Synapses Vol. 1 (2017)

SYNAPSES A Creative Journal of Chicago Medical School VOLUME 1, INAUGURAL ISSUE SPRING 2017



SYNAPSES A Creative Journal of Chicago Medical SchoolEDITORIAL STAFFWilliam Agbor-Baiyee, PhD Editor-in-ChiefCandice Kosanke Managing EditorEDITORIAL BOARDJeffrey Bulger, PhD FacultyMorgan Gilmour StudentBarbara Hales, MD ’76 AlumnaDaniel Houser StudentMeredith Main StudentGwendolyn Messer, MD, FAAP FacultyKaren O’Mara, DO FacultyAubrey Penney StaffHector Rasgado-Flores, PhD FacultyREVIEW BOARDOmeed Ahadiat StudentSalvatore Aiello StudentIbukunoluwa Araoye StudentMatthew Cozzolino StudentAnna Dailey StudentKaitlyn Egan StudentDiAna Elcan StaffSyed Khalid StudentMichelle Lim StudentJennifer Obrzydowski StudentDaniella Sandoval StudentSwapna Shanmu StudentBarbara Vertel, PhD FacultyJOURNAL OVERSIGHT BOARDJames Record, MD, JD, FACP Committee Chair Dean of Chicago Medical SchoolNutan Vaidya, MD Senior Associate Dean for Academic Learning Environment, Chicago Medical SchoolLee Concha, MA Vice President for Marketing and Brand Management Rosalind Franklin UniversityRebecca Durkin, MA Vice President for Student Affairs and Inclusion Rosalind Franklin UniversityChad Ruback, MSEd, MBA Vice President for Institutional Advancement Rosalind Franklin UniversityJudith Stoecker, PT, PhD Vice President for Academic Affairs Rosalind Franklin University CHICAGO MEDICAL SCHOOL 3

INSIDE The Journey Taken William Agbor Baiyee 10 11POETRY Specimen J a v i e r J i m e n e z 12 13 Kaena Point Zak Ritchey To Those Who Suffer Hannah Samberg ART/ Sun on the Lake Maria Isabel Camara 16PHOTOGRAPHY A Helping Hand J e f f r e y D a v i e s 18 Disclose Anatomy Concentration Melissa Hoshizaki 19 20 A Moment With Surgeon Y u r o n g M a i 22 23 The Center of My Universe R a n a R a b e i 24 25 Agape Angela Wu 25 26 Making Connections Patricia Calimlim 28 Into the West M e l i s s a C h e n 30 30 I Ride Alone M e l i s s a C h e n Fine ARchiTecture of Chicago V a r u n K u m a r Skyline Above and Below the Horizon V a r u n K u m a r The Photographer V a r u n K u m a r S e a r c h i n g f o r S y n a p s e s S y e d K h a l i d 4 ROSALIND FRANKLIN UNIVERSITY

SYNAPSES CONTENTS Rush of Thought Roberto Loanzon 31NON FICTION The Role of Patient Temperament A m i s h i B a j a j 34 in the Delivery of Quality Care Laura Leigh French 38 “Suffering Needs Stories”: 42 ‘The Diminished Self’ in 46 Fiction and Memoir 48 51 Proper Care J a v i e r J i m e n e z 54 My Faustian Debt A r i e l K a t z A Tale of Two Pictures Mildred M.G. Olivier Platelets and Potassium: How I M e r v y n S a h u d Learned That Enthusiam and Limited Humility May Lead One Astray When the Circus Came to Town A d a m S i l v e r ALUMNI A Physician’s Odyssey: From Richard Rappaport 60FEATURES Chicago Medical School to S h e r w i n W a r r e n 64 the World A Lesson in Surgery CHICAGO MEDICAL SCHOOL 5

ABOUT SYNAPSES Synapses is a creative journal of Chicago Medical School at Rosalind Franklin University. The journal provides a forum for the expression and dissemination of creative works demonstrating Chicago Medical School’s commitment to develop a community of reflective learners and practitioners. The journal seeks to publish on an annual basis quality works that focus on experiences in medicine and expressions of the human condition. Submissions of creative works of poetry, art, photography, fiction and non-fiction, including narrative and reflections, to Synapses are open to faculty, staff, students, residents, fellows and alumni of Chicago Medical School. Each submission is reviewed blindly at two levels, first by reviewers followed by editors. Authors will be notified of editorial decisions. Submissions will open in mid-October and close in mid-January. The journal is published once per year in the spring. © 2017 Rosalind Franklin University of Medicine and Science. The University has obtained permission to use the literary and artistic works that appear in this journal. The authors reserve all other copyrights for their works. Credit for images on front cover, back cover and section dividers: iStock.6 ROSALIND FRANKLIN UNIVERSITY

SYNAPSESFROM THE EDITORIAL BOARDWe are pleased to introduce the inaugural issue of Synapses. The journal provides a platform to disseminateideas and artistic expressions of members of the Chicago Medical School at Rosalind Franklin University ofMedicine and Science. The first issue demonstrates the range of Synapses’ creative vision.One year ago, Chicago Medical School initiated efforts to conceptualize and implement a creative journal.We selected the title “Synapses” because these structures are at the core of learning, creativity, thinkingand communication. Giving our journal this title represents the idea that sharing original, creative workswith one another will foster meaningful connections between us and thereby enrich our lives.To produce this publication, we organized meetings with various stakeholders, recruited members forthe journal boards, trained reviewers and editors, developed guidance materials, invited submissions, andselected original works.We received fifty-eight submissions from students, residents, fellows, faculty, staff and alumni. After adouble-blind review, we selected twenty-seven works for publication. These pieces reflect the journal’sfocus: experiences in medicine and the human condition.We hope Synapses helps us to better understand ourselves as members of a vibrant academic learningenvironment. We appreciate those who supported its development and dedicate our continuing efforts topublishing creative works that nourish our community. CHICAGO MEDICAL SCHOOL 7

POETRY8 ROSALIND FRANKLIN UNIVERSITY

SYNAPSESPOETRY CHICAGO MEDICAL SCHOOL 9

POETRY WIL L IAM AG BO R BAIYE E , FACULTY The Journey Taken The august occasion came. You taught them. Now it is gone. They learned too. You were there in your regalia. --- They were there in theirs too. The crowning moment came. You journeyed with them. Now it is gone. They followed you too. You were there beaming with joy. You gave them understanding. They were there joyfully too. They offered you love too. You inspired them. You socialized with them. They persisted too. They admired you too. You saw in their eyes — --- promise. The capstone moment came. They saw in yours — Now it is gone. belief. You were there standing in awe. You left your imprint on them. They were there awestruck too. They left theirs on you too. You advised them. You made a difference. They trusted you too. We all applaud you. You guided them. They respected you too.10 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESJAV IE R JIME NE Z , CMS ’18 SpecimenFill me up with you, let me hold you in my mind, a Let me codify you perfect wilting specimen sanctify you on paper Illness to be tested and digested, medicated sedated your entire life Person or disease; a process or a life Let me hold you for a whileLet me hold you, let me cut you, let me dive inside In this bed, Your guts and nuts and bolts, surgical, precise your head, your bones,Your inner working, psychiatric, bio psycho social and everything mind filled with pills the thrill of a line I can heal you with a word, a pill, a knife fluid rush heart pump Tell me, give me everything let me jot it, let me write it burn anesthetic energetic on this sheet so white chemical solution to all your ills black words Human shaped Rest tonight Specimen Pinned Good morning Here I am, your doctor Don’t worry, we’re doctors Hand over your life We have a plan. Don’t worry, I’m so gentle We promise. utterly kind We’ll give you back your life. . Trust me, I’m a doctor brightest of the bright CHICAGO MEDICAL SCHOOL 11

