SYNAPSES A Creative Journal of Chicago Medical School VOLUME 2, SPRING 2018
Front cover: “Synapses,” artwork by Gloria Joo, CMS ’21 Artist’s Statement: This is a playful reinterpretation of your basic neuronal network. I was inspired by observing light microscopy slides of neurons in my histology class. It wasinteresting how the dendrites and branches of axon terminals took on the uncanny shape of hands after they were stained with silver.
SYNAPSES A Creative Journal of Chicago Medical SchoolEDITORIAL STAFFWilliam Agbor-Baiyee, PhD Editor-in-ChiefCandice Kosanke Managing EditorEDITORIAL BOARDKaren Black, MD ’88 AlumnaJeffrey Bulger, PhD FacultyBarbara Hales, MD ’76 AlumnaMelissa Hoshizaki StudentGwendolyn Messer, MD, FAAP FacultyKaren O’Mara, DO FacultyAubrey Penney StaffHector Rasgado-Flores, PhD FacultySherwyn Warren, MD ’56 AlumnusREVIEW BOARDOmeed Ahadiat StudentSalvatore Aiello StudentIbukunoluwa Araoye StudentChristopher Collier StudentMatthew Cozzolino StudentAnna Dailey StudentMichael Drake StudentKaitlyn Egan StudentDiAna Elcan StaffJessica Liang 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 Senior Vice President for University Enhancement 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 Splendid Encounter William Agbor Baiyee 10 11POETRY These Tears W i l l i a m A g b o r B a i y e e 12 13 Does the Soul Linger Henry Del Rosario 14 15 Untitled H e n r y D e l R o s a r i o 16 17 Untitled H e n r y D e l R o s a r i o 18 19 Untitled H e n r y D e l R o s a r i o The Road to a Calling Morgan Gilmour Untitled V e r o n i c a G r o s s Inheritance A u b r e y P e n n e y There Will Be a Moment Jordan Swenson Untitled E l i z a b e t h B o g g i o 22 24 ART/ Cortical Neuronal Forest Maria Bompolaki 26PHOTOGRAPHY 27 28 Synapse G l o r i a J o o 29 30 Synapse J o r d a n N e w m a n Synapses Angela Wu Solar Eclipse D a l e B u c h b i n d e r Joshua Tree M e l i s s a C h e n 4 ROSALIND FRANKLIN UNIVERSITY
SYNAPSES CONTENTS Kayak M e l i s s a C h e n 32 32 Sunset M e l i s s a C h e n 33 34 Lily Pond E l i e C r y s t a l 36 38 Holy Perspective H u n t e r L a u n e r 39 39 Spirit Illuminated H u n t e r L a u n e r Untitled P r a g a t i M a m t o r a Untitled P r a g a t i M a m t o r a W e B u i l d Angela Wu In White J o h a n n a S t e c h e r 42 45 FICTION/ Legacy of Love Karen Black 48NON FICTION S w a p n a S h a n m u Moral Frameworks of the Burgeoning Medical Student CMS and Me: A 50-Year David Forsted 52 Retrospective 55 ALUMNIFEATURES My Last Day M e l v i n Y o u n g 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. © 2018 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 back cover and section dividers: iStock.6 ROSALIND FRANKLIN UNIVERSITY
SYNAPSESFROM THE EDITORIAL BOARD CHICAGO MEDICAL SCHOOL 7
POETRY8 ROSALIND FRANKLIN UNIVERSITY
SYNAPSESPOETRY CHICAGO MEDICAL SCHOOL 9
POETRY WIL L IAM AG BO R BAIYE E , FACULTY Splendid Encounter You move between them as the stars sing the harmonies of peace. You move between them as the stars dance the rhythms of joy. You move between them as the stars play the drum of understanding. We know the moment has arrived when you align with them. We know the moment has come when you we wear your crown of majesty. We know you are there when you perform your show of a lifetime.10 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESWIL L IAM AGBO R BAIYE E , FACULTY These Tears Here they are. Tears of loss. Release them — Your unique way. Here they are. Tears of pain. Release them — Your best way. Here they are. Tears of sadness. Release them — Your only way. Here they are. Tears of sorrow. Release them — Your natural way. Let your tears flow like a river. Let them go. Let your tears bring acceptance.Let your healing begin. Believe anew. Love afresh. Hope again. Live. CHICAGO MEDICAL SCHOOL 11
POETRY HENRY DEL ROSARIO, MD ’14 Does the Soul Linger? Does the soul linger doctors who walk away— after the last heart beat? see the hand that grazes a sister’s shoulder then Does it uncover the lines and cords grabs a chart strewn on the body— to note some thing slide the half that expired? gown aside— Does it swell and croon flush on its way over when its family members an exposed old breast— then drift across cup their mouths and hesitate the limbs to slip shyly to the ground to touch or stand away? where rubber gloves And what about the soul and wrappers alone when sick? lie limp? Does the soul examine Or does the soul push the two residents standing violently back— by the door— jabbing and slugging— gaping at the green line swinging wildly trembling against the chest wall on a black screen? once our palms withdraw Does that soul for retreat? wonder what Rabid for air— could have been