Harmony Magazine, Volume 7 (2005-2006)

V O L U M E
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A R I Z O N A
H E A L T H
S C I E N C E S
C E N T E R
M A G A Z I N E
O F
T H E
H U M A N I T I E S
Art Essays Ideas Photographs Poetry Prose
Ribbons 2
Mark Story
ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES Editor Katherine Glaser, M.F.A., M.P.H. Art Editor Lisa Goldman, M.S.W. Editorial Board Monica Gustafson Charity Jackson (Shad) Farshad Fani Marvasti Christina Menor, M.S. Faculty Advisor Helle Mathiasen, Cand. Mag., Ph.D. Advisory Board J. Lyle Bootman, Ph.D. James E. Dalen, M.D., M.P.H. Vincent A. Fulginiti, M.D. Marjorie A. Isenberg, D.N.Sc., R.N., FAAN Keith A. Joiner, M.D., M.P.H. Kenneth J. Ryan, M.D. G. Marie Swanson, Ph.D., M.P.H.
Harmony is a publication of the Arizona Health Sciences Center (AHSC). It is sponsored by The University of Arizona College of Medicine Medical Humanities Program, the Medical Student Government, and the Kenneth Hill Memorial Foundation as a gift for the community. All works in Harmony, both visual and literary, are the exclusive property of the artist or author and are published with her/his permission. Authors retain their copyright for all published materials. Any use or reproduction of these works requires the written consent of the author. Views expressed are solely the opinions of the individual authors and are not representative of the editors, advisory board, or the AHSC. For more information, please visit http://humanities.medicine.arizona.edu. Complete guidelines for subscriptions, donations, and submissions may be found in the back of this journal.
Cover Artwork: LaTanya Simone Cover Design: Roma Krebs, Biomedical Communications, AHSC
The University of Arizona is an EEO/AA - M/W/D/V Employer.
6 FOREWORD Christine Krikliwy 7 OPEN THE BOOK J. Laukes 7 A TREES REASON NOVEMBER MORNING Anonymous 8 GETTING IN Chloe Becca 8 KHONG PHAPENG WATERFALL, SEPARATING THE UPPER AND LOWER MEKONG RIVER, LAOS Kelly Sandburg 9 GRANDMOTHER CALLED A WHILE BACK Bruce Vaughn 9 UNTITLED John Racy 10 REFLECTIONS ON THOSE WHO DONATE THEIR BODIES Lisa Goldman 11 RETRATO Paula Marchionda 12 ODE TO MY UTERUS Gonzalo M. Sanchez 13 A NEUROSURGEONS ADVENTURE IN MEDICAL EGYPTOLOGY Charity Jackson 19 NO TURNING BACK NOW (Shad) Farshad Fani Marvasti and Quinn Synder 20 TO FULFILL OUR SACRED OATH Andy Gulbis 25 UNTITLED Marilyn S. Brodwick 25 GRANDMOTHER AND CHILD R. Dennis Bastron 26 SIR WILLIAM OSLER Kelly Sandburg 26 COURSE CHANGE Cliff Martin 27 UNTITLED Kelly Sandburg 27 STALINS BUNKER La Tanya Simone 28 HEALING BLOOD Christina Menor 28 RUNNING THROUGH Charles W. Putnam 29 NOT MUCH BLOOD, REALLY... Bruce Vaughn 33 UNTITLED
HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES
Anonymous 34 CALLING Anonymous 35 BLACK MARKET ORGANS UNDO THE DAMAGE Eva Shaw 36 EATING FROM THE INSIDE Chloe Becca 36 CITY OF HAVANA Ron Spark 37 NECKTIE ASSOCIATED IATROGENIC INFECTION? KNOT! Bruce Parks 38 ISCHEMIC HEART Keven Siegert 38 MOUNTANGULAR Mary Foote 39 EMPATHY Chloe Becca 39 YOUNG GIRL FROM THE VILLAGE OF HUEI THAMO, LAOS Lane P. Johnson 40 THE CHRISTMAS GIFT Norma J. Leslie 42 GRIEF Susan Ferguson 43 I REMEMBER LULA Dalila Ayoun 44 MAISON HIVER Sue Quigg 45 MOTHER Chloe Becca 45 FLOWER AFTER RAIN, ANTIGUA, GUATEMALA Dan Shapiro 46 ABLAZE Eve Wood 47 OUR CAPACITY TO HEAL: A MESSAGE OF HOPE Kelly Sandburg 48 HOPE Joel Meister 49 CROSSING THE LINE Nyle Hendrickson 52 MEDICINE BY HORSEBACK TEACHING ABOUT TUBERCULOSIS 53 GLOVEBALL Donald Sullivan 55 A REVIEW OF LIABILITY REFORMS SPELL RELIEF FOR TEXAS EMERGENCY PHYSICIANS PUBLISHED IN THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS NEWS, FEBRUARY 2005 Joe Scionti 55 BLACK CAYMAN HUNTING IN THE PERUVIAN RAIN FOREST Nyle Hendrickson 56 HAITIAN FISHERMAN 57 SAILBOAT
