SYNAPSES A Creative Journal of Chicago Medical School VOLUME 2, SPRING 2018
Front cover: “Synapses,” artwork by Gloria Joo, CMS ’21 Artist’s Statement: Hand-sketched with a pen and colored with Adobe Photoshop. This is a playful interpretation 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, MS, MHA StudentGwendolyn Messer, MD, FAAP FacultyKaren O’Mara, DO FacultyAubrey Penney StaffHector Rasgado-Flores, PhD FacultySherwyn Warren, MD ’56 AlumnusREVIEW BOARDOmeed Ahadiat StudentSalvatore Aiello, MS StudentIbukunoluwa Araoye, MS StudentChristopher Collier StudentMatthew Cozzolino StudentAnna Dailey StudentMichael Drake StudentKaitlyn Egan StudentDiAna Elcan, MA StaffJessica Liang StudentMichelle Lim StudentJennifer Obrzydowski, MS StudentDaniella Sandoval StudentSwapna Shanmugavelayutham 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 The Road to a Calling Morgan Gilmour 10 11POETRY Open Door Policy Veronica Gross 12 13 These Tears W i l l i a m A g b o r B a i y e e 14 15 Does the soul linger Henry Del Rosario 16 17 The hospital seizes Henry Del Rosario 18 In the morning Henry Del Rosario When my needle Henry Del Rosario Inheritance A u b r e y P e n n e y There Will Be a Moment Jordan Swenson Cortical Neuronal Forest Maria Bompolaki 22 24 ART/ Artatomy E l i z a b e t h B o g g i o 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 32 Synapses Angela Wu We Build A n g e l a W u Joshua Tree M e l i s s a C h e n Kayak M e l i s s a C h e n 4 ROSALIND FRANKLIN UNIVERSITY
SYNAPSES CONTENTS Sunset M e l i s s a C h e n 32 33 Holy Perspective H u n t e r L a u n e r 34 36 Spirit Illuminated H u n t e r L a u n e r 37 38 Cadence P r a g a t i M a m t o r a 40 Soliloquy P r a g a t i M a m t o r a Lily Pond E l i e C r y s t a l Solar Eclipse D a l e B u c h b i n d e r In White J o h a n n a S t e c h e r 44 FICTION/ Legacy of Love Karen Black 47NON FICTION Moral Frameworks of the Swapna Shanmugavelayutham 50 Burgeoning Medical Student CMS and Me: A 50-Year David Forsted 55 Retrospective 58 ALUMNIRETROSPECTIVES 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. All ideas and opinions expressed belong to the authors. Credit for images on back cover and section dividers: iStock.6 ROSALIND FRANKLIN UNIVERSITY
SYNAPSESFROM THE EDITORIAL BOARDWe are delighted to present our second volume of Synapses, the creative journal of the Chicago MedicalSchool at Rosalind Franklin University of Medicine and Science. The works in this volume reflect thecreativity, imagination and passion of our community.Our journal is named for the components in the nervous system that form the connections betweenneurons and allow information to pass from one neuron to another. Synapses’ inspiration and purposeis rooted in this idea of connections — the connections between science and humanities, physicians andtheir patients, and the readers of this journal and the authors and artists who have shared their works withus. We hope that you enjoy this year’s collection of artwork, poetry and prose reflecting on the medicalprofession and the human experience.During this submission cycle, we invited the community to submit artworks to a special category: worksthat reflected a literal or artistic rendition of synapses. The whimsical work of art on the cover, by first-yearmedical student Gloria Joo, was in response to this request. Subsequent volumes will include this specialsubmission category, and each year one image will be chosen for the front cover of the journal.We acknowledge the dedication of our review, editorial and oversight boards to the development ofanother quality volume of Synapses. We thank all submitters for sending their creative works for reviewand congratulate the authors whose works are published in this volume. CHICAGO MEDICAL SCHOOL 7
POETRY8 ROSALIND FRANKLIN UNIVERSITY
SYNAPSESPOETRY CHICAGO MEDICAL SCHOOL 9
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.10 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES VERONICA GROSS, CMS ’18 Open Door Policy 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 11
POETRY WIL L IAM AG BO 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.12 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES HENRY DEL ROSARIO, MD ’14Does 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 limbsto 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 and CHICAGO MEDICAL SCHOOL 13
POETRY HENRY DEL ROSARIO, MD ’14 The hospital seizes 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 disagree14 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES HENRY DEL ROSARIO, MD ’14In the morning 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 wrinklesMy hand traces— your life gently ripples CHICAGO MEDICAL SCHOOL 15
POETRY HENRY DEL ROSARIO, MD ’14 When my needle 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 bolts16 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES AU B R E Y P E N N E Y, S TA F F InheritanceMy 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 diesand the legs splayed in goo are her didactic philosophy of art. From her I have the fear of breast cancer. Him: melanoma. CHICAGO MEDICAL SCHOOL 17
POETRY JORDAN SWENSON, CMS ’19 There 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.”18 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESCHICAGO MEDICAL SCHOOL 19
ART/ PHOTOGRAPHY20 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES ART/PHOTOGRAPHY CHICAGO MEDICAL SCHOOL 21
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 that22 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 23