POETRY Z A K R I TC H E Y, C M S ’ 1 8 Kaena Point Snap goes the strap, The island claims another victory on this rocky shoreline hike. My slipper is rendered useless, and my left foot lays bare. A mixture of humiliation, anger, and defeat colors my face. Leeward rain explodes from the sky, further escalating the ridiculousness of it all As the glass-laden mud engulfs my sole and I sink deeper into the path. Four miles to the beach. Laughingly, my two fellow hikers — best friends since childhood — suggest turning around. Retreating would be akamai, the Hawaiian word for smart. With one slipper and no shoes, a foot laceration is inevitable. But today, I decide not to be akamai. As the sharp, clammy rubble encapsulates my toes, Bullishly I trudge forward. My friends, who were wise enough to bring shoes, snicker ahead of me. Step by step, slip by slip, my unprotected feet burn with pain. Avoiding pointy rocks is futile, apparently. Two miles to the beach. Sheets of rain pelting down, we turn a corner and a glimmer of hope emerges in the gray mist. At the horizon we finally spot Kaena Point, A fenced shoreline where Hawaiians believe ancestral spirits move from one world to the next. Such sacredness is only highlighted by the picturesque surroundings and quiet remoteness. Upon reaching the rusty fence, the gates creak open willingly And with a collective “GO!” we haphazardly sprint to our destination. One mile to the beach. Chasing the footprints of those before us, we race over wet sand, hop lava rocks, And run our hands through the deep-rooted naupapa shrubs dotting the landscape. Soaring above, an albatross squawks menacingly as we draw close to her nest. Meanwhile, relaxing in a tide pool covered by pipipi shells, A monk seal groans and flops over in a splash, Signaling me and my friends to plop down on the sand ourselves. Catching our breath, we listen to the thunderous sky and open up about the days ahead. One friend shares that she is soon starting a job in Portland, Clearly both excited and scared. The other reveals that he plans to propose to his Boston-based girlfriend, But still cannot find the words to do it. I express uncertainty about impending career decisions, Worried about being so far from home for so much longer. Here sits three 30-something-year-olds on Christmas vacation, Kama’aina back home and brought together for an afternoon jaunt, Each on the verge of starting new journeys, yet again. But, do we really have to? The question washes over our tired faces as we lay in cold silence, Acknowledging the comfort of simply stopping here, barely halfway done. Six feet on the beach. Eventually, we all somehow realize That it is time to get up and dust off the sand. We chuckle at my tempura-like feet, sigh, and restfully return the way we came in. The sun starts to set behind us, but we don’t look back. A cool breeze nudges us forward, as the wild rain subsides And the waves gently break in the growing distance.12 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES HANNAH SAMBERG, STAFFTo Those Who Suffer Persistent pain and a muddied mind,Searching the emptiness for a path back to the surface Pushes me to reach a hand, And pull you up safely. An irreplaceable and precious core, Fights with courage Against an illness that grips the mind And paralyzes pleasures. Know in life, That you are not alone. CHICAGO MEDICAL SCHOOL 13

ART/ PHOTOGRAPHY14 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES ART/PHOTOGRAPHY CHICAGO MEDICAL SCHOOL 15

ART MARIA ISABEL CAMARA, CMS ’1916 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES Sun on the LakeArtist’s Statement:Painted from aphotograph, 2005. Oil onCanvas.It is ambiguous as towhether this is a sunriseor a sunset. But theviewer’s perceptioncan make a world ofdifference. Thus, one ofmy favorite quotes fromsurgeon Atul Gawande,MD, MPH, is applicable:“We look for medicineto be an orderly fieldof knowledge andprocedure. But it isnot. It is an imperfectscience, an enterpriseof constantly changingknowledge, uncertaininformation, fallibleindividuals, and at thesame time, lives on theline. No matter whatmeasures are taken,doctors will sometimesfalter, and it isn’treasonable to ask thatwe achieve perfection.What is reasonable isto ask that we nevercease to aim for it.Yo u m ay n o t co n tro llife’s circumstances,but getting to be theauthor of your life meansgetting to control whatyou do with them.” CHICAGO MEDICAL SCHOOL 17

ART JEFFRE Y DAVIE S, CMS ’20 A Helping Hand Artist’s Statement: This is a drawing of my cadaver Deborah’s hand that I did off hours. I feel that the hands, more than any other part of the body, connect us to our surrounding world, and dissecting the hand was when Deborah was most humanized to me. I wanted to capture that feeling in this drawing, sacrificing some anatomical correctness for abstraction, and honor her generous donation towards my journey of becoming a physician.18 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES MELISSA HOSHIZAKI, CMS ’18Disclose Anatomy ConcentrationArtist’s Statement:Watercolor, 2011.Rendition of on lin e im age : C ircu lat ion Syste m o f th e H e a d . P r in t Co lle c tio n. h ttp s ://www.pr intcollection .com/produ ct s/circu lat io n - syste m - o f - th e - h e a d . Acce ss e d A p r i l 5 , 2 01 7. CHICAGO MEDICAL SCHOOL 19

ART YURONG MAI, CMS ’1820 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES A Moment With SurgeonArtist’s Statement:This is a quick sketch tocommemorate my mentor,Dr. Vossoughi, during mysurgery rotation at LittleCompany of Mary Hospital. CHICAGO MEDICAL SCHOOL 21

ART RANA RABEI, CMS ’18 The Center of My Universe Artist’s Statement: Drawing, gold leaf, and digital media. I use visual art-making as a means to interpret and reflect upon my experiences. As I have transitioned from the classroom to the clinical environment, the content of my artwork has naturally shifted towards capturing salient patient care encounters. In this piece, I have created an uplifting and somber image that captures my experience of caring for a patient dying of heart failure.22 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSES ANGELA WU, CMS ’18Agape (Pronounced Agápe)Artist’s Statement: I chose to title this painting in Greek because I could not find an Englishword to sufficiently portray this moment. In the Greek language, there are different wordsfor “love,” and agape describes the love that “calls out of one’s heart by the preciousnessof the object loved. It is the noblest word for love in the Greek language. This love keepson loving even when the loved one is unresponsive, unkind, unlovable, and unworthy. It isunconditional love,” as one reference puts it. CHICAGO MEDICAL SCHOOL 23