Anonymous 58 THE SYMPHONY Dalila Ayoun 58 TEMPLE Helle Mathiasen 59 LITERATURE AND MEDICINE: MOLIERE WAS NOT AN IMAGINARY INVALID Anne Welch 62 THE ARTIST Joe Scionti 62 MASTER CRAFTSMAN Paula Marchionda 63 THREE GENERATIONS AT THE GATE WATER CALLIGRAPHY, TEMPLE OF HEAVEN, BEIJING WATCHTOWER, GREAT WALL, BEIJING 64 ROCK WALL ICON, GUILIN ART INSTITUTE, GUILAN PEDI CABBING IN THE HUTONGS, BEIJING OUT FOR A WALK, GREAT WALL, BEIJING Joy Lippe 65 PERSPECTIVES ON PHYSICIANS Dalilia Ayoun 66 ALMAICIN Roger Tran 67 THE RESURRECTIONIST Christina Menor 67 LA ENTREVISTA Sarah Daniels 68 BAD NEWS Mark Mussari 69 KIERKEGAARD: IMPROVING MEDICAL PROFESSIONALISMONE PARABLE AT A TIME Christina Menor 70 TORMENTA Sren Kierkegaard 70 THE STORM Daniel Cucher 71 THE SPIRIT CATCHES YOU AND YOU ABANDON YOUR RESISTANCE TO MYSTICAL MEDICINE Jared Robbins 73 CHANGING PERSPECTIVES, IMPROVING CARE Kelly Sandberg 75 PERSONAL REVIEW OF ANNE FADIMANS THE SPIRIT CATCHES YOU AND YOU FALL DOWN Paula Marchionda 76 PRAYERS, JADE BUDDHA TEMPLE, SHANGHAI Allison Kleine 77 THE STUFFED CAT TABBY Patricia Stanley 78 ALYSSA NIKOLE ELISE Betsy LeRoy 79 DANDO EL PECHO
Chloe Becca 79 MOTHER AND HER TWO CHILDREN, VILLAGE NEAR KHONG PHAPENG WATERFALLS, LAOS 80 BABY IN MERCADO, ANTIGUA, GUATEMALA Nicky Teufel-Shone 81 LEARNING TO BE A TRADITIONAL NAVAJO WOMAN IN 2004 Jess LeBlanc 83 GROUNDED Vincent Fulginiti 84 KOOKABURRA Brooke Vezino 85 KNOWING US UNTITLED CHAPSTICK Chuck Gawad 85 INSIDE THE PYRAMID Jennifer Suriano 86 RUMI POEMS Chloe Becca 86 OLD CAPITOL Georgia Hall 87 AMERICAN INDIAN ELDERS: REFLECTIONS THE LAST SHEEP I HAVE LEFT, NAVAJO, 1974 88 I REMEMBER HOW MY GRANDMOTHER MADE POTTERY, TOHONO OODHAM, 1979 THE CHILDREN ARE GONE, WHITE MOUNTAIN APACHE, 1980 Michelle Morrison-Galle 89 BEAUTY 90 SOMEWHERE BETWEEN ROME AND POMPEII 91 IDEOLOGY 92 THE PAPAYA WARS Laila Halaby 93 A DAY AT THE PARK FEW DAYS BEFORE Kelly Sandburg 94 HITLERS VICTIMS Laila Halaby 95 DAY 4: THE IRAQ WAR, PENMANSHIP Ron Grant 96 THE OTHER SIDE OF THE CURTAIN Chloe Becca 99 SAINT PAUL S CATHEDRAL, SIDE ENTRANCE, LONDON Donna Swaim 100 MY REALITY Tessie OTalley 100 A HAIR-RAISING FUN TIME Marilyn S. Brodwick 101 BIRD LADY 102 CONTRIBUTORS Eskild Petersen 109 BUENOS AIRES NATIONAL WILDLIFE REFUGE Marilyn S. Brodwick 111 JAVANESE WOMAN
Harmony began as Hermes seven years ago. Hermes founders recognized that those working side by side in the hospital shared medical knowledge, but diverged in their lives outside the hospital. Those lives might be creative and that creativity a secret. Within these pages, the work of medical students shares pages with the work of students of public health, with the work of doctors, nurses, researchers, professors, and people working in all aspects of health care and education. There are thoughts on entering medicine and leaving it and the moments in between. Harmony is elusive. The headlines, the evening news, our national statistics regarding divorce reveal this daily. The work contained within this journal reects a struggle for harmony and toward harmony, in a world of discord. Years ago, I taught English in Malawi, Africa. Released from my post for a week, I headed north toward Zanzibar, the Spice Island, and its fabled beaches and exoticism with the language Kiswahili and a history tangling Africa with Sultans. To get the catamaran to Zanzibar, I had to go to Dar es Salaam, the capital of Tanzania, a city of about two million people. There, in a hotel catering to budget travelers, I met a Canadian whose parents had emigrated from India. The Canadian, a medical student studying in Ethiopia, was Sikh and invited me to the nightly meal at the Sikh temple. He explained that the temple offered food to anyone, without questions. He told me, though he had never been to this temple, that we would all sit on the oor, eating the same simple meal. What I know of Sikhism, I learned from this meal and from Michael Ondaatjes well-crafted Sikh sapper in The English Patient, but as I understood this, we were all equal in this place, and be we kings, queens, or paupers, we would eat together side by side.