done— averse to rancor— what could have been done? does it rush through the throat to escape Or wonder only to break if a stranger’s prayer like a wave onto a rock can fill an empty room? when it hits a plastic tube? To palm the hidden and the deep— we saw it fold inside its body— Or does the soul gaze through the half-closed because once we turn away it will detach and crumble like a leaf— eyes of a frozen head turned and when the curtain’s drawn— scuttle in the wind at the nurses and12 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESHENRY DEL ROSARIO, MD ’14 Untitled The hospital seizes the night with me— convulsing to the funk and junk of M83 Nerves may dread to head the hundred revisions and medical decisions as one moves from said to bed but a brain that grooves ahead the dead has hips to dance and feet to beat— for the rhythm of a physician is to agree and disagree CHICAGO MEDICAL SCHOOL 13
POETRY HENRY DEL ROSARIO, MD ’14 Untitled In the morning, we skim over your history HTN DM CAD Our eyes— like smooth stones flung across a pond— hope not to land on things that make us sink GSW at 17 homelessness a divided family After sign-out, I drift to your bedside as a fog over morning water— your face more sedated than a puddle— ribs scars wrinkles My hand traces— your life gently ripples14 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESHENRY DEL ROSARIO, MD ’14 Untitled When my needle breaks your skin it stings Your eyes clench as your keloid swells with steroid— I only know you as the 22 year old black male with gun shot wounds trusting me with a body broken by our city— It must burn and boil like a dark cloud steeped in thunder and bolts CHICAGO MEDICAL SCHOOL 15
POETRY MORGAN GILMOUR, CMS ’19 The Road to a Calling Two Roads Diverged: A Career Path Poem As a young child, Third year student, My father sat upon my bedside, Burning with the fire of new-found love. As I recited Surgery, my field. Poetry and scripture I love this noble work. He said to me, I cannot wait, Memorizing the ancient and wise, To enter the hospital daily, Will prepare your mind, Assess, operate, Your heart, and your spirit. Resolve, fix, correct, cure. Now in my life, “It’s a hard job.” I see patterns in interactions, “Residency is competitive.” “The work hours are tough.” Echoes of those words, “Do you have what it takes?” Learned and internalized. Two roads diverged, Two roads diverged, In a yellow wood. My path is sure. In the yellow wood of Robert Frost. I am Designed, Named, In the one path lay to mend bodies, heal souls. A male patient, forty. This universe A hernia. Pulls you from light with misty darkness Can’t play with his kids or lift at work. Hold to Truth — only Church goer, hunter. those who answer are Called. In room four-nine-five-six.16 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES VERONICA GROSS, CMS ’18 Untitled It is said death is a stalker A hunter A crouching, lurking menace, prepared behind each corner. Not so I have seen death; she is unhurried Wingtip to wingtip, she brushes the corridors And pauses at each room. Like an attentive doctor Like an inquisitive nurse Raps the metal door frame twice Clatters open the drape Breezes in without invitation (Of this, I too am guilty) And we? Not gatekeepers — That is conceit. Valets Butlers Chief dissuaders, perhapsStanding beside our patients, our hands clasped, our voices demure. You are not expected. So sorry The master is detained The mistress is occupied Your calling card, yes, this silver dish We will let them know you came Some guests are more persistent No voice is absolute. At times, we are commanded: step aside Do not hinder a welcome visitor A respectful bow We exit the room Leave her to close the curtainCHICAGO MEDICAL SCHOOL 17
POETRY AU B R E Y P E N N E Y, S TA F F Inheritance My mother claims he gave me his work ethic (not a compliment) and his crinkled eyes, but not his hairline. We both see exotic knowledge segmented in the gaze of flies; he takes a picture, I write a lyric — my mother does performance art: it dies and the legs splayed in goo are her didactic philosophy of art. From her I have the fear of breast cancer. Him: melanoma.18 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES JORDAN SWENSON, CMS ’19There Will Be a MomentThere will be a moment: for the aggregate of human experience to melt into the abyss of space and float quietly across the universe, for our eyes to be locked on death and our friends consequently to travel forward through time and space — almost without a hiccup in the tapestry of humanity. We rack ourbrains constantly with questions of our competence, for the petty validation of our mortal peers and fail to realize that their voices too