PHOTOGRAPHY PATRICIA CALIMLIM, RESIDENT Making Connections Artist’s Statement: Artistic manipulation of the world-renowned Chicago Cloud Gate as a human brain that includes firing “synapses” to represent the everyday connections we make in our city and our world.24 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESME L ISSA CH E N, FACULTY Into the WestArtist’s Statement:Rays before sunsetFleeting footsteps in the sandOne last wave to catch. I Ride AloneArtist’s Statement: Solitary ride in Banff National Park. Chill winds bracing, sun risesearly, but freedom calls. CHICAGO MEDICAL SCHOOL 25

PHOTOGRAPHY VARUN KUMAR, FE LLOW Fine ARchiTecture of Chicago Skyline26 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESArtist’s Statement: This fine art like photo was taken from Montrose Beach, Chicago. CHICAGO MEDICAL SCHOOL 27

PHOTOGRAPHY VARUN KUMAR, FE LLOW Above and Below the Horizon28 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESArtist’s Statement: Horizontal bar on the window perfectly divided the foggy sky fromdew on the ground. Windows with curtains made a unique frame. CHICAGO MEDICAL SCHOOL 29

PHOTOGRAPHY VARU N KU MAR, F E L LOW (TOP ) / SYE D K H ALID, CMS ’17 (B OTTOM) The Photographer Artist’s Statement: While walking along the Magnificent Mile in Chicago, I saw a photographer adjusting his gear to capture his perfect shot. Lights from the car behind illuminated him and I captured him in a perfect spot. Searching for Synapses: Uncovering the Basis of Neuronal Connectivity A r t i s t ’s S t a t e m e n t : Im m u n oe n h an ce m e n t o f a p o st- n ata l d ay 2 8 Po m C 1 - C R E L S L- td To m ato m ouse brain afte r cle arin g t h e brain of lip i d — a l ow m a g n i f i c ati o n l o o k ( 2 0x ) . Ta ke n at th e Ko l o dkin La b at the Solomon H. Snyder Dept. of Neuroscience at Johns Hopkins School of Medicine and Howard Hughes M e dical I n st it u te. Spe cial t h a n ks to A l ex Ko l o d ki n , P h D; R a n d a l H a n d , P h D ; a n d Edric Ta m , B S.30 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESROBERTO LOANZON, CMS ’20 Rush of ThoughtArtist’s Statement: This photograph is a self-portrait taken in front ofSkógafoss during a two-week road trip in Iceland. CHICAGO MEDICAL SCHOOL 31

NON-FICTION32 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESNON-FICTION CHICAGO MEDICAL SCHOOL 33

NON-FICTION AMISHI BAJAJ, CMS ’18 Self-Fulfilling Prophecies and Fundamental Attribution Errors as Psychosocial Determinants of Health: The Role of Patient Temperament in the Delivery of Quality Care In the words of the great Sir William Osler, “The good physician treats the disease; the great physician treats the patient who has the disease.” 1 Of the numerous challenges that arise in treating patients, there is one that is always present but seldom addressed, and that is the conundrum of how to manage “easy” patients and “difficult” patients, with “easy” and “difficult” referring to patients’ temperaments during bedside interactions and overall willingness to cooperate with the treatment team and the treatment plan. The “easy” patient is the woman who is amenable to the medical student performing her pelvic exam, maybe even smiling tightly while the student fumbles in placing the speculum in spite of the discomfort she may feel. Or the man who smiles pleasantly and listens attentively and asks appropriate questions about the new medication you prescribed. And then there are the “difficult” patients, like the woman who narrows her eyes and frowns at you as you step into the room and addresses you coldly. Or the man who shows up at your office after having cancelled his three previous appointments and has made none of the dietary and lifestyle modifications you suggested when you last saw him — and his body mass index (BMI) shows it. The terms “easy” and “difficult” are universally understood and acknowledged. Nurses encourage medical students to practice placing intravenous lines by telling them, “Go ahead, Mr. Brown is nice and an easy patient to practice on.” A family medicine resident will check his clinic schedule and groan, “Oh no, Mrs. Stein is back again!” And there is at least one “difficult” case in the Clinical Skills part of the United States Medical Licensing Examination (USMLE) Step 2 in which the patient responds to the medical student’s questions with curt replies conveying annoyance, intending to repel the examinee and assess the student’s ability to maintain a kind attitude. It seems that nurses, residents, and examiners are all aware of this distinction. However, although it is commonly utilized, I feel that the verbalized distinction of “easy” patients and “difficult” patients hinders quality care. In fact, I feel that we should abolish this distinction in our conversations in the healthcare setting entirely, unless we are acknowledging this distinction as a threat to the medical ethics principle of justice heralding equitable treatment of all patients. Assigning patients into categories is the first step on the slippery slope to inequality. You feel compelled to do the best you can for your “easy” patients and think to put them on clinical trials that you neglect to mention to your “difficult” patients because you anticipate the “difficult” patients’ reluctance in advance and do not even bother offering the alternative option. Your “difficult” patient drains your empathy. She complains about the pain from her tumor, and while you hear her, it does not evoke the same response as if she were one of your favorite patients. Slowly, as time passes, these subconscious behavioral differences accumulate. Ultimately, a self-fulfilling prophecy is born. Your “easy” patients engage in light-hearted conversation with34 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESAMISHI BAJAJ, CMS ’18you during their appointments and enjoy seeing you. They never miss appointments, and consequently,their conditions are well managed. Your “difficult” patients frustrate you, however, and you are closed offto them without even realizing it. They are speaking to you, but they do not feel understood by you, evenwhen they spend a full twenty minutes in your office. They can sense that you do not particularly like them,and that compromises the trust that is intended to bond patient and provider in the sacrosanct healingpartnership. The “difficult” patients likely feel just as uncomfortable with you as you feel with them, andsomeday they may suffer medically because of that feeling.A classic social psychology experiment performed by Rosenthal and Jacobson in 1968 demonstratedself-fulfilling prophecy in the classroom by showing that students’ performance in the classroomwas enhanced when teachers felt that they had a higher IQ.2 This landmark study led to the coiningof the terms “Pygmalion effect,” in which higher expectations led to significant improvement in overallperformance, and “Golem effect,” in which lower expectations diminished performance.2 Just as studentsin a classroom are susceptible to the effects of self-fulfilling prophecy, “easy” patients for whom there arehigher expectations may succeed secondary to the Pygmalion effect. Conversely, your expectations maybe lower for the difficult patients, who can already sense your lack of enthusiasm for their condition, andcorrespondingly, they may yield suboptimal results.I once had a patient who was admitted to the hospital after falling, sustaining head trauma and experiencinga post-traumatic seizure. I was responsible for completing his history and physical exam. As I stepped intohis hospital room and laid my eyes upon him for the very first time, he immediately began to scream atme. “Why don’t you people leave me alone?” he yelled loudly. “Everyone keeps running in and out of myroom. I haven’t even had a chance to eat breakfast!”I smiled and apologized. He met my gaze with cold, unwavering eyes. I was unsurprised by his demeanor,as the notes in his chart had already revealed him to be a “difficult” patient. “Patient not cooperative,”one nursing note stated. “Patient is angry and refuses to be examined,” a consulting physician wrote. Iwondered to myself if I should just accept defeat and walk away. There were other patients to be seenthat morning.But I stayed. I smiled confidently. I sat next to him and made light, friendly conversation. I watched him eathis breakfast and commented on the show he was watching on the television. He finished his French toastin silence before looking up at me in wonderment. “You stayed,” he said. “Why are you here?”“I just figured we could chat a bit about you,” I said. “You know, like talk about how you’re doing and what’sgoing on.”It all came pouring out. He was depressed, he said. He was angry about the fall he had sustained andthe seizure he had had. He confessed to some retrograde amnesia. He was frustrated because he hadjust entered a new romantic relationship and was concerned about how he would be perceived by hisgirlfriend. He was a recovering alcoholic, he admitted. He was sober for five years before returning to hisold ways, and his fall was a consequence of inebriation. He said that he resented his poor decision-making, CHICAGO MEDICAL SCHOOL 35