ART ELIZABETH BOGGIO, CMS ’1824 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESArtatomyArtist’s Statement:This is a series ofsketches from my notesin medical school. Ikeep most of my art onInstagram to connectwith other artists inmedicine. Many of mydrawings and paintingswere done just prior orafter a surgery. CHICAGO MEDICAL SCHOOL 25
ART GLORIA JOO, CMS ’21 Synapse Artist’s Statement: Hand-sketched with a pen and colored with Adobe Photoshop. 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:Digital artwork.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 Synapses Artist’s Statement: Layering of two photos taken by my DSLR Nikon D3300 and edited by Polarr Photo Editor.28 ROSALIND FR ANKLIN UNIVERSITY
PHOTOGRAPHY SYNAPSES ANGELA WU, CMS ’18 We BuildArtist’s Statement:This was captured outside of my apartment. This is how icicles are formed — it startswith a few frozen droplets, and when it reaches a certain size, the drops begin todrip 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 toprogress, building on the hard work of those who have gone before us. 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
SYNAPSESHUNTER LAUNER, CMS ’20 Holy PerspectiveArtist’s Statement:Photo taken at the Kotel in the Old City of Jerusalem. Every praying Jew faces towardsthis point, t h e last re m ain in g wall (We ste r n Wa l l ) o f th e H o l y Te m p l e. Th e s e two p ray atthe closest point, yet choose different perspectives to obtain their ma’kom kodesh (HolySpace). CHICAGO MEDICAL SCHOOL 33
PHOTOGRAPHY HUNTER LAUNER, CMS ’2034 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 35
PHOTOGRAPHY PRAGATI MAMTORA, CMS ’19 Cadence Artist’s Statement: Finding beauty in the small things.36 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESPRAGATI MAMTORA, CMS ’19 SoliloquyArtist’s Statement:Nature teaches me to be flexible, calm, and resilient. By hiking, getting lost, andfinding my way back again I’ve found that I can find a solution to any problem thatlife 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 willfind your trail once again. CHICAGO MEDICAL SCHOOL 37
PHOTOGRAPHY ELIE CRYSTAL, RESIDENT Lily Pond38 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESArtist’s Statement:This image of the Alfred Caldwell Lily Pond in LincolnPark, Chicago, is an unaltered digital photographtaken on a Nikon Coolpix S6400 handheld digitalcamera.Among photos I’ve taken, this one might be uniquelyappropriate to demonstrate the interconnectionsbetween the humanities (psychology), art (thephotograph) and science (neuroscience). Thereflections of the trees in the pond were remarkablyclear that morning. When I processed the photo, itseemed to me that turning the photo 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 and intruded byvariously strange or magical looking lilies. The ‘sky’backdrop is both a reflection of the actual sky, butalso represents the penetrance of the daylight tothe floor of the pond. Finally, the very bottom of thephotograph shows a ghostly reflection of some rockson the edge of the pond and, then, actual terra firmaand a small stand of brush and flowers.The psychology in the photograph is in the playbetween the real and the distorted; in the coexistenceof two equally valid, though different, ‘truths’ orperceptions; and in the importance of perspective,especially regarding foreground and background.Analyzing this photograph is not dissimilar to whatI sometimes do as a psychiatrist in training. I meeta patient. He shares with me a snapshot of himselfat a given time, on a given day. Part of my job is toassimilate that which he presents to me and use thetools of the neuropsychiatric lexicon to pick out notonly symptoms, but strengths. Having done that,formulating a plan has a ground that is patient-centered, and can combine any number of modalities,including pharmacology, talk therapy, and others.The science in the photograph begins with the digitalcamera which captured the photo. If one inquires intothe mechanism of image capture used by the digitalcamera and then into the mechanism of image capturein roentgenography, computed tomography, magneticresonance, and photon emission tomography, one willhave gained a basic understanding of a fundamentalpart of modern medicine.Lastly, as the images of the world impinge on thelenses of our eyes, they are flipped on their heads asthey make their way to our retinas. We nonethelessperceive the world in its unflipped form through theaction of our intervening cerebrum. Our ‘vision’ ofothers, including patients, can be distorted in otherways, as well. We all accrue biases, prejudices, andpreconceived notions as time goes on. It takes theeffort of a conscious, conscientious, and attentivestudent or health care practitioner to notice whenthese accrued distortions impinge on our ability todo our jobs well. When this happens, we can take amental step back, refocus our lens, and try again. CHICAGO MEDICAL SCHOOL 39
PHOTOGRAPHY DALE BUCHBINDER, MD ’ 76 Solar Eclipse Artist’s Statement: Photo taken with a Nikon D500 with a 600mm lens. Thi s ph oto was t ake n in Te ton Vi l l a g e, Wyo m i n g , o n Au g u st 2 1 , 2 01 7. M y w i fe a n d I traveled to Wyoming to have a chance to see and photograph the solar eclipse — an event that doesn’t happen often. When not practicing Vascular Surgery my hobby is nature and wild-life photography.40 ROSALIND FR ANKLIN UNIVERSITY
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FICTION/ NON-FICTION42 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSES FICTION/NON-FICTION CHICAGO MEDICAL SCHOOL 43