will be silenced by the great equalizer. What is there to be said: about good and bad, for heaven and hell, of those sentenced to a life of solitude? Billions walk the earth creating villains and heroes out of each other — when the good are half bad and the bad are half good, culling people between this binary classification of heaven and hell, right and wrong, black and white. The Muslim, Christian, Buddhist, and Daoist it seems are all, respectively, the embodiment of the eternal and all-inclusive good — if only in their eyes. What is the shape of a child’s hope — that is flickering in the dark? A child that sits genuflected before the stars in deep supplication, asking that the moon turn down the volume of war. Does he care what hands robbed him of his parents, or which found him in prayer and embraced his convulsing, panic stricken body — tear ducts going liberal. Does a flower wonder who helped him germinate? What hands gave him soil, water, sun or life? I am persuaded by the innocent adjuration of Candide, “We must cultivate our gardens.”CHICAGO MEDICAL SCHOOL 19
ART/ PHOTOGRAPHY20 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES ART/PHOTOGRAPHY CHICAGO MEDICAL SCHOOL 21
ART ELIZABETH BOGGIO, CMS ’18 Artist’s Statement: This is a series of sketches from my notes in medical school. I keep most of my art on Instagram to connect with other artists in medicine. Many of my drawings and paintings were done just prior or after a surgery.22 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESCHICAGO MEDICAL SCHOOL 23
ART MARIA BOMPOLAKI, CMS ’19 Cortical Neuronal Forest Artist’s Statement: This is an image of a cohort of cerebral cortical neurons from a rat brain that was processed using a silver stain technique known as Golgi Stain. Camillo Golgi developed this technique in 1873 and it enabled him to visualize neurons in very fine detail. This technique was then used by the neuroanatomist Santiago Ramón y Cajal, whose discoveries set the basis for understanding the organization of the nervous system that24 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESwe now have. The magic and utility of using the Golgi stain lies in the simple fact thatneuronal staining, defining cell bodies, dendrites, even fine spines, can be visualizedusing just a light microscope. In our lab, we are using this technique to study thecomplexity of the dendritic tree of pyramidal neurons in the basolateral amygdala, abrain region that processes emotions. Elaborate dendritic complexity with increasedspines on these neurons is observed in the amygdalae of stressed rats, whereas theopposite is true for non-stressed animals. Understanding the mechanisms that manifestthese anatomical changes will aid our efforts to prevent and treat anxiety relateddisorders, such as Post-Traumatic Stress Disorder. CHICAGO MEDICAL SCHOOL 25
ART GLORIA JOO, CMS ’21 Synapse Artist’s Statement: The most fundamental purpose of a synaptic network involves the relaying of information from one cell to another, without physically touching each other. I was interested in capturing this relationship in a more intimate way, by drawing my hands in a similar arrangement.26 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESJORDAN NEWMAN, CMS ’21 SynapseArtist’s Statement:This is one of my interpretations of a synapse. I drew the extracellular environment of thesynapse in a color close to Rosalind Franklin University’s signature maroon. The pre andpost-synaptic terminals of each cell are multicolored to represent both the multitude ofreceptors and proteins present in a synapse; it could also be interpreted as representative ofthe multitude of programs at our interprofessional university. Finally, I left the intracellularenvironment blank to highlight the differences between the two compartments. CHICAGO MEDICAL SCHOOL 27
ART ANGELA WU, CMS ’18 Synapses28 ROSALIND FR ANKLIN UNIVERSITY
PHOTOGRAPHY SYNAPSES DALE BUCHBINDER, MD ’ 76 Solar Eclipse CHICAGO MEDICAL SCHOOL 29
PHOTOGRAPHY ME LISSA CH E N, FACULTY30 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES Joshua TreeArtist’s Statement:As a friend in needThe arms of the Joshua TreeReach through darkened light CHICAGO MEDICAL SCHOOL 31