NON-FICTION AMISHI BAJAJ, CMS ’18 and it was easier to lash out at others than to internalize his self-directed anger and intense fear. There was a long pause of silence. Suddenly, it was as though I was in the presence of an entirely different patient. “Thank you,” he said softly. “Thank you so much for caring about me.” He smiled widely at me. “Everyone walks in and out of my room all the time and asks me all of these questions and tries to touch me, and none of them actually seem to care about me. You’re the first person to ask me about my new girlfriend.” I smiled in return, and that’s when I realized that my “difficult” patient had magically transformed into an “easy” one. In spite of all of the notes in his chart warning about the patient’s reluctance to cooperate with a history and physical exam, he was more than willing to cooperate when he felt that his providers were willing to invest the time in him on a personal level beyond his medical care. In social psychology, there is a term known as fundamental attribution error, which is described as a phenomenon in which “When determining the cause of a person’s behavior, perceivers often overweigh dispositional explanations and underweigh situational explanations.”3 Stated simply, people tend to ascribe actions to intrinsic personality traits rather than to external factors. When someone has cut you off on the highway, you may feel a surge of rage and think that the person is rude or a reckless driver, discounting the possibility that the driver is an anxious father-to-be whose wife has gone into labor and is rushing to the hospital. Similarly, when faced with “difficult” patients, we often tend to believe that they are difficult to deal with simply because of their personalities, and we underestimate the influence of other factors affecting their demeanor at the time. Fundamental attribution error is especially important to keep in mind in the care of patients, as patients may be acting in ways that we feel are “difficult” simply because of their medical condition. Patients may act in unsavory manners due to a wide gamut of reasons, including severe pain, compromised psychiatric health secondary to a general medical problem, frustration due to significant medical costs in an era of uncertain health insurance coverage, and fear of the unknown. Often, the patient who is pushing you away may actually be the patient who needs you most. This is the patient you must not turn your back on, and yet this is the patient at greatest risk for suboptimal outcomes secondary to the Golem effect. How can we combat the inherent pull we feel towards the patients who smile at us, as well as the natural tendency to limit our time with the patients who cause us to question our prowess as healthcare providers? To start, we must make ourselves aware of the unequal treatment that may be delivered to patients simply by assigning them to categories such as “easy” and “difficult.” Next, we must never give up on our patients who act “difficult” with displays of anger, resentment or apathy towards healthcare providers, as challenging as that may seem. And, finally, we must always keep in mind the fundamental attribution error that perpetually colors our patient interactions and clinical judgment, reminding ourselves that there are no difficult patients, only difficult circumstances that we must overcome. In our quest to provide quality care to patients who seek our expertise, let us not give preferential treatment when all of our patients need us: that is the art of medicine.36 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESAMISHI BAJAJ, CMS ’18References:1. Centor RM. To Be a Great Physician, You Must Understand the Whole Story. Medscape General Medicine. 2007;9(1):59.2. Reynolds D. Restraining Golem and harnessing Pygmalion in the classroom: A laboratory study of managerial expectations and task design, Academy of Management Learning and Education. 2007;6(4): 475–483.3. Kubota JT, Mojdehbakhsh R, Raio C, Brosch T, Uleman JS, Phelps EA. Stressing The Person: Legal and Everyday Person Attributions Under Stress. Biological Psychology. 2014;103:117-124. doi:10.1016/j. biopsycho.2014.07.020. CHICAGO MEDICAL SCHOOL 37

