the crucial role of creativity in compassionate care. The work depicts a single spark of light, surrounded by a halo of swirling colors and shapes. This spark represents the moment of inspiration that can ignite a person’s imagination and help them to think in new and innovative ways. At the same time, the surrounding shapes and colors suggest the many possibilities and potential paths that can emerge from this spark of creativity. The importance of creativity in compassionate care is highlighted by the bright and uplifting color palette of the piece, which evokes feelings of hope, positivity, and healing. The work suggests that by harnessing the power of creativity, caregivers can better connect with their patients, understand their needs, and provide more effective and personalized care. In this way, “Creative Spark” serves as a powerful reminder of the transformative power of creativity and the critical role it can play in compassionate care. *Disclaimer: I chose to create this image and description with the assistance of AI software as a testament to technology’s future impact on creative works.* Digital artwork with assistance from AI software. 68 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES GU RVARDAAN BAL, CMS ’26 Approaching the Inevitable When death approaches, One may walk in suspense Or trepidation A sallow, sickly, and ultimately pointless sentimentality When death approaches, Another may walk in ignorance Or disregard their own contraindications As disease and gluttony lead to premature mortality But when death approaches, Those who walk forward in acceptance Yet raging, fighting the night with indignation Those streak across the sky brightly ■ CHICAGO MEDICAL SCHOOL 69

SYNAPSES TERRANCE ZHANG, CMS ’26 Don’t Wait for Me 70 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES Artist’s Statement: Don’t wait for me Or your food will grow cold I will always help you remember As your memories grow old Savor the flavors of life And take your time During your long goodbye Rosy pink blossoms blush bright as they bloom And cherry petals sign that spring is coming soon Under a sky of clouds serene enough to consume Silky spring sun that sweetly shines and shimmers With a warm wholesome wind that weakly whirls and whispers In a time when it was impossible to meet So please don’t wait for me Go ahead and eat. [01/29/2022] --- A recreation of my grandmother’s favorite foods, and a homage to the skills that she taught me. (1) Seaweed fried fish with stir-fried Bok Choi (2) Egg tarts with green tea (3) Clay pot rice with baijiu. CHICAGO MEDICAL SCHOOL 71

SYNAPSES MICHAEL MITTELMANN, MD ’57 We Walked Together Artist’s Statement: W hen grad u at in g from C h icago M e dic a l S c h o o l i n 1 957, my w i fe, S u z a n n e, wa s p re s e n te d w i t h a humorous Putting Hubby Through (PHT) Certificate by the Class President. Since then, we walked together for almost 65 years. Now I walk with family or friends but still alone. Shadows mark changes over time, though memories do not fade as quickly and are not as dark. Location: Harvest Lane, Manasquan, New Jersey. Taken on an iP h on e 7 M P came ra, f/ 1. 8. 72 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES N AO S U K E YA M AG U C H I , C M S ’ 2 6 Final Stretch of Light Artist’s Statement: Final stretch of light. Taken on 35 mm Kodak Ult ramax co l o r n e g ati ve f i l m . S a n ta Mo n i c a , C A . CHICAGO MEDICAL SCHOOL 73