In Harmony, I see us as equals in our experiences, whether we are students, professors, or tted best with any other title. The words of students of medicine struggling with the actions necessary in an anatomy lab, a medical examiner who sings country tunes, or a citizen angry about the warall those ideas have a place here. They come to the table equaland hungry. As one of my writing professors, Richard Jackson, said, No one knows more than any one else. We all know different. The poor grammar was intentional; he knew what he was saying. Here, the omission of the authors or artists title and degrees is intentional, leaving the reader to meet the poem, essay, or picture without preconceptions. In the National Museum of American Art, a sculpture of discarded items occupies two hundred square feet in its own room. This work is the Throne of the Third Heaven of the Nations Millennium General Assembly, work cobbled together by James Hampton, a janitor for the General Service Administration. He labored alone, his work only discovered upon his death in a warehouse that he rented near his home. In Harmony, we labor together, our voices and vision nding a safe haven in the discord.
Katherine Glaser Editor
Christine Krikliwy
OPEN THE BOOK

Transient, restless, homeless words sitting on a page patiently awaiting consumption Jump off the page Slide off the page Too heavy to lift sit silently on the page They are smart bombs help them explode Words depend upon the level of absorption They can be constructive, and extremely destructive They can be digested Excreting all or none Resulting in verbal diarrhea Words enter through the occipital lobe await regurgitation Others lodge in the temporal lobe searching for a home Those scrambling in the frontal lobe may never nd a home Dont be afraid Open the book Let the words embrace you Help them nd a home
J. Laukes
A TREES REASON
If a tree could grow forever it might never shed a leaf as each branch remembers soil we cling to our beliefs as this night will nd tomorrow the sky reveals stars. with the warming earth beneath, your touch runs deep and far in a slowly turning whirlwind hear the rocks and trees reply if we never give our love away there is no reason why
November Morning
J. Laukes 7
Anonymous
GETTING IN
The inbox was vacant for weeks now. Email has enhanced and estranged the way we communicate with one another. But can it communicate my future? I am not talking about psychic epiphanies or clairvoyant musings. I am simply asking if email can carry a message to me that unfurls the uncertain path before me. A message, perhaps it could even be called a secret. Yes, a life-altering secret still conned to the abstract ethers of the Internet. This supreme importance casts email in a new light. This thing, this notion that delivers me these prophesies now transcends the software used to create it; it takes on form and shape, eerily human like, perhaps god-like? I pray to email every night to deliver me this secret. I also pray to email that it is the secret I want to hear. Prayers unanswered. Inbox still vacant. I checked it regularly, or was it religiously, to see what the deity Email had conveyed. Nothing. I knew she would change my life. I was a true believer. But in what way? And when? ...You have one new message. She has spoken. All this waiting, but now am I ready to hear? I am not ready. I get cold feet. But I have been ready for so long. She will decide my fate. No she wont. I am a solipsist only I am real. But what if the message is what I want to hear, then will I believe. No, I am an existentialisther words mean nothing, I am in charge of my destiny. Falter, Disintegration, Failure. I crack under pressure. I believe again. I have faith. I will open it, now... It is our distinct pleasure... She has spoken; it is what I wanted to hear. Conrmation, Salvation. A tiny particle of water lies dormant in the ocean. It begins to move. The movement provokes movement of his neighbors, and water is in motion. Movement, motion, momentum. Are they all the same? Where will this wave go? Will it have an effect? Of course. A wave building upon itself, gathering energy, gathering lifelearning, creating, destroying, living. The wave grows, swells, breathes, laughs, sighs...moves. Where is it moving? It will meet the shore. Will it greet it with a gentle ripple, or punish it with a mighty blow? Both are good. Both could happen. How will we nd out? It is a big wave, moving in... A tear. It is our distinct pleasure...
Khong Phapeng Waterfall, Separating the Upper and Lower Mekong River, Laos Chloe Becca
Kelly Sandburg
GRANDMOTHER CALLED A WHILE BACK

She asked how medical school was going. I told her about it. She asked about anatomy lab. I told her. She said she had an old neighbor friend whose husband died and she allowed him to donate his body to science and they came and took his body away the same day he died, no funeral or mourning at all. Grandmas friend took it hard. She wonders if she dreamed up her rm decision (with ambiguous antecedent). I tell her that my experience with cadavers has been so helpful in understanding the geography of the body. I tell her many of my classmates spend dozens of hours every week with them and clarify how these former people have died. I wonder if she believes me. Or rather, if she believes
my intentions of
telling her all this.