NON-FICTION LAURA LEIGH FRENCH, CMS ’17 “Suffering Needs Stories”: ‘The Diminished Self’ in Fiction and Memoir Arthur Frank, a sociologist and survivor of cancer, has written that “suffering needs stories.” 1 Frank makes the case that those who are suffering need to tell their stories because it not only helps the world to understand illness, but helps the sufferer make sense of his or her own journey. In the following article, the stories of suffering and death told in Arthur Frank’s The Wounded Storyteller, Elie Wiesel’s Night, and Leo Tolstoy’s The Death of Ivan Ilyich will be briefly discussed with the intent of learning what these authors are conveying about life and death through their narratives — with the ultimate goal of improving physician understanding and sensitivity to those who are suffering. More particularly, we will attempt to understand how patient suffering can lead to the concept of the “diminished self.” In short, the purpose of this study is to use the power of stories to step into the shoes of those who have suffered and soak up all the wisdom that is obtainable, and then step back out and apply this to the practice of medicine. The Diminished Self Arthur Frank in The Wounded Storyteller begins his work by addressing a recurring theme that is also echoed in Night and The Death of Ivan Ilyich. To summarize this theme, he quotes Anatole Broyard’s posthumous work Intoxicated by My Illness. Broyard states, “It may not be dying we fear so much, but the diminished self.” 1 This “diminished self” is characterized by a “falling out of love with yourself.” 1 In illness, we are forced into a state of dependence; we lack control. As humans, we tend to love control; the loss of control is therefore devastating. The ill person ceases to desire and contemplates whether there is any purpose in continuing with his or her life. Frank gives the example of a sick man who questions the purpose of even buying shoes or going to the dentist. In his state of illness, the man was indifferent to these mundane acts and wondered if he was even worth the cost of clean teeth and new shoes. As a cancer survivor himself, Frank wonders aloud how if he relapsed he could avoid feeling that his life is diminished by illness. While Elie Wiesel does not use this terminology, this concept of “diminished self” is nevertheless present in the Holocaust memoir Night. As a young Jewish teenager living through the horror of a World War II concentration camp, Wiesel feels dehumanized by his captors. Wiesel, his father and eighty of his Jewish neighbors are loaded like animals onto a single train car that was meant to haul cattle. They are not told their destination. At this point, the men still act relatively humane to one another. But after months of suffering in the concentration camps and being treated like animals, the men seem to revert to their baser animal desires. When bread is thrown into their train car later in the book, the men fight to the death for a small piece of bread. Sons even kill their fathers for survival. Wiesel says they were “trampling, tearing at and mauling each other. Beasts of prey unleashed, animal hate in their eyes… sharpening their teeth and nails.” 2 The contrast between this animal behavior and the more dignified behavior exhibited by the prisoners earlier in the book is startling. Suffering diminished these men. As the memoir progresses, Wiesel loses hope. He loses his faith in God. He seems to lose himself. When he looks at himself in mirror on the last page of the narrative, he does not recognize himself. Instead, he says that looking back at him “From the depths of the mirror, a corpse was contemplating me.” 2 Wiesel has such a “diminished self” that he sees himself as a corpse. The only thing keeping Wiesel alive during these dark times appears to be the presence of his father. He knows that he cannot force his father to endure38 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESLAURA LEIGH FRENCH, CMS ’17the burden of his death, so he keeps going. After his father’s death, Wiesel records nothing more of hisexperience. He states that “nothing mattered to me anymore… I spent my days in total idleness. With onlyone desire: to eat.” 2 Wiesel is indeed a living corpse — or the textbook definition of a “diminished self.”The Physician as Cause for Diminished SelfReturning to Arthur Frank’s theme of the “diminished self” being more feared than dying itself, Franksuggests that one of the most important causes of this “diminished self” in modern medicine is thedoctor herself. Frank notes that it is important for the physician to realize that providing treatment is notequivalent to providing care. As part of providing care, the physician should help the patient find his orher story — thus theoretically preventing the feeling of a “diminished self.” Frank believes that physiciansdiscourage the ill from developing their own individual stories; he states that “the ill person’s voice hasbeen taken away.” 1 He makes it clear that while a physician takes a “history” from the patient, the physicianrarely captures the patient’s true personal story. In fact, if the patient veers too far into telling his story,the physician will likely interrupt to get the patient back on track for the “important” information that isrelevant to the doctor’s cognitive process of reaching a diagnosis.Furthermore, Frank indicates that the physician inadvertently discourages the patient’s story because,for the physician, the ideal story is that of triumph over illness, with the physician as the hero of the storyand the patient as victim. This is far from the real story for most patients. For the suffering person to gaincontrol of their future, the story must be rewritten with the patient at the center. Frank argues that storieshave the power to “repair the damage that illness has done to the ill person’s sense of where she is in life,and where she may be going. Stories are a way of redrawing maps and finding new destinations.” 1Leo Tolstoy’s The Death of Ivan Ilyich provides a good example of an unhealthy doctor-patient relationshipwhere the one who is suffering is treated by his physician, but not cared for by him. Ivan Ilyich, the maincharacter of Tolstoy’s work, is a magistrate who has reached a position of some influence and finds pridein his accomplishments, social standing, and material belongings. After falling one day while hangingcurtains in his new home, he begins to have a pain in his side that grows more and more intense. Upon hiswife’s insistence, Ivan Ilyich goes to the doctor to have the problem evaluated. Ivan compares his time inthe doctor’s office to his days in the courtroom, except here he is the prisoner instead of the judge. Likea judge in the courtroom, the doctor makes his patient wait and when the doctor arrives, he assumesan “important air… the same air toward him as he himself put on towards an accused person.” 3 Thedoctor appears to speak over Ivan Ilyich’s head, leaving him in confusion as he tries “to translate thosecomplicated, obscure, scientific phrases into plain language and find in them an answer to the question: ‘Ismy condition bad?’” 3 The doctor, presumably a brilliant man, had devised a splendid differential diagnosisand treatment plan for the patient. But yet, the doctor does not answer the one question Ivan has for him— is this medical condition dangerous?Although written over 100 years ago, the doctor-patient relationship has not changed drastically sincethe time of Leo Tolstoy. While there is more emphasis today on “patient-centered care,” it would notbe unusual to see a similar encounter occur today. Ideally, the patient’s agenda should come before thephysician’s. The physician should strive to speak as simply as possible to help the patient understand. Inthis case, Ivan’s doctor provides him with a surplus of technical information about his condition, but does CHICAGO MEDICAL SCHOOL 39

NON-FICTION LAURA LEIGH FRENCH, CMS ’17 not answer the most important and only question on his mind. To state the obvious, this is a poor partnership between physician and patient. From the very beginning of the encounter, the physician fails to treat his patient with the respect that should be due to him as a fellow human being. Instead, he diminishes Ivan by his tardiness and his haughty bedside manner which suggests his superior, all-knowing, godlike status. Ivan feels like a prisoner before his judge. This is a sad comparison. Just as a judge does not personally care about the fate of his prisoner or consider the prisoner’s perspective, so Ivan’s doctor fails to care or even answer Ivan’s one question. In reflecting upon the narrative, there is much we as future physicians can learn from this encounter — namely, what not to do as a physician. Ivan Ilyich’s doctor did not fail because he was poorly educated or lacking in zeal. Rather, it appears that the physician’s primary problem was a failure to respect his patient. If he had respected his patient, he would have listened to him. Instead, he saw him as a worthless prisoner whose perspective was unimportant. As physicians, we must have respect for our patients because they are our fellow human beings, created equal in dignity to us. How could this change the way we practice medicine if we showed respect for every patient — not just the well-to-do or well-connected? Out of respect, we would listen to our patients; by listening, we would learn from them. Frank states that “one of the our most difficult duties as human beings is to listen to the voices of those who suffer. The voices of the ill are easy to ignore, because these voices are often faltering in tone and mixed in message, particularly in their spoken form before some editor has rendered them fit for reading by the healthy. These voices bespeak conditions of embodiment that most of us would rather forget our vulnerability to. Listening is hard, but it is also a fundamental moral act.” 1 Listening shows the patient we care, but furthermore teaches the physician to understand what it means to suffer. Considering Arthur Frank’s serious accusation that physicians contribute to the “diminished self” of ill persons, it is incumbent upon us to ask how we can help those who suffer to live full lives and maintain their love of self. Frank believes that helping the patient find his or her story is essential because stories give direction and help those who are ill make sense of their experience. He suggests that stories make people feel less alone because by nature, a story requires an audience, thus connecting the ill person with society. Frank argues that stories can even heal. By telling one’s story, the ill person can become a storyteller himself who helps someone else walk through similar circumstances by the bond of shared experience. At the risk of putting words into Frank’s mouth, it seems that Frank is suggesting that those who suffer need to find purpose and meaning (or “story” as he refers to it) for their lives in order to prevent the loss of that precious sense of self. Purpose and meaning can only be found in living for something greater. If the sense of self is lost, we might as well be a living corpse like Elie Wiesel. Conclusion Elie Wiesel believed his story was important to tell because the world must know about the suffering that his people endured. Likewise, as physicians, we must help our patients find their stories for their sake and for the world to learn from them. In his acceptance speech for the Nobel Peace Prize, Wiesel states that he “swore never to be silent whenever and wherever human beings endure suffering and humiliation… human suffering anywhere concerns men and women everywhere.” 2 Suffering in this world is horrendous and it is40 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESLAURA LEIGH FRENCH, CMS ’17so terrible at times that words are not even adequate to describe it. Even though words cannot accuratelydescribe it, the evils must be told. Or else these evils will be ignored just as the Holocaust was in WorldWar II. If the suffering is ignored, the world is guilty as a co-conspirator. If there is suffering anywhere, theworld cannot watch in silence, whether that suffering be on a battlefield or in a hospital bed. Listening tothe story of the suffering is just the beginning.References:1. Frank AW. The Wounded Storyteller: Body, Illness, and Ethics. Chicago, IL: University of Chicago Press; 2013.2. Wiesel E. Night. New York, NY: Hill and Wang; 2006.3. Tolstoy L. The Death of Ivan Ilyich. CreateSpace Independent Publishing Platform; 2014. CHICAGO MEDICAL SCHOOL 41