SYNAPSES A L E X A N D E R E L LY I N , C M S ’ 2 5 The Unlikely Friendship As the new year began in 2006, I made it a priority to emphasize health. I was a busy medical student and was neglecting many important areas of my life, including exercising, eating healthy, and cultivating friendships. In fact, my doctor told me that I needed to start exercising and eating healthier to lower my blood pressure and lose weight. I figured it was time to make some changes. On the first day of the new year, I set my alarm for 5:00 AM. My goal was to walk one mile before starting my school work for the day. In the past, running five miles would have been my goal, but walking one mile presented a real challenge at this point. As I exited the house, there was an older man walking by. “Good morning, Paul,” he said. To be honest, I had never seen this person in my life. How does he know my name? “Good morning… sir,” I replied. He continued on his way, and I started walking the opposite way. While the walk was nice, I got home and was upset with myself. This man clearly knew me, and I made no effort to engage with him. One of my resolutions was to meet new people, so why didn’t I talk to him? Maybe tomorrow, I thought. I continued on with my day, nose buried in a book, as usual. As I exited my house the next morning, I was relieved to see the older man again. Apparently, we were on the same schedule for our morning walks. This time, I decided to approach him. I said it was nice to see him again. “Could you please remind me of your name again?” “Arthur,” he said. “I moved in next door a few months ago.” I’d been so busy studying that I didn’t know we had a new next-door neighbor. I explained to Arthur that it had been quite a busy time for me lately. I was best friends with the Morton family kids growing up. We were neighbors for 25 years. Yet because I was so consumed by my own schoolwork, I didn’t know they moved out. Life had gotten away from me, but it turned out that Arthur knew this feeling better than most, as he would go on to explain. “I was a lawyer for 35 years,” he said, with pride and a hint of regret. “I’m honored that I was able to help many people, but I let my job become my life. I let my career take over. I neglected my own family.” I could sense Arthur’s pain. The pace of our walk slowed down to a halt. “My wife left after 20 years of marriage. My children went off to college and then moved away. Our relationships suffered because of my work.” I didn’t know what to say to Arthur. “I’m sorry that this happened to you.” “Thank you, Paul. But I take full responsibility. And I hope someone can learn from my mistakes.” I felt like I was looking in the mirror when I looked at Arthur. I was afraid of becoming the version of himself that he regretted. I feared I was already becoming that person, considering I wasn’t even aware he was my neighbor. 74 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES Over the next few weeks, Arthur and I kept walking. We didn’t call or text each other, but we trusted that each morning around 5:00 AM, we would both be out there. We were friends. I learned that Arthur had mended the relationships with his wife and kids. One morning, he was particularly energetic. He explained that it was his only son’s 50th birthday today. Arthur had a flight to Los Angeles later to surprise his son and grandkids. “How did you repair those relationships with your family?” I hesitated to ask, but couldn’t resist. Arthur paused. “I called them, listened to them, and gave advice when I could offer something. I sent them birthday cards, gifts, and showed up for holiday dinners. I did everything I should have done earlier. I became the father and husband I was meant to be. I’m no longer married to my wife, but we’ve never been closer. Thankfully, it wasn’t too late for my family to accept that I had changed. I wasn’t always there for them, but I’m there for them now.” Arthur was so honest with me. I was grateful to hear his story. One morning, I was driving to school and saw Arthur walking down the main road in town. I was concerned because he was already a mile away from home. “Arthur? Are you okay?” I asked as I pulled over the car. “Hello, Paul. I’m fine. Thank you. I’m just going for a walk.” Our morning walks usually lasted about 30 minutes, and Arthur was usually pretty winded by the end of it. “We’re pretty far from home, Arthur. Do you need help?” “I’m okay. Thank you for asking, though.” I accepted what Arthur said and went to grab coffee next to our town’s grocery store. As I was leaving the parking lot, I saw Arthur exit the grocery store with multiple bags in each hand. “Arthur, please let me drive you home.” “I don’t want to be a burden.” “I’m happy to help.” As Arthur explained on the ride home, his vision was deteriorating, and he wasn’t comfortable driving anymore. Each week, he walked to and from the grocery store. I was stunned and wanted to help him. “I didn’t want to add another problem to anyone’s plate. Everyone is so busy.” Arthur had helped me more than he knew. He was a friend, gave great advice, helped me stay motivated to exercise, and taught me the importance of balance in my life. Now it was time for me to help him. Moving forward, Arthur and I would go the grocery store together each week after one of our walks. I offered to bring the groceries to him, but he liked going to the store and being around other people. CHICAGO MEDICAL SCHOOL 75