Untitled
Bruce Vaughn 9
John Racy
REFLECTIONS ON THOSE WHO DONATE THEIR BODIES

Donor Memorial Service January 20,2005
As we honor the memory of those who have donated their bodies to scientic study and the education of future physicians, it may be wise to note how recent this phenomenon is. I do not know the exact history of such donation, but it cannot be much more than a century old. Yet, the study of the human body has been at the heart of medical training since ancient times. We stand in debt to all those brave (and sometimes foolish) pioneers who dared to look into the human body after death, when such activity was considered a sacrilege. We note the pioneering contributions of Vesalius, Michelangelo and Leonardo de Vinci, among many. As recently as the 19th century, medical schools relied on the services of body snatchers to acquire corpses for dissection. On a recent trip to Edinburgh, Scotland, we drove by the cemetery from which many such bodies were snatched at night. In time, the citizens became so enraged that they placed armed guards in towers around the cemetery to prevent the activity. The guard towers may still be viewed today. Foiled in their effort to dig up bodies from the cemetery, two enterprising Scotsmen, William Burke and William Hare, proceeded to nd their own. They waylaid and murdered homeless and helpless wanderers of the night and sold their bodies to the medical school. The authorities nally caught up with them, but the evidence for prosecution was weak. Eventually, one (perhaps it was Burke), betrayed his partner, who was promptly condemned and hanged. Burke was rewarded with his freedom. It has been well over half a century since I had my rst encounter with a cadaver at the American University of Beiruts School of Medicine. Yet, the memory remains vivid to this day. In a word, my response and that of my Anatomy table partners was shock. We dealt with it by laughing. For weeks on end, we laughed more than we ever had or have since, and at the most insignicant happenings. Not long after we started the dissection, I dreamt that I was a cadaver being dissected. The process of dissection is a difcult task, as well you know. The human body is not always beautiful, and the contents of its organs are sometimes hard to contemplate. Further, what one is looking at is never as clear and distinct as it is in Netters illustrations, and no dissection is ever as clean as one performed by Norm Koelling. The profound impact of the cadaver and its dissection comes from confrontation with mortality, day after day, without the freedom to look away. Yet another shocker was in store: the immense volume of information to be learned. Academically, I had led a charmed life. I was the youngest member of my class until I entered medical school and was routinely at the top in grades. Anything less than an A was cause for alarm. I recall that my aunt and I stole and faked a term report with As, Bs and Cs and showed it to Mother, so we could amuse ourselves by watching her response. In College, I attended seriously to the courses as I was taking them, studied the evening before tests, and aced them. I approached Anatomy (then a year long course), with the same plan. I did notice that a number of other students were staying up late at night reviewing for weeks ahead of the test. But I did my usual thing, and by 10 PM on the evening before the test, I had managed to review osteologythe bones. Yet to be covered were the vascular system,
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the muscles and several organs. Panic set in. I sought the counsel of Avedis Katchadourian, a fourth year student (to a rst year student facing disaster, a fourth year student is next to God). He gave me two pieces of advice (both questionable, in retrospect): 1. Review the heart. When they see you are in trouble [he was referring to the oral examination], they will ask you about the heart. If you answer correctly, they will let you stay. 2. Get some sleep. I told him that I could not sleep. He said that I should lie down and shut my eyes, and that was as good as sleep. I believed him and did as I was told. Next morning, we were all gathered in a classroom adjoining the Anatomy lab. We were admitted alphabetically one by one, to be examined at the dissection table, and dismissed through another door. Those of us waiting had no idea what had happened to our predecessors. I do not recall greater anxiety than I experienced during the wait or greater irritation that my name came so late in the alphabet. What I, and others, faced was the prospect of failure. Only, for me (and some others) that was a totally novel experience. We had successfully denied the reality of death, young, healthy and condent as we were, and even laughed in its presence. Now, it stalked us and shook us to our roots through a fear that a student can understand and cannot deny: failure. In the event, I ended up with a C in Anatomy for the rst semesterbarely passing. It was a lesson in humility I have not forgotten and a reminder of the treacherous and hazardous attachment to grades than can afict the best and the brightest. All medical students confront their own version of mortality through their work with the cadaver. It is truly a rite of passage which goes far in shaping their identity as physicians. In recognizing the altruism of those who donate their bodies, we recognize their immense contribution to what we learn, but even more, to what we become.
Retrato
Lisa Goldman
11
Paula Marchionda
ODE TO MY UTERUS
12
Gonzalo M. Sanchez
A NEUROSURGEONS ADVENTURE IN MEDICAL EGYPTOLOGY

Direct involvement in medical Egyptology began appreciation of it changed as my professional for me in 1996, but my interest in the subject life experience transformed me, from student to goes back to 1965, during my rst year residency teacher, then back to student of our medical past. at New York University when I was exposed Attempting to grasp the enormity of time that to a short article on the Edwin Smith Papyrus separates us, I envision what it would have been appearing in a publication entitled: Classics in like to be a physician at the beginning of recorded Neurosurgery. This papyrus was purchased in history, to witness a time when human acts, 1862 by Edwin Smith, an American living in medical concepts, and technical skills were being Luxor. Having enough knowledge of the hieratic translated into practical realities and transmitted script (an abbreviated form of hieroglyphic in writing. This was the beginning of the long writing) in technical which the development papyrus was of medicine. written, Smith As evident in recognized the medical its value papyri, the but was not physicians able to make hieroglyphs progress in its in ancient translation. Egypt After the accumulated document was and recorded donated to their clinical the New York experiences Academy of along Sciences by Figure 1 Hieroglyphic text reads from right to left. with their Edwin Smiths concepts of daughter, anatomy and physiology (i.e., descriptions of the this institution asked the Director of The Oriental brain, the cerebrospinal uid, the pulse). P. Smith Institute at