NON-FICTION JAVIE R JIME NE Z , CMS ’18 Proper Care “She said, ‘Because he has Medicaid we’re not going to treat his eye.’” My psychiatry resident’s smile told exactly what she felt: thinly masked frustration and disappointment. “So I repeated back to her, ‘Because the patient has Medicaid we’re not going to care for him?’” she continued, anger sharpening the edges of her voice. “She said, ‘No, that’s not what I said.’” After a pause, she finished, “But that’s exactly what she said.” Our patient, admitted to the psychiatric service for anxiety, was also suffering from a recently diagnosed cavernous hemangioma, a benign cancer of blood vessels in the muscles just behind his left eye. It had grown to such a size that it was causing constant headaches and blurred vision. We had reached out to neurosurgery for their thoughts. Their thoughts were that his surgery would have to be charity care and instead we could refer him to Cook County Hospital, a hospital that does things for free because it’s funded by local taxes, not insurance claims. The chair of psychiatry shook his head at the story. There was a palpable frustration in the room, and I shared in it. That afternoon, I mentioned to my resident that I had worked at Cook County on several rotations. I knew that Cook County does wonderful work for those in need, but their resources are limited. “It could take months just to be seen,” I said, more angrily than I intended. She stood, looking at me. “This is improper care,” I added. “It is,” she agreed. That night I went home to rest. My mind was unsettled, struggling to reconcile the recognition of wrong against the inability to act against it. I felt powerless, a third-year medical student with no authority standing on the edge of a vast machine of real doctors, insurance companies, and the legal and business minds that drive them. But my mind was also rebelling against inaction. I thought back to my medical ethics classes. Maybe putting words to the situation would channel my thoughts. Maybe naming the transgressions would ease my mind, the way codifying crimes makes them somehow more sterile. “Autonomy, the patient’s right to participate in deciding which treatments or procedures to try.” We were not violating this principle. We were not forcing care upon a patient who did not want it. We were not giving him a treatment he had not agreed upon. In fact, we were offering him no treatment at all. “Justice, the principle that we distribute health care resources fairly.” This was questionable. Would performing an operation on this man impact the care of others? In a non-emergent situation, that’s a difficult argument to make. It seemed to me, at most we would inconvenience someone a few hours, either another patient or a surgeon. “Beneficence, the requirement that we act in the interest of the patient.” By delaying his treatment, were42 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESJAV IE R JIME NE Z , CMS ’18we acting with beneficence? Cavernous hemangiomas are somewhat benign and slow growing, but hishad already grown to a point it impacted his sight. In what world, in what conceivable way could it beargued we were acting in the best interest of the patient by sending him away to seek care at some otherhospital, setting him adrift on a sea of fear and anxiety, with no support but a referral?Primum non nocere, our first and greatest dictum. “Non-maleficence, the command that we do no harm.”What were we doing other than acting in maleficence? We were consciously, willingly delaying the patient’scare by, very likely, months, in sending him to an institution known to have limited resources.There was no doubt in my mind. We were violating medical ethics. I just did not know what to do about it.The next morning I checked in on our patient. He was upset: his speech halting, his body hunched, hisarms cradling himself. His eyes rested in the corners of the room, as if seeking a safe place. I asked thequestions I needed to ask (“how are you doing, any side effects from the medications, how did you sleep,any thoughts of hurting yourself”), tried to comfort him as best I could, then moved on.Before long it was time to round with our attending psychiatrist. Before much longer it came time toupdate him on our gentleman’s progress. I looked at my resident. There was something different in herposture. She stood straighter. Her gaze was steady.“I spoke with neurosurgery. They say the patient can fill out a charity care application. We need to find away to keep him in the hospital though.” I hadn’t known but she had been pushing back against a systemof plausible deniability and bureaucracy to get the patient the care he needed, making calls and filingpaperwork.The attending considered for a moment. “Medicine won’t take him. I guess we could keep him here for awhile but it would be hard to justify. Maybe we could push his medication schedule a little. He’s alreadycharity care, so I don’t mind holding him,” he said, then paused, then smiled, almost amused but alsoapproving.Her mind seemed to be turning over the possibilities. I watched in pleasant surprise. I had seen doctors fightfor their patients before but somehow this seemed different, not an angry phone call but a realignment ofcogs in a mechanism. We moved on to the next patient.As we walked, my mind wandered back to a time at Cook County, to my internal medicine rotation. Iremembered a patient, a long-time heroin addict with COPD, suffering from pneumonia. I recalled listeningto her lungs, my stethoscope resting gently on her dark, black, thin skin stretched taut like parchment overher ribs. I listened to an orchestra of chaos inside her lungs, the classic rattles and wheezes of years ofcigarettes mixed up with the wet phlegmy crackles of pneumonia.She pointed a few times to her head and whispered something. I didn’t understand. She was wearing heroxygen mask. She pointed again. I leaned in. “Too tight,” she was whispering. I loosened buckles that duginto her scalp. I was upset. She didn’t even need to be wearing it. It was just for sleep. CHICAGO MEDICAL SCHOOL 43