SYNAPSES As we approached the halfway point of the year, I reflected back and was proud of what I had accomplished. I was eating healthier, exercising each day, and had made new friends, including Arthur. Time went on, and I began applying for residency positions. Arthur and I continued our walks, less frequently now, as Arthur wasn’t feeling well enough to walk each day. His children organized an at-home grocery delivery service for him as well. Seventeen years later, I sit at my desk, remembering Arthur on his birthday. He passed away in 2012, but I still feel his impact every day. When I was getting ready to move out to Connecticut for my residency, Arthur wrote me a note. Dear Paul, Congratulations on your new residency placement in Connecticut. You will do great things in this world. I wanted to share with you five pieces of advice that I wish someone told me after I finished law school. 1. Family and friends are most important. If you get married and have children, do whatever you can to put them first. 2. You are a person, too. Cultivate hobbies and think of yourself as more than your career. Be creative and try new things. 3. Get a gym membership and continue those walks… maybe at a faster pace since I know I slow you down. 4. Work hard but do not overdo it. 5. Look around you. Amazing things happen all the time. Pass this advice forward if you find it to be true. Add pieces of advice to this list. You will meet many young people like yourself who could benefit from the words of someone who has been in their shoes. Take care. Your Friend, Arthur Arthur forever impacted my life, and I share this advice with my children and the students I work with today. His story and advice certainly deserve to live on. To him as a dear friend, I say thank you. ■ 76 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES S O P H I A YA N G , C M S ’ 2 3 Connections Artist’s Statement: Standing at the base of the frozen Minnehaha Falls, I couldn’t help but be struck by the beauty of the surrounding forest. As I looked closer, it was as if I was gazing upon a forest version of the human brain. The trees, with their bare branches reaching towards the grey sky, looked like a network of synapses, each connected to the other in a delicate balance. The tall and stately oaks, with their strong and sturdy branches, stood like sentinels, while the delicate birches and willows seemed to dance and sway in the icy breeze. But beyond just the visual beauty, there was something deeper and more meaningful at work in this forest community. Even the roots of the trees, hidden beneath the frozen earth, mimic the axons that transmit signals from one neuron to another. And like synapses in the brain, they work together to create a cohesive whole, a beautiful and harmonious ecosystem. They are united in their purpose to thrive and grow in the harsh winter landscape. As I continue to take in the beauty of this natural synapse-like network, I am reminded of the intricate and interconnected web of life that surrounds us. This snapshot was a beautiful example of the interconnectedness of nature and the importance of community in times of a d v e r s i t y. Minnehaha Regional Park, 2022. CHICAGO MEDICAL SCHOOL 77

SYNAPSES N E I L B R A D B U RY, P h D, FAC U LT Y Sex on the Brain Artist’s Statement: The biology and function of each of our 3.7 x 1013 cells is determined by the DNA in the 23 pairs of chromosomes sequestered within the cell’s nucleus. A classical view of genetics, is that the 22 pairs of autosomes underlie the bulk of the transcriptional activity, and that the sex chromosomes are merely there for gonadal development, and then pretty much shut down. This means that any sex differences between males and females occur only secondary to the effects of sex hormones. However, current evidence shows this viewpoint to be naive and erroneous. Gene expression of sex chromosomes occurs in all tissues examined, including liver, immune cells and the brain. This has consequences for drug metabolism, immune diseases and brain function. The effects are unrelated to hormones and are intrinsic to cellular transcription and translation of genes from the X and Y chromosomes. Taken from Bradbu ry, N A . Al l Ce l l s H ave a S ex : St u di e s of S ex C h rom os om e Fu n ct i on at t h e Cellular Level. In: Principles of Gender Specific Medicine (Third Edition) 2017: 269-290. Digital artwork. 78 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES H O L LY H U N S B E R G E R , P h D, FAC U LT Y Merge Mosaic Artist’s Statement: Coronal section of a mouse brain. The neurons stained represent memory. Cells stained green were activated during encoding of an experience, cells stained magenta were activated during retrieval of the same experience, and the overlap of these two colors represents a memory. Both cells were important for encoding and retrieval. The blue stains all nuclei. Medium: Microscopy. CHICAGO MEDICAL SCHOOL 79