the University of Chicago, James Henry proves that it was the physicians of ancient Egypt Breasted to translate it. After ten years, Breasted who established the clinical methodology still in completed this titanic feat and published it as The 1 use (mistakenly attributed to Hippocrates) and Edwin Smith Surgical Papyrus in 1930, and, in who began classication of diseases by singling doing so, he gifted the world and medicine with the out groups of symptoms and signs, matching them earliest and most scientically important medical to a variety of observed outcomes. For extensive document known to date. This treatise is a teaching information about medicine in Ancient Egypt, text devoted to trauma. It contains 48 clinical I would refer you to the following sources.2 Of entities that are topographically structured from utmost importance, the Edwin Smith Papyrus the head down, arranged by progressing severity of stresses humanistic concepts expressed in the injury, and individually studied in the same manner manner in which the teacher instructs the pupil to we currently do in our medical schools and our continue the patients treatments: a) until recovery, daily practice. b) until the period of his injury passes by, or c) you My curiosity about this document turned to major know if he will live or die. Beyond this, the teacher interest, and then evolved to admiration. My admonishes his student in a case of a severe head
13
injury with poor course: Undertake him; do not desert him because of weakness.3 (g # 1) Similar recommendations are given in Ebers Papyrus, paragraph 200.4 As a fellow practitioner, my identication with the author of the Edwin Smith papyrus becomes interactive, drawing on my medical experience in the process of study and discovery, while immersing myself into his thinking process, attempting to understand it, not putting words in the ancient physicians mouth to conform to my preconceived hypothesis, but not taking them away either when the clear purpose of the author-teacher was documentation and knowledge transmission. I have followed the same investigational methodology in the analysis of sections of Papyrus Ebers, Brooklyn, and Kahun, and in the study of the battle injuries depicted in the battle Reliefs of King Sety I, at the temple of Karnak, and in Ramesses IIs Reliefs of the Battle of Kadesh in Upper Egypt and Nubia. Before addressing some of the most interesting facts I have encountered in my Egyptology adventure, I must add further personal background. My neurosurgical training in New York was followed by 28 years of active surgical practice, rst at the National Neurological Institute and the Childrens Hospital in Mexico City, then in the U.S. Army Medical Corps during the Viet Nam War, serving as Lieutenant Colonel and Chief of Neurosurgery at Brooke Army Medical Center, and then by 23 years of private practice in South Dakota University afliation. Through these years my contact with the Smith Papyrus remained sporadic, my interest and curiosity deepening in proportion to my frustration at my inability to understand Egyptian hieroglyphs and lack of time to study. Then, in the spring of 1996, arthritis in my hands resulted in my premature neurosurgical retirement. As disrupting as an event of this nature is, it allowed me to have the time to immerse myself into Egyptian History, Hieroglyphs, and Ancient Egypts Medicine. I undertook these studies through courses (noncredit) offered by The Oriental Institute of the University of Chicago, working on the Egyptian medical texts on my own. These learning experiences were coupled with visits to Egypt, allowing me to pursue my own research into
Egypts New Kingdom Battle Reliefs, beginning my own adventure into medical Egyptology. Scholarly work on various medical papyri produced ndings, presentations and publications on the following subjects:
I THE MEDICAL PAPYRI

1 Edwin Smith Papyrus. A detailed revision of this document has been my main focus, arriving at the following conclusions: a) Case # 7, Head Injury complicated by Tetanus Infection. The puzzle was not coming together; it was 2 AM after having worked on this section of the Edwin Smith papyrus for weeks, getting nowhere. It was a 3,550 year old puzzle I was busy with, and it was in hieroglyphs. Most parts have been brilliantly put together by Henry Breasted,5 other parts by Thierry Bardinet.6 The puzzle referred to Case # 7, a head injury with a compound skull fracture to the Frontal area, penetrating the air sinus. The patients initial condition included symptoms and ndings that we interpret now as indicative of basal skull fracture and meningismus. Then, the case evolves in two possible directions. In the rst, the patient is showing signs of a fatal infectious complication. In the second, the injured patient appears to be following a long-drawn, but more benign course. This much was clear, but the remaining pieces of the puzzle did not seem to t grammatically, or clinically, and the yet untranslated word tiA kept repeating medical usage, tiA could be related to trismus, the characteristic jaw contraction and baring of the teeth seen in tetanus. The multiple appearances of this word did not t with a single meaning, remaining a problematic part of the puzzle. As my computer screens were turning off, a screen saver with an old painting from Parke Daviss collection of medical illustrations from the 1940s popped up. It showed an Egyptian physician (or swnw) examining and treating a patient. This unexpected apparition, catching me in a drowsy state, had the effect of someone touching my shoulder saying: this text was written by a physician like you, think as one! I did. That very night the puzzle was completed. Medically it t perfectly, and also grammatically,
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as one of my Egyptology friends at the Oriental Institute informed me. The infectious complication consisted of febrile symptoms and symptoms of cephalic tetanus: trismus, opistotonus, Bells palsy and risus sardonicus. The word tiA in our text applied to both, trismus as a symptom, and to the designation of the complication of tetanus as a syndrome, just like the word lockjaw used in the English language.8 b) The Third Verdict An Illness Not To Be Treated9
severe cases. Yet, in other cases this verdict meant exactly what it said. A case might not necessarily be fatal, just not amenable to successful treatment, such as case 24, a multiple comminuted jaw fracture. c) P. Smith Case # 21 is temporal bone fracture with basilar skull fracture and a peculiar symptom described as and it is painful when he hears speech, because of it. This is a remarkable clinical observation of what we understand now as an intramastoid injury to the Facial nerve Stapedious branch. It is obvious that the ancient physician did not know the physiopathology, or even the detailed anatomy of the inner ear, but his accuracy in recording it as important clinically is remarkable. It also illustrates Breasteds comment regarding the Egyptian physician: I also noticed his sense of obligation to record ndings, tests, results or lack of, all for what we now consider scientic purposes.