PHOTOGRAPHY M E LISSA CH E N, FACULTY Kayak Artist’s Statement: Each wave a soft touch Paddle through Alaskan rays Journey to beyond Sunset Artist’s Statement: Like father, like son Surmounting the ridge as one Sunset silhouette32 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESELIE CRYSTAL, RESIDENT Lily PondArtist’s Statement:I submit this photograph as a PGY-1 Psychiatry Resident at RFU. The image above is a photographof the Alfred Caldwell Lily Pond in Lincoln Park, Chicago. The photo was taken May 25, 2014. It isan unaltered digital photograph taken on a Nikon Coolpix S6400 handheld digital camera. I chosethis photograph because I think it is beautiful. Among photos I’ve taken, it might be uniquelyappropriate to briefly demonstrate some possible interconnections between the humanities(psychology), art (the photograph) and science (neuroscience). The reflections of the trees in thepond were remarkably clear that morning and I snapped the photo. When I processed the photo,it seemed to me that, turning it on its head, as I’ve submitted it here, gave the brief impressionthat the reflected trees were not reflections, but real, and were being superimposed upon andintruded by variously strange or magical looking lilies. The ‘sky’ backdrop is both a reflectionof the actual sky, but also represents the penetrance of the daylight to the floor of the pond.Finally, the very bottom of the photograph shows a ghostly reflection of some rocks on the edgeof the pond and, then, actual terra firma and a small stand of brush and flowers.The psychology in the photograph is in the play between the real and the distorted; in thecoexistence of two equally valid, though different, ‘truths’ or perceptions; and in the importanceof perspective, especially regarding foreground and background. The art is here; a photographand a short essay analyzing it. As a psychiatrist in training, this is not dissimilar to what Isometimes do. I meet a patient. He shares with me a snapshot of himself at a given time, ona given day. Part of my job is to assimilate that which he presents to me and use the tools ofthe neuropsychiatric lexicon to pick out not only symptoms, but strengths. Having done that,formulating a plan has a ground that is patient-centered, and can combine any number ofmodalities, including pharmacology, talk therapy, and others. The science in the photographbegins with the digital camera which captured the photo. If one inquires into the mechanismof image capture used by the digital camera and then into the mechanism of image capture inroentgenography, computed tomography, magnetic resonance, and photon emission tomography,one will have gained a basic understanding of a fundamental part of modern medicine. Lastly,as the images of the world impinge on the lenses of our eyes, they are flipped on their headsas they make their way to our retinas. We nonetheless perceive the world in its unflipped formthrough the action of our intervening cerebrum. Our ‘vision’ of others, including patients, can bedistorted in other ways, as well. We all accrue biases, prejudices, and preconceived notions astime goes on. It takes the effort of a conscious, conscientious, and attentive student or healthcare practitioner to notice when these accrued distortions impinge on our ability to do our jobswell. When this happens, we can take a mental step back, refocus our lens, and try again. CHICAGO MEDICAL SCHOOL 33
PHOTOGRAPHY HUNTER LAUNER, CMS ’2034 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES Holy PerspectiveArtist’s Statement:Photo taken at the Kotel inthe Old City of Jerusalem.Every praying Jew facestowards this point, the lastremaining wall (Western Wall)o f th e H o l y Te m p l e. Th e s e twopray at the closest point, yetchoose different perspectivesto obtain their ma’kom kodesh(Holy Space). CHICAGO MEDICAL SCHOOL 35
PHOTOGRAPHY HUNTER LAUNER, CMS ’2036 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES Spirit IlluminatedArtist’s Statement:Photo taken at the Churchof the Holy Sepulcher in theChristian Quarter of the OldCity in Jerusalem. Womangazes into memorial lights. CHICAGO MEDICAL SCHOOL 37
PHOTOGRAPHY PRAGATI MAMTORA, CMS ’19 Untitled Artist’s Statement: Finding beauty in the small things.38 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES PRAGATI MAMTORA, CMS ’19 (TOP) / ANGELA WU, CMS ’18 (BOTTOM) UntitledArtist’s Statement: Nature teaches me to be flexible, calm, and resilient. By hiking, gettinglost, and finding my way back again I’ve found that I can find a solution to any problemthat life throws at me. Just as in medicine and life in general, when crisis strikes, the mostimportant thing is to stay calm and trust your ability knowing that you can and will find yourtrail once again. We BuildArtist’s Statement: This was captured outside of my apartment. This is how icicles areformed-it starts with a few frozen droplets, and when it reaches a certain size, the dropsbegin to drip along the side of the structure. It continues to grow longer and bigger this way.This concept makes me think of the advances in medical sciences-we continue to progress,building on the hard work for those who have gone before us. CHICAGO MEDICAL SCHOOL 39