NON-FICTION JAVIE R JIME NE Z , CMS ’18 “I’m sorry about that,” I told her. She looked at me with sad, tired eyes. “Thank you,” she whispered. On rounds that morning I performed the internal medicine ritual. I presented her to our attending, our residents, and the other students, eight of us in all. We stood outside her door and described the condition of a hypothetical person in precise medical terms. “Plan for the day is to continue her antibiotics, continue her COPD treatment, continue CPAP,” I ticked off each item by memory. The senior resident looked at me almost angrily. “You’re just saying continue, continue, continue.” Shocked, I stared. “Do you know what the proper treatment is for pneumonia in the setting of COPD?” he asked. I did not. He rattled off some treatment guideline. He loved guidelines and decisional algorithms. He turned to the attending and stated, “We can discharge her today.” The attending nodded. My heart pounded in my chest. I was afraid, but somewhere in me some scratching, aching need forced me to speak. “Are you concerned that her white blood cell count is 12.6 and her temperature is still over 100? She looks ill.” The senior resident looked at me for a moment then shook his head in disapproval. We entered the room and continued on with rounds. My thoughts were lost in a storm of emotion and memory the rest of the day. I ruminated on the scene, turning it over and over in my mind, reliving each and every moment, embarrassment and anger playing like electric fire over my skin. I left at 4:00 p.m., another day done, another pointless exercise in note writing completed and another 1.5 hours of driving in Chicago traffic to go. The next day I came in at 4:30 a.m. to see my patients and write my notes before rounds. I checked the patient list. She was still listed. Her chart told a story: white blood cell count was still dropping, now at 10.2; temperature had stabilized in the high 90s, well below a fever. I went to see her. She looked comfortable, resting in bed. “I’m going to do a quick exam, all right?” I asked her. She nodded. Her lungs sounded better, I thought. I smiled. I thought back on this as I watched my psychiatry resident fighting against the parts of our hospital system that were not in line with where they should be, sliding along tracks greased by profit rather than the ideals we have all given oath to, the oaths by which we gain the trust of our patients and society. These are the oaths we must live by in order to continue having the privilege of doing what we do. The day we began discussing charity care for our patient, I would write in his daily progress note, “Neurosurgery and medicine in discussions on proper care of patient’s eye. Psychiatry will hold until discussions completed.” More days passed. We continued to hold the patient. An attending neurosurgeon would eventually write that the patient was “at risk of progressive and total loss of vision.” He agreed to perform the procedure on approval of the charity application. More days passed after that. We continued to hold the patient, in no hurry to see him go. His application was approved. Then his follow-up appointments were made.44 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESJAV IE R JIME NE Z , CMS ’18Eventually, one morning, my resident told me, “We’ll discharge Tim today.”“Great,” I replied and added, “I’ll write his discharge paperwork.” She nodded, then left.I checked on him one last time. He was sitting on his bed, comfortable in his old Levi’s and sweater. “Lookslike all your appointments are made,” I opened with, smiling warmly.“They are. I’m so thankful for everything you all have done,” he told me. He looked it. Relief seemed to pourout of every muscle, a sort of nervous relaxation.“Dr. Morgan worked hard to get all of this done,” I added.“I know,” he replied. I asked a few questions, made sure he didn’t need anything else, then left.I felt at peace, content. CHICAGO MEDICAL SCHOOL 45

NON-FICTION ARIE L KATZ , FACULTY My Faustian Debt Mrs. S was a 78-year-old patient, recently diagnosed with an aggressive form of Acute Myelogenous Leukemia (AML). She had been living in a church basement for the last few years and now had nowhere to live because of her deteriorating functional status. At this point, the hospital declared her a “disposition issue.” In 2008, she suffered a stroke with residual aphasia, anxiety and tangential thoughts. In the summer of 2014, she presented to the clinic with profound fatigue. Subsequently, her internist, who had been following her for the past six years, sent her directly to the Emergency Room. In the Emergency Room her peripheral blood smear revealed profound pancytopenia. Shortly thereafter, she was diagnosed with a terminal cancer of the blood. After thoroughly vetted discussions, the patient opted for chemotherapy. Two weeks after the initial chemotherapy, her blood counts were at critical levels. She requested further treatment for her cancer but refused nursing home care. By this point, she was too weak to live at the church. She could not live with her daughter either — who was living with a child of her own in a small studio apartment. A palliative care consult determined that the patient’s goal was to live as long as possible, and therefore, we continued to treat her as a “Full Code” including transfusion care to prevent spontaneous brain bleeding. Four weeks later, I was brought into the case: a woman with end-stage diagnosis, with nowhere to live, refusing nursing home care and requiring near daily transfusions. As the unofficial hospital physician advisor, my task was to move the case from an abstract problem to a concrete solution. She had only two options: 1) if she elected to undergo further treatment, she would be placed in a nursing home and return as needed to our hospital for transfusion care, or 2) if she elected to forgo treatment she would qualify for hospice care which, due to her social situation, would be in a nursing home as well (as her husband had died in a nursing home, this was a nightmare scenario for her). She didn’t want to choose either option, so she told us to contact her daughter; the daughter refused to make a decision for her mother. This back- and-forth continued her on the non-viable path of remaining in the hospital until she eventually died of her disease. So, what were we to do? If we determined she was medically incompetent, the decision would be made by her daughter or state appointed guardian. As her daughter clearly refused to make the decision, it would likely fall upon the latter: a process that would take weeks to months. In the meantime, our patient was in the hospital consuming multiple platelet and blood transfusions. Her hospital stay neared $500,000. With nowhere else to turn, we presented her case to the Bioethics Committee. The Bioethics Committee considered further transfusion as medical futility and concluded that the health care system was not responsible for administering further transfusions to the patient. At this point, the patient’s only option was to enroll in hospice care which she continued to refuse. In the end, her internist convinced the daughter to transfer her to a nursing home. She died two months later. Despite all of the time, effort and money we invested, nobody got what they wanted out of this case. In the end, our patient was placed in a nursing home, and her daughter felt guilty. We are judged as a society by how we treat our most vulnerable people. Did we spend $500,000 to avoid the guilt of making a difficult decision? To me, the injustice here is that we all knew that hospice care was the best option. But none of us were able to tell her that it was her only option.46 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESARIE L KATZ , FACULTYIn the new era of medicine, our patients make bad decisions. Part of the problem is the compartmentalizationof medicine. Over the course of her hospitalization, she had five separate hospitalists, three palliative carephysicians, an ethicist, and a hospital administrator all involved in her care. Who could she trust? In theend, it was her primary physician who helped her decide. Our county hospital provides care to those whohave nowhere else to turn. We deliver it with respect and compassion. We failed Mrs. S, because we couldnot provide her with the dignity that she deserved. I am sure if you ask her daughter, she would agree. Butthis is the unfortunate consequence of choosing not to decide. CHICAGO MEDICAL SCHOOL 47