SYNAPSES PAUL J. KIELL, MD ’56 Why Do You Do It? Answering that age-old generic question found for me no greater laboratory than that of the final leg of the Alcatraz-to-shore swim, maybe some twenty years ago. There, you are immersed in the swirling and near-arctic waters that bridge Alcatraz Island to San Francisco’s Aquatic Park. And, like everywhere, you find only partial answers — all right, all wrong, as in the fable of the blind men describing the nature of the elephant, each relating only to the part he could feel. There are glib retorts such as, “It feels so good when you stop.” Or more hackneyed responses proclaiming that it’s a microcosm (or a metaphor) for life itself. Maybe you trivialize it, calling it — inaccurately at that — an “endorphin high.” All of these responses are one-dimensional and flat. None resonate, none sing, none float. There can be, however, one of those “moments,” wrote two-time Olympic marathoner Kenny Moore, “when athletes surrender themselves to effort and are genuinely transformed.” Attempts at describing it becomes shrouded within the myriad mysteries that the faculties of mind and body concoct. We succeed and, at the same time, fail to define or explain it adequately. But that year (2002), as I was finishing the swim and was wading in waist-high water, I may have found one more piece of the puzzle, one more segment of that colossal question of why we do some things. Having reached the inlet protected by artificial barriers shielding the swimmer from the maelstrom that was once a witch’s blend of obscuring damp fog, chilling waters, and disorienting roiling currents that rudely slap columns of water into your face and mouth, there comes a sudden quiet where the end of the odyssey comes into clear sight. Soon you see the faces of people, people who were living that race with you, identifying with the swimmers, known or unknown. Nearing land where I could start to wade in, I spotted my dear friend Ralph Paffenbarger. Once before, I had seen this look on his face. It was the same look of joy, excitement, and love he beamed the time his wife, JoAnn, was playing her cello at an informal recital. Ralph, a pioneer in exercise research, was a one-time leading long-distance runner. He once held the age-group record for the 100-mile Transierra trek. But near 80 years old at the time of my swim, with his athleticism severely limited by illness, my safe completion, my success, became his too. And there was that race official, a young woman about my middle daughter’s age. She was standing in the shallow waters, yards before the sandy shore of Aquatic Park. Eye contact was brief. As I slowly passed, her gaze tracked me. Hers had been a look of revelation, excitement, and relief. Could it be that she was thinking of her parents or older friends who might do this same thing if they’d work at it, discarding all their preconceived sense of limitations? These are the instants that will linger in The author after completing the swim from memory, those shining moments soon to be Alcatraz Island to shore. as fading embers, yet fueled and warmed by the thought that your accomplishment was shared, and that maybe, maybe your example did something good for someone else. ■ 80 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES KU HN H O NG , MD, FACULTY Free at Last Artist’s Statement: As Ukrainian refugees arrived, their hopes for safety became reality. Though their futures were uncertain as to where to stay and what they could eat or drink, you could imagine their sighs of relief. I, too, experienced similar uncertainties during the Korean War, although I was too small to comprehend the seriousness of our situation. I hope these refugees will find safe temporary shelters and eventually return to their homes when the terrible invasion ends soon. Medium: Oil on canvas, 24 by 30 inches. 2022. CHICAGO MEDICAL SCHOOL 81

SYNAPSES ARCHANA CHATTERJEE, MD, PhD, DEAN Weavers for Care Artist’s Statement: These photos are of items I crocheted and donated to Weavers for Care, an organization that provides the se h an dcrafte d ite ms to n e e d y fa m i l i e s i n N ew Yo r k. 82 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES A N S H U L T YAG I , C M S ’ 2 6 The Little Library Artist’s Statement: Box of ideas. Box of care. Box of inspiration. CHICAGO MEDICAL SCHOOL 83

SYNAPSES Abhinav Agnani, CMS ’26 Untitled Artist’s Statement: Like our artistic renditions of the brain and synapses, artificial intelligence programs represent an attempt at recreating aspects of the human mind. As such, it felt fitting to see how these programs themselves might visualize the brain. The original concept of a watercolor painting was f ir st f le sh e d ou t in to a su it able p ro m p t u s i n g O p e n A I ’s C h atG P T. Th e f i n a l p ro m p t wa s then used by OpenAI’s DALL-E to render the final image. Final prompt: “watercolor art style human brain depicted in a soft, dreamy way, with pastel colors and flowing, organic lines, conveying a sense of tranquility and introspection.” Digital art. 84 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES JING HSU, CMS ’26 Wilderness in Black and White Artist’s Statement: A year ago, I went to Zambia to conduct clinical research aiming to improve pregnancy outcomes in developing countries. I had the opportunity to go on a safari and photograph some of the stunning wildlife found in this amazing country. One of my favorite images from this trip is a photograph of a group of zebras in the savannah, their striped coats blending into the golden grasses of the plain. This photograph not only captures the raw beauty and majesty of these incredible animals, but also reminds me of the work that I was doing to help improve the lives of people in Zambia and beyond. Through this photography, I hope to not only showcase the beauty of the world around us, but also to bring attention to important issues and causes that I am passionate about. CHICAGO MEDICAL SCHOOL 85

SYNAPSES QAIS DIHAN, CMS ’24 The Winding Road Ahead Artist’s Statement: The path forward is not always straight. For in the midst of towering mountains, lies a winding road ahead. Surrounded by difficulty, we forge. Onwards, onwards. For our journey lies, on the winding road ahead. Ta ke n in Zion N at ion al Park , U ta h . 86 ROSALIND FR ANKLIN UNIVERSITY