FICTION/ NON-FICTION40 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES FICTION/NON-FICTION CHICAGO MEDICAL SCHOOL 41
FICTION JOHANNA STECHER, CMS ’21 In White It was raining again. Not the type where an umbrella would keep its owner dry, or where people fell in love with their water-coated eyelashes. As if. It was slanty rain, so intoxicated by the wind that it would’ve followed it in any direction, horizontal as much as vertical. Emory’s socks were sufficiently waterlogged in her off-brand Keds, as she crossed the street to the hospital. Her scrubs clung to her ankles. She entered the hospital lobby, fished out her ID tag for the burly security officer to approve, and made her way to the surgical suites. Clean and pristine, a light cloud of disinfectant mixed with the whiff of luxury leather and office politics. Emory inhaled it, knowing today was bound to be a great one: an aneurysm clipping with the hopes of a transplant later on. She swapped her shoes for green rubber clogs, and exchanged her cardigan for the white coat hanging in the cubby of the women’s locker room. Roxie, the general surgery resident, met her on the way to the vending machines. “Morning Emory, we’re in for it today. The Chief has that pharmaceutical group from Amsterdam coming for a tour.” “So?” Emory mumbled as she fed the machine coins for a caramel macchiato. She knew two of the pharmaceutical reps, Geritt and Paul, in the way she knew her hairdresser. Four times a year for a quick touch-up, a refill of sorts. “So, they’re a bunch of overpaid pill-pushers that conveniently have their pharmaceutical conferences located in the tropics. Meanwhile, we have twice…” “…the hours and half the paycheck,” Emory finished, smiling. “The chief is doing a breakfast thing with them, though, right?” The cylinders parted to reveal the steaming paper cup, which Emory grabbed only to feed the machine again, this time with an order for a double-shot espresso. “I don’t know, that’s the least of my concern,” Roxie stated as she opened her cubby to pull out her coat and tie her hair up in a ponytail. “I have a liver today, and a colon resection. Which will have to wait for the ruptured spleen that’s coming in. Guy’s sixty-five years old, just had a massive MI not three months ago and here he is, back again.” Emory only half listened as she turned her back to her colleague to pour the double espresso shots into her macchiato. The Red Bull from an hour ago was already giving way to the prelude of a headache. This was going to be good. With just a few sips she could feel herself coming back to normal. Her hands would quiet down, her pupils constricting in pure concentration. Far from being the nervous medical student with the shaky hands, barely able to hold a scalpel the right way, Emory was off to the races. Most people were not cut out to be gods and goddesses in white. And what graced the top of Emory’s list of accolades each year was that she was not most people.42 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESJOHANNA STECHER, CMS ’21She excused herself from Roxie’s babblings to face real life-threatening situations, like the beautifulaneurysm, which with every pulse was coming closer to breaking through its membrane. It was mockingher, really. She made her way down the hallway and took a small detour to get to her favorite elevator. Theempty one, void of sniffling lunatics and kids that tugged on stranger’s coattails.She reached the fifth floor and headed for the nurse’s station.“Good morning, Dr. Parks, how are you doing today?” a nurse greeted her. “Are you doing night shift againtonight? ”“Hi Mandy, yes I am,” Emory responded, though really only interested in finding her patient’s chart.“How is my patient doing? The aneurysm. Did you make sure the other nurses enforced the NPO?” Shelooked at Mandy for confirmation, setting her empty coffee cup aside and plopping down on one of theswivel chairs near a desktop to access the file.“Oh absolutely. His blood pressure is stable around 135 over 70, and he’s oxygenating well at 98 percenton room air. The family would like to have a word. They’re waiting for you in his room.”“Okay, I’ll be right there.”She scanned through the images of the CT and MRI scans, noting how the aortic root bulged under theincreased pressure of the massive aneurysm.Christmas morning on a computer screen.Emory adjusted her stethoscope and placed a loose strand of hair behind her ear before getting up tofind room A15.“Good morning everyone,” she greeted the family members, as she walked into the room with an intentspeed. It made her coat flow majestically behind her that way. The wife had red, tear-rimmed eyes andclothes on from the day before. She looked up from her husband’s bedside at Emory’s entrance, her mouthquivering as if she would soon resume crying.