This verdict appears exclusively in the Edwin Smith Papyrus. It is one of three options given by the ancient Egyptian physician indicating his specic course of action. Appearing in 14 cases, verdict # 3 was associated by Breasted with fatal outcomes, and it has been equated to our current phraseology used in triage of mass casualties. However, in contrast with the nality inherent to a triage verdict, many of the fourteen cases in the P. Smith containing this opinion are Figure 2 Edwin Smith Papyrus Three Verdicts. Text followed by varied 2 Ebers Papyrus reads from right to left. forms of therapy. Paragraph # 273 Moreover, the translation of mr n iriw ny (g # 2) should be: An This case is part of the last group in P. Ebers, illness for which nothing can be done,10 rather thought to be tumors or growths. The clinical than An illness not to be treated. These similar ndings in it include multiple surface and deep phrases express a verdict based on analytical tumors in limbs, which produce snake-like objectivity and the realistic acknowledgement deformities, without appreciable movement in of medical and surgical limitations, but their them, and which would be injured/produce pain by differences carry signicant implications. It is not physically striking them. Some of the surface skin an opinion discarding the patient as untreatable, lesions are described as if being inated by air. but, in line with the rationale of P. Smith and its In contrast with the preceding case #872 which early scientic nature, it implies openness, in the appears to be an aneurysm in a limb and with case ancient physicians mind, to further observation. #876, which suggests clusters of varicosities or an Instead of the abandonment of a triage verdict, it arterio-venous malformation, our case 873 does often recommends implementation of therapeutic not have pulsations, and should not be treated by measures, proven to be helpful in similar, but less the hot (cautery) iron, used in #872 and #876. All
15
of these features suggest case # 873 to be a case of Neurobromatosis I.11
3 Brooklyn Papyrus # 28
The Brooklyn Papyrus12 deals objectively and rationally with snake bites. One example is extreme accuracy in the description of the Sahara Horned Viper Cerastes cerastes, description of its bite, effects in humans and infrequent fatalities in this document, perfectly comparable to modern description of all of these features in modern Herpetology texts.13
experiences of such trauma. In the sub-category comprising 20 individuals involving injuries of the head, neck and limbs, all but two were found to be appropriate representations. One illustrative case is the Shasu soldier (g # 3) with chest and right upper extremity injuries I have determined to be a possible rst depiction of a peripheral (radial) nerve injury. I do not imply that the Egyptians in the New Kingdom possessed the level of knowledge about the nervous system that we have in the 21st century. It is evident, however, that their high level of clinical experience with trauma of the head and spine, their , observational skills, their battleeld experience, and their ability to represent the human body, all contributed to sufcient accuracy in these battle reliefs to allow us to make medical assessment.
II BATTLE RELIEFS
1 King Sety I
The Battle Reliefs of King Sety I at the temple of Karnak, Thebes, depict injuries sustained by 122 enemy soldiers.14 As injuries that involved the head, neck or limb would necessarily have neurological consequences, I studied individual reliefs.
The depiction of injuries, in particular those of neurological signicance, I found to be appropriate and consistent with our current understanding and
Figure 3 From the Battle Reliefs of King Sety I. NE wall, Hypostyle Hall. Temple of Karnak, Luxor, Egypt. Notice wrist drop due to radial nerve injury.
2 Ramesses II
A similar study was carried out in medical evaluation of 345 Hittite soldiers from the Battle of Kadesh
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reliefs at the temples of Luxor, the Ramesseum, and Abu Simbel.15 The type and location of their injuries were found consistent with contemporary weaponry and military tactics in offensive and defensive military actions. The degree of medical accuracy observed in the analysis of injuries depicted in the Battle of Kadesh reliefs is in agreement with Ramesses IIs requirement of precision in all matters represented, singling it out as a concrete historical event with major religious implications. Of particular interest in this study are ndings of a head arrow injury in a Hittite charioteer shown that produces typical Descerebrate Posturing (g # 4) and an example of a Figure 4 Battle of Kadesh Reliefs. Ramesseum Temple, Western hematoma of Thebes, Luxor, Egypt. Descerebrate posturing exhibited by charioteer the abdominal with an arrow head wound. Compare with example. soft tissues, depicted in a soldier at the Temple of Luxor (g # 5) with accurate details of soft tissue dissection limited by rib-cage muscular attachments. These are some examples, medical jewels and vignettes which I have encountered in my ongoing adventure in medical Egyptology. I have been privileged to be accepted and supported by both disciplines in my endeavors, publishing, speaking nationally and abroad, and recently, participating in two National Geographic Television productions related to medical issues in Ancient Egypt. Along with Egyptology, I am in the process of doing a full revision and update of Papyrus Smith.
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ENDNOTES
1 2
J.H. Breasted. The Edwin Smith Surgical Papyrus. The University of Chicago Press. Chicago, (1930).
Westendorf W. Handbuch der altgyptischen Medizin. Brill Leiden (1999); Bardinet T. Les Papyrus Mdicaux de LEgypte Pharainique. Fayard Lyon (1995); Lefebvre G. La Mdicine gyptienne de Lpoque Pharaonique. Presses Universitaires de France. Paris (1956); Ghalioungui P. Magic and Medicine in Ancient Egypt. Hodder and Stoughton, London (1963); Estes, J.W. The Medical Skills of Ancient Egypt. Science History Publications, Canton MA (1993); Nunn J.F. Ancient Egyptian Medicine. University of Oklahoma Press (1996). J.H. Breasted. The Edwin Smith Surgical Papyrus. The University of Chicago Press. Chicago, (1930). Case # 7, Gloss J, 199.
3
H.Grapow. Die Medizinischen Texte in Hiroglyphischer Umschreibung Autographiert. Akademie Verlag, Berlin (1958), Eb. 200, 159-160.