NON-FICTION MIL DRE D M.G . O LIVIE R, MD ’88, FACULTY A Tale of Two Pictures The arts and artistry are important to everyone, but have a special place in the lives of those of us who work in healthcare. In an age of high patient loads, myriad tests for each patient, increasingly complex electronic medical records, and shared patient care that limits the time we spend with each individual, it is a challenge to relate to our patients as multidimensional human beings. Sharing our own humanity with patients, other professionals and our own communities is made more difficult by our obligations and schedules. Reflecting on the pieces that make up our lives is yet a deeper task, aided by the arts. I come to my medical practice and academic life at Chicago Medical School as a first-generation Haitian American, born in Chicago to Haitian parents who both worked in medicine. My parents immigrated to the U.S. in 1958, giving our family a way to dream big in the land of opportunity. Then and now, Haiti offers a powerful example of the global mosaic of cultures. Having paintings reflecting my cultural roots is both a way of showing pride in my heritage and also a way to remind me of what I bring to medicine. In my office hang two paintings commissioned from internationally acclaimed Haitian painter Essud Fungcap. One commemorates the 25th Annual Convention of the Association of Haitian Physicians Abroad, held in Chicago. The other is a pictorial representation of events in my professional life over the past year. They are meaningful to me as a record of significant events, and also as vivid examples of Haitian artistry. Though now a New Yorker, for many years Fungcap was a cornerstone of Chicago’s Haitian American art scene. Fungcap is the quintessential Haitian artist. His work pulses with the music and vitality of Haitian expression. His ebullient use of color, visual rhythm and form explodes with vibrancy and music. Abstract elements, surreal perspectives, and episodic montages sing across his canvases. The planes of a human face echo in petal-like shapes across the paintings. Brilliant floral motifs dance among street musicians in island markets. Of his work Fungcap said: “I see myself as a composer of sorts, bringing together different mediums, ideas, and emotions to create harmony and bring ‘life’ to my paintings. With a bi-cultural upbringing, my Chinese father and Haitian mother have added to my sense of wonder of the world around me.” 1 Born in Port-au-Prince, Fungcap demonstrated his formidable talent from a very young age. As a student of the Foyers des Arts Plastiques, his teachers included Haitian masters such as Dieudonne Cedor, Jacques- Enguerrand Gourgue, Nehemy Jean and Luckner Lazard. He would go on to study at the Academy de Beaux Arts, later at New York’s SOHO Art Center, Coral Gables Museum of Art in Florida, and eventually Houston Art Institute of Texas. Fungcap’s work has been honored with awards from Manhattan Arts International Magazine and The Chicago Museum of Science. It’s easy to see why some have called Fungcap a “Renaissance man,” since his artistic expression encompasses musical composition, performance and graphic design as well as painting. He is also an accomplished teacher of art, maintaining his studio in New York City. Fungcap’s paintings can be found in galleries and private collections around the world. Prior to the 25th anniversary of the Association of Haitian Physicians Abroad, I asked Essud Funcap to create an interprofessional painting depicting the collaborations which exist when health professionals come to together and work towards a common goal. The gathering was held that year in Chicago. It48 ROSALIND FR ANKLIN UNIVERSITY

SYNAPSESMIL DRE D M.G. O LIVIE R, MD ’88, FACULTYincluded Haitian American physicians, attorneys, businesspersons and academics, drawn from theirvarious walks of life to talk about healthcare. The occasion also gave us a chance to meet to talk aboutwho we are and what we bring to medicine.At the time there was frank reluctance on the part of convention planners to the idea of bringing togethersuch disparate persons as doctors and nurses, politicians and investors, academics and business people.To the naysayers’ great amazement, the interdisciplinary mélange proved a great success. New resourceswere discovered, new advocates for healthcare were recruited and projects launched that continuesuccessfully to this day. For me, Fungcap’s painting captures that energy and optimism brilliantly, and itinspires me still.I believe passionately that we accomplish the most when we work together. In my earliest medical missionsto Haiti and other countries, I functioned as a single glaucoma specialist. I provided exams, rendereddiagnoses and performed surgeries. But I saw immediately that need far outstrips the capacity of anyindividual to provide care. Instead of fishing, I committed to teaching others how to fish. Instead of goingalone on these missions, I went with a community. Instead of doing the care myself, I spent as much timeteaching as tending to patients. In the spirit of my Fungcap painting, I learned how to make my time awaya time of interprofessional sharing.In the intervening years between the 25th anniversary celebration and today, I learned how to recruitother practitioners, suppliers of medicines and equipment, technicians and volunteers from all walks oflife to join the medical missions. I learned how to connect with the local communities, including medicalprofessionals, social and faith-based organizations, so that our skills could be transferred to people whocould continue to heal long after my own return to Chicago. Working together, we can leverage enormousenergy and capacity to make life better. All it takes is the openness and determination to move beyondfamiliar paths to embrace what others have to offer. All it takes is seeing myself as part of the vivid paradeof people highlighted by Fungcap’s art.Fungcap used my own experiences over the last few years as the basis for the newest painting that hangsin my office. That work helps me reflect on my origins, and sharing my culture continues through my roleat Rosalind Franklin University of Medicine and Science/Chicago Medical School as Director of GlobalHealth. As this article is being written, I have just returned from a “medical mission” to Haiti. That work isreally a continuation of alliances started many years ago which was part of the CMS partnership in GlobalHealth. I hope we have the opportunity to continue our alliance in the near future with Haiti. I met up withretinal specialist and faculty member Dan Alter, MD, who brought supplies, medications, and equipment totreat hundreds of patients at the University Hospital Eye Clinic, and a private practice physician increasinghis skills in the subspecialty of retinal diseases and surgery. Dr. Alter has continued to advance the skills ofone of the Haitian ophthalmologist and started training a second retinal physician. His contributions are inthe spirit of the work and collaborations with other physicians.I feel very fortunate to be here in Chicago where we enjoy a rich immersion in the arts. Ours is a world-class city with amazing museums. Among Chicago’s important collections of art is the DuSable Museum,founded in 1961. It is one of the institutions in the U.S. developed to preserve and display the experiencesand achievement of people who are of African descent. It is named after Jean Baptiste Point DuSable, a CHICAGO MEDICAL SCHOOL 49

NON-FICTION MIL DRE D M.G . O LIVIE R, MD ’88, FACULTYHaitian of African and French descent, who in 1779 established the trading post and permanent settlementwhich would become known as Chicago.It is telling that today, I serve as Assistant Dean for Diversity in a school whose mission is interprofessional.We are committed to one common mission, yet we contribute unique and diverse roles. This picturereminds me of how individuals from diverse opinions and backgrounds can come together for a commongoal. Last year, I asked this painter to help commemorate my last several years in my different roles:increasing women and underrepresented minorities in medicine and giving the opportunity for many tolearn what a museum like DuSable can represent.I recently was asked if I had seen the movie Hidden Figures, an untold story about the space missionand the critical role that these smart scientific black women were able to contribute. Movies and art area depiction of life, as is photography. I am most fortunate that an artist created a mosaic image of thoseparts of my life.These paintings now hang in my office, reminding me of the possibilities of which we can dream. Thepractice of medicine must be seen in the context of our culture and community. Our patient’s activitiesexist in families and neighborhoods inseparable from their languages, their homes, their jobs, their supportnetworks and the passions to which they commit their time. Whether patients spend their time with musicor art or crafts or cars or videos, those activities can help us know them better. As practitioners we bringour own backgrounds, experiences, values and individual perspectives. It cannot be any other way.The Fungcap paintings in my office remind me that the great value of art is that it helps us acknowledgewho we are, gives an insight to others on what we value, and provides common ground for discussion ofthe things that contribute to making healthcare a healing process.References:1. Fungcap E. About Fungcap. Fungcap Arts. http://fungcaparts.com/About.html. Published 2012. Accessed January 31, 2017.50 ROSALIND FR ANKLIN UNIVERSITY