“Hello, Dr. Parks,” she said, getting up to shake Emory’s hand. “We were just getting ready to leave. Thenurse said he needed to go to pre-op. Thank you for meeting with us.” Two women stood in the corner,also wiping their eyes and holding onto their husbands.Emory felt all eyes on her, expectantly. If truth be told, she would avoid these encounters altogether. Asidefrom the fact that this aneurysm had such a large fan following at seven in the morning, the tears beingshed by these five people was ruining her high. Alas, once she scrubbed herself sterile, the lacrimationwould be a distant memory, following her epidermal cells down the drain.“I will be with your husband every step of the way, and our surgical team is beyond qualified and dare I say CHICAGO MEDICAL SCHOOL 43
FICTION JOHANNA STECHER, CMS ’21over-prepared,” she paused to give a small smile. “Now don’t tell them I said so, but half of them could dothis with their eyes closed.”This was far from the truth. The surgery was so intricately complicated that the mortality rate was oversixty percent. But that is not what Emory could say to the family that cried like they were already at hisfuneral. The best way, she decided, to explain something that only a slim population in the world couldunderstand, let alone treat, was to cover only the very basics and slip in a few comforting half-lies. Thatway, only the easy questions would be asked, like how long the surgery would take or how long hisrecovery would be.“About how long will his recovery be, you know, after,” one of the sniffling women in the corner asked.Once again, Emory paused to purse her lips into a small smile, like medical school had taught her.“He’ll be in the hospital for about seven days, depending on how well he recovers. Then another four tosix weeks at home.” She checked the patient’s monitor again, assured the family, answered each of theirfurther questions and then excused herself to get ready. She looked at her watch. Seven minutes. A newrecord.On her way to operating room seven, she intercepted Geritt and Paul at their breakfast. They lookedrelaxed and happily plump, tan even. She pulled them to the side, away from the Chief’s table at the frontof the room.“Good Morning boys, I see you’re doing well.”“Dr. Parks, what an honor. I read your last article on endovascular stents. Truly inspiring,” Gerrit exuded.“We have some samples with us today, especially for your patients that are running around all day. It’s astimulant, keeps you going, you know?”Emory sighed. The little game they played where naturally their occupations were only ever about thepatient’s well-being.Because she did know. She knew plenty. She knew better.She slipped a few into her pockets and popped one in her mouth down in the OR. She grabbed a scrub capand tied it tight around her head. She rubbed her hands together to turn on the sink, scrubbing antisepticup to her elbows.Turning her face into the crook of her shoulder, she yawned.44 ROSALIND FR ANKLIN UNIVERSITY
NON-FICTION SYNAPSES KAREN BLACK, MD ’88 Legacy of LoveI always dreaded July 4th, but this year I was excited for the holiday. On this day, while I was in my thirdyear at Chicago Medical School and at the age of twenty-seven, my mom died. It had been thirty yearssince her passing and to celebrate her life, my brothers and I decided to have a reunion at Mahoney StatePark outside of our home in Omaha, Nebraska. One of her favorite things was to rent a cabin at a statepark and have neighbors, friends, and family come and visit. We were determined to do the same. My threebrothers and I put the word out for friends and family to come and have a barbeque with us one of thedays, while we planned an activity-filled, holiday weekend for our immediate families. As the traditionalorganizer of events for the family, I was pleasantly surprised by how involved and eager my brothers wereto join in and make this a special time for us all.Two of my brothers, Mark and Chris, happened to already live in Omaha with their families, while my middlebrother, Jeff, lived in Chicago. He and his family drove to Omaha for this occasion while I flew in fromCalifornia with my husband and five kids in tow. When I was in medical school, Jeff was actually studyingat the University of Chicago for his PhD. It was wonderful having him near me at the time and I love allmy brothers dearly. However, for this gathering, I was particularly looking forward to seeing my youngestbrother, Chris. My daughter, Sherry, currently attends Creighton University in Omaha and had grown veryclose to her uncle. He was there for her when she was transitioning as a freshman away from