4
Breasted. The Edwin Smith Surgical Papyrus. (1930), 49.

5
Bardinet, T. Dents et Mchoires dans les Reprsenations Religeuses et la Pratique Mdicale de Lgypte Ancienne. Editrice Ponticio Istituto Biblico. Roma (1990), 162-188.
6
C.B.Courville, in Injuries to the Skull and Brain in Ancient Egypt Bulletin of the Los Angeles Neurological Society (1949) 14,46. Nunn, Ancient Egyptian Medicine. 75, 181-182. Bardinet, Dents et Mchoires, 166186. Ghalioungui, Magic and Medicine, 62. Lefebvre, La Mdicine gyptienne, 183-184. R.L. Miller Tetanus after Cranial Trauma in Ancient Egypt. J. Neurol Neurosurg Psychiatry. (1997) 63 (6), 758. P.H. Chapman Case Seven of the Edwin Smith Surgical papyrus. JARCE (1992) 35-42.
7
G. M. Sanchez. Tetanus in the Medical Papyrus of Ancient Egypt: Identication of the Disease in Remote Antiquity. Given at the Annual Meeting of the American Research Center in Egypt Brown University, Providence R.I. April 28, 2001.
8
Breasted, The Edwin Smith Surgical Papyrus, 64,47.

9
G. Sanchez. An Ailment not to be Treated : The Third Verdict in the Edwin Smith Papyrus. Given at the Annual Meeting of the American Research Center in Egypt, The University of Arizona, April 16, 2004.
10
G.M.Sanchez and Siuda T. Ebers Papyrus Case #873: A Probable Case of Neurobromatosis 1 South Dakota Journal of Medicine 55,12, (2002) 529-534.
11 12
Figure 5 Double arrow injury in soldier # 28. Neck wound identied, but abdominal wound was clearly seen after high contrast photography. Note shape of the hematoma by the arrow, with limited upward expansion, indicative of its deep muscular abdominal origin.
S. Sauneron. Un Trait gyptien dOphiologie. LInstitut Franais dArcheologie Orientale, Cairo (1989), 25,26.
13 14
S. Spawls, B. Branch.The Dangerous Snakes of Africa (1995), 121-123.
G. M. Sanchez. A Neurosurgeons View of the Battle Reliefs of King Sety I : Aspects of Neurological Importance JARCEXXXVII (2000), 143. G.M. Sanchez. Injuries in the Battle of Kadesh. Given at the Annual Meeting of the American Research Center in Egypt. The Johns Hopkins University, Baltimore MD. April 28, 2002.
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Charity Jackson
NO TURNING BACK NOW

A summary of the rst semester of medical school
Oh, the leg bones connected to the...hip bone. I think everyone is aware the body is more complex than this. The process of becoming a physician entails realizing how complex things truly are and understanding the hows and whys of it. Isnt that what sets us apart from the rest of societythe ability to view the body in all of its complexities and make sense of it enough to protect it, to heal it? And to have others trust us to do so? I have recently completed my rst semester of medical school and my life has changed forever. For good, for bad...forever. Never again will I look at the human form in the same way. I will always see through the outer esh to the muscles working and blood pumping beneath the surface. I know what its like to slice skin and peel fat; to feel the strength of a tendon and the fragility of a blood vessel. Never again will I look at a person without picturing what is underneath. I look at death differently. I have seen the ravages of sickness on the body and wonder if it isnt worse than the Great Unknown of death. Perhaps it is simply my youth that allows me to think so. I view knowledge differently. It has always been a tool, but now it is becoming a life-saving one. The more I know, the more I can help; the more I can do. It is only now that Ive begun to put two and two together with everyday occurrencesto look at my grandfathers nger and know why it doesnt bend properly, or at my little brothers cheeks and know why they ush when he plays. It is budding knowledge that fuels me onward. But it is this insignicant amount of knowledge that frustrates me, for I speak to patients and know nothing of their illnesses. I have stacks of notes and piles of books, yet still have few answers at my ngertips. I have come far and yet have a seemingly insurmountable distance to go. How is it possible to know all that is necessary to make a diagnosis, to heal what you nd? Yet I know that it is possible, for thousands have gained such knowledge before me and use that information every day to better the lives of those around them. Knowing this instills both condence and hope within me that someday, I, too, will hold such kernels of wisdom close to my heart.
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(Shad) Farshad Fani Marvasti and Quinn Synder
TO FULFILL OUR SACRED OATH

A Survey Of The UA COM Classes Of 2007 & 2008
After years of ignoring or repressing our diversity, we have come to acknowledge that differences exist among people and that they can be a source of enrichment to our personal and professional lives. For professionals in most elds, simply tolerating differences is sufcient. Moving well beyond tolerance, physicians must strive to understand and embrace differences in a manner that would be uncomfortable for most people. This understanding is much more than simple cultural competency or political correctness. It is a form of genuine acceptance that allows us to serve all of humanity with equal diligence and compassion. The purpose of this survey is to provide us with a window into our profession, into ourselves. By sharing our differences and realizing the importance of having an opinion on the issues raised in this survey, we will be better equipped to meet the needs of our patients who will come from every background imaginable. When we learn to articulate our personal values by engaging in a dialogue with each other about our differing views, we will be able to truly accept the reality of differences among us as colleagues and ultimately among all of us as human beings, patients or doctors. The survey you are about to read was created by and for the students of the classes of 2007 and 2008 at The University of Arizona College of Medicine. We asked ourselves as students what we wanted to know about ourselves. This generated the questions on the survey. We also asked ourselves what we wanted to know with respect to correlations of specic responses from our classmates. This generated the correlations that we gladly share with you here. As we all know, statistics can be dangerous if taken out of context. Therefore, we ask that you exercise caution in your attempts to draw larger conclusions from the results. Nonetheless, our hope is that this will lead to many fruitful conversations about differing values, ideals, and lifestyles. Ultimately, this dialogue will enable us to fulll our professional oath to care without prejudice for every human being we encounter in any setting and at any time throughout our lives. We wish to thank everyone who was involved with the preparation of this survey, particularly Charlie Morrow, and also Harmony for giving us this opportunity to share a selection of our results with a larger audience.