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 for a double-shot espresso. “I don’t know, that’s the least of my concerns,” 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 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.44 ROSALIND FR ANKLIN UNIVERSITY
SYNAPSESJOHANNA STECHER, CMS ’21She excused herself from Roxie’s babbling 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. Truth be told, she would avoid these encounters altogether if shecould. Aside from the fact that this aneurysm had such a large fan following at seven in the morning,the tears being shed by these five people were ruining her high. Once she scrubbed herself sterile, thelacrimation would 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 45
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 theirquestions and then excused herself to get ready. She looked at her watch. Seven minutes. A new record.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 thefront of 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.46 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 at the age of twenty-seven, my mom had 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 mymiddle brother, Jeff, lived in Chicago. He and his family drove to Omaha while I flew in from Californiawith my husband and five kids in tow. When I was in medical school, Jeff was studying at the Universityof Chicago for his PhD. It was wonderful having him near me at the time; I love all my brothers dearly.However, for this gathering, I was particularly looking forward to seeing my youngest brother, Chris. Mydaughter, Sherry, currently attends Creighton University in Omaha and had grown very close to her uncle.He was there for her when she was transitioning as a freshman away from home and she enjoyed gettingtogether to talk with him about her college experiences. She saw him in May and told me at the time that“Uncle Chris didn’t look so good.” I had attributed it to stress from having a misbehaving eighteen-year-oldson; as a mother of teenagers, I thought I could help him or at least be an empathetic listener. He seemeddistracted the last time I talked to him on the phone, so when July 4th came around, I was keen on givinghim 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 for a Midwest summer, withheat, humidity and storm clouds in the distance. The kids were discussing all that they would be doing: asteak dinner, a golf tournament, outlet shopping, competitive card games, and just enjoying time with theircousins. Uncle Chris drove up to our row of cabins 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 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’t apatient’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 47
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 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 and a 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 brothers 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,48 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 soak in all the wonders. CHICAGO MEDICAL SCHOOL 49
NON-FICTION SWA P N A S H A N M U G AV E L AY U T H A M , C M S ’ 2 0 Moral Frameworks of the Burgeoning Medical Student As a second year medical student, I know I’ve only just begun my professional journey and that experiences that will change me, mature me, and mold me professionally and philosophically still lie ahead. When we start medical school, it can seem as if we are born anew. Inundated with 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 to this point are challenged by the rigor of our academic coursework and the demands of developing ourselves into rational, logical, efficient healthcare providers. So we are eventually pulled into the lower stages of moral reasoning, and under the current state of medical education — a state founded on reward and punishment, on shame, fear, and competition — I would argue we are kept there. Kohlberg’s theory of moral development states that there are six stages of morality. Stages 1 and 2 correspond to actions that are in avoidance of punishment and pursuit of reward, respectively. These are the pre-conventional stages. The middle stages (3 and 4) broaden the criteria of evaluating the morality of an action from solely individual to include social consensus. The highest stages of Kohlberg’s staging of moral development (5 and 6) call upon the individual to base their decision on abstract reasoning, ethical principles, and “higher” concepts such as justice, compassion and life. 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 “type A” 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” overachievers, competitors, we start to get a taste for academic triumph — 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 (Stages 2 and 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 eventually concludes, we find we have acclimated 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 the path of least resistance, as it requires no extracurricular thinking. I believe developing medical students think themselves to be operating at the higher stages of Kohlberg’s moral development scheme (Stages 5 and 6), basing their action on a higher moral theory or philosophy, because for most of us (I would hope) that was our primary motivation to be here — 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 emphasis50 ROSALIND FR ANKLIN UNIVERSITY
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