home andhe was a family member she enjoyed getting together with to talk about her college experiences. She hadseen him in May and had told me at the time that “Uncle Chris didn’t look so good.” I had attributed it tostress from him having a misbehaving eighteen-year-old son, and being I had teenagers, I thought I couldhelp him or at least be an empathetic listener. He seemed distracted the last time I talked to him on thephone, so when July 4th came around, I was keen on giving him a huge hug.We flew in from Los Angeles, drove to the park on the outskirts of the city, and checked in to our cabin,prepared for the weekend ahead. All went smoothly. The weather was typical Midwest summer with heat,humidity and storm clouds in the distance. The kids were discussing all that we would be doing: a steakdinner, a golf tournament, outlet shopping, competitive card games, and just enjoying time with theircousins. At our row of cabins, Uncle Chris drove up with his wife and two kids. As I approached him, it tookonly a minute to process that my baby brother was very, very sick. He was walking dead sick, end-stagedisease sick. He was dying. I was in complete shock.I have been in a solo internal medicine practice for over twenty years. In this old-fashioned, Marcus Welby,MD, way of practice, you know your patients well. In many cases, I take care of their whole family. Not tobe cliché, but they are more than just patients to me. This year happened to be an especially hard onebecause I lost many patients I was fond of and truly loved. They were a part of my life for all these years.Some were old, some were young; some were expected, some were not; some suffered significant pain,some did not; some were anxious about their impending death, and some were at peace. Every one ofthem came to me to guide them through this scary time.While we are in treatment mode, the patient can become just a sum of their data and results. What arethe genetic markers? Are they responding? What did the PET Scan show? I started thinking: Why can’ta patient’s spirituality and my medical plan be on parallel tracks instead of mutually exclusive? I believedI could be a better physician, a true healer, if these worked together instead of in conflict. Regardless ofyour beliefs, giving up control to a “higher being” is comforting and can bring peace in a difficult situation. CHICAGO MEDICAL SCHOOL 45
NON-FICTION KAREN BLACK, MD ’88 This transformation is of paramount importance and I realized I could be the facilitator. And because of this, each patient became more whole, more human. This year was deeply moving yet overwhelming, and here are just a few examples: I had a long-time patient who always brought in Girl Scout cookies to my office….the kind you can only get in Orange County, not Los Angeles. He was terminal, and I realized it was the quality time with his daughter that helped ease his anxiety provoked by a breathing difficulty. I had another patient who was a newlywed mother of a twenty- two-year-old son. She had been battling cancer for years, yet succumbed so quickly. We made sure the whole family was together in prayer during this difficult time. There was one patient whom I hadn’t seen in years, and was saddened to find he had died unexpectedly. He took care of his five grown sons after his wife died, and had always made us laugh. I knew he was surrounded by love, faith, and many good memories. Losing these patients put me in a very fragile state and I could tell it took its toll, but I found solace in knowing I helped them medically and spiritually. We had connected on every level. My baby brother died three weeks after the reunion in July. At the reunion, he just wanted to be there with us, to be surrounded by those who loved him and whom he loved. This is what he wanted to do before he was gone. He wanted his kids to be with our kids. He wanted to reminisce. He wanted to laugh. My brother and I would ask him questions about his treatment and Chris would reply, “Thank you for your concern.” The doctor in me said “wrong answer”, but truthfully it was time to start letting go. It was the time to be human. It was so hard. My kids kept saying to me “You can help Uncle Chris, right? You can make him better”…but I knew better. I didn’t know when he would die, but I knew he was terminal. I was able to see him one more time after our family reunion. He was in the hospital with all the bells and whistles. I watched his numbers and tried to get him to eat and take walks. But mostly I was there to watch our last Wimbledon together, read our last newspaper together, and to especially make sure everyone had quality time with him. He allowed me to let people know. Up until then, over the time of his short illness, he kept it to himself. Our mom was private in that way while our dad was the town crier. I am somewhere in- between and I respect the varied communication styles. My brother was a devout Catholic and we shared this with frequent priest visits and daily communion together. One day he told my brother he felt defeated and within twenty-four hours he was gone. After his death, we found a personal journal with a poem he wrote. Here are the first and last verses: If you have wandered through the Venetian landscape you know I have lived. If you’ve known the friends and family I have, you know a quality life. If you have seen the sunset over Florence you know of beauty… For if you have seen the wonders of the world, read the great books, seen the great art, heard the great music, and most importantly loved and been loved by fine humans,46 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESKAREN BLACK, MD ’88then you have fulfilled an existence as I have, and know what God had in mind for manMy brother was ready. His legacy for me as a physician is to help script my patients’ end of life in thefashion they desire. Maybe I can meld medical, emotional and spiritual care to help patients in all aspectsof their lives throughout their whole life.In my brother’s honor, I traveled to Italy to see his favorite place and to soak in all the wonders. CHICAGO MEDICAL SCHOOL 47
NON-FICTION SWAPNA SHANMU, CMS ’20 Moral Frameworks of the Burgeoning Medical Student When medical students start medical school it can seem as if we are born anew. Inundated with the stimulus of new rules, structures and a steady but rapid current of factual stimuli during the first year, we are like newborns taking in all the information and trying to make sense of it within ourselves and our personal narratives. The preexisting moral frameworks we have developed over the course of our lives up this point are challenged by the rigor of our academic coursework and the demands of developing ourselves into rational, logical, efficient healthcare providers forces us into lower stages of moral reasoning. Under the current state of medical education, a state founded on reward and punishment, shame, fear, and competition I would argue, we are kept there. Using Kohlberg’s stages of moral development as a scale of evaluation for the moral development of a medical student, it could be said that most of the structure of medical education constrains the developing student to the first four stages. We start school with a sense of anticipation and sometimes anxiety, and our desire to learn and excel are propelled more often than not by the fear of inadequacy or failure — a fear that, to the typically self-critical, “A-Type” medical student is tantamount to a punishment (Stage 1). As coursework and momentum builds, exams elapse, and assessments start taking place, we begin to gauge our abilities and performance better. As “type A’s”, overachievers, competitors we start to get a taste for academic prowess — a high score on a test, a professor or colleague’s praise, a favorable assessment. Our choices start to become motivated by the gratifying feeling of success and our colleague’s admiration (Stage 2, 3). Still we are at the early stages of Kohlberg’s moral development scale, driven in alternatingly Pavlovian and fearful ways toward success. As the rigor of first year continues and concludes, we find we have automated ourselves to the rules and culture of the institution. Our lives have become structured around our exams and assessments. The knowledge that to stray from the course would be a threat to the success and factual regurgitation that is demanded of us requires that we ascribe to the rules of our environment (Stage 4). This is an easy place to reside as it requires no extracurricular thinking. I believe the developing medical student thinks themselves to be operating at the higher stages of Kohlberg’s moral development scheme (Stages 5, 6), basing their action on a higher moral theory or philosophy because for most of us (I would hope) that was our motivation to join medical school — some notion of justice, compassion, and empathy. But ultimately the relentless grind of modern day medical education, the perpetuation of a highly competitive and comparative environment, and the lack of emphasis on humanistic reflection and application keeps those who are unwilling (or unable) to exert the extracurricular philosophical or moral efforts of introspection tethered to the lower stages of moral development.48 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESCHICAGO MEDICAL SCHOOL 49
ALUMNI FEATURES50 ROSALIND FR ANKLIN UNIVERSITY
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