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Survey of UACOM Classes 2007 and 2008 2007 and 2008 Combined Results [n=149]
Circle your class: [n=147] Circle your sex: [n=148] 07 53% M 41% 08 47% F 59%
On Doctoring In the following situations I would either provide care (Y), not provide care and not refer (N), refer the patient to another doctor assuming someone else will provide care (R): Y N R Homosexual Patient [n=149] 98% 1% 1% Patient addicted to illegal drugs [n=149] 97% 1% 2% Woman asking for abortion [n=149] 47% 11% 42% Physician-assisted suicide (if legal and appropriate) [n=146] 50% 16% 34% When I grow up, I want to go into ____________________ (write in your intended specialty) [n=149] #1 Dont Know/No answer 41 (results in # people, not %) #2 Emergency 18 #3 (tie) Family 16 #3 (tie) Peds 16 #5 Surgery 12 Circle the setting where you wish to work: Rural [n=146] 5% Urban 38% Suburban 11% Y 73% Mixture 46% N 27%
Do you intend to incorporate integrative/complementary/alternative medicine into your practice?............................................................[n=143] Family Circle the terms that apply to you: rstborn middle child youngest child only child (twin) [n=145] 44% 15% 29% 10% 1% married in a relationship single divorced [n=133] 28% 44% 28% 1% Do you feel that you have a functional family?.....................................[n=149] Are your birth parents still married?....................................................[n=149]
Y 87% 72%
N 13% 28%
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Religion Y N Do you consider yourself to be religious?...........................................[n=149] 48% 52% Do you consider yourself to be spiritual?............................................[n=149] 82% 18% Do you meditate? (if so, how often?)..................................................[n=148] 32% 68% Avg = 0.95 times/wk Mode = 0 How often do you attend religious services? Never 1-2/year 1/month weekly >1/week [n=147] 27% 38% 15% 17% 3% Drugs Have you ever been or are you currently addicted to a drug (incl. EtOH and cigarettes)?................................................................[n=145] How many cigarettes do you smoke per week? [n=137] Y 19% N 81%
Avg = 1.2 Avg among smokers = 12% Smoking = 10% Not drinking = 23% Mode = 0
How many alcoholic beverages do you consume per week? [n=138] Avg = 2.8%
Lifestyle How many times per week do you eat fast food? [n=148] Avg = 1.6 % Not eating = 24% Mode = 1 How many times per week do you exercise? [n=148] Avg = 3.4% Not exercising = 7% Mode = 3 How many hours a day do you take for yourself? [n=146] Avg = 2.5 Mode = 3 How many nights a week do you get enough sleep? [n=149] Avg = 3.9% w/0 nights = 7% w/7 nights = 15% Mode = 2 How much time do you spend outside each day (mins or hrs)? [n=147] Avg = 62 Mode = 60 Y N Do you spend enough time outside?[n=148] 9% 91% Healthcare and Politics Healthcare is a: [n=144] I consider myself to be: [n=149] In the last election, I voted for: [n=146] right 85% Pro-Choice 70% Bush 29% privilege 15% Pro-Life 23% Kerry 60%
Undecided 7% Other 3% Worse 38% 36%
Did not vote 8% Same 26% 23%
Better Compared to today, the future for physicians will be: [n=144] 36% Compared to today, the future for patients will be: [n=146] 41% 22
Do you feel up to date on current events?...[n=148] Do physicians have a duty to be active in the community?[n=149] Do you believe in the death penalty?.......[n=139] Do you believe direct to consumer advertising by pharmaceutical companies is appropriate?..................................[n=144] Do you believe for-prot healthcare is appropriate?[n=142]
Y 59% 75% 55% 25% 44%
N 41% 25% 45% 75% 56%
In my opinion, I would describe the current American healthcare system as: Excellent Adequate/Satisfactory Inadequate Beyond repair (we need a new system) [n=146] 2% 14% 60% 23% Discrimination: Have you ever been the victim of discrimination?[n=148] Do you believe racism is a problem in America today?[n=148] Do you believe sexism is a problem in America today?....[n=148] Do you support increasing minority representation in medicine (e.g. Afrmative Action)?........................................................................[n=143] Travel Do you have a passport?........[n=149] Have you traveled outside Arizona?[n=149] Have you traveled outside the U.S.?...[n=149] Have you traveled outside North America?.[n=149] Y 61% 89% 89% 54% Y 86% 100% 98% 88% N 39% 11% 11% 46% N 14% 0% 2% 12%
Medical School and me Medical school has had a positive(+), negative(-), or neutral(x) effect on the following aspects of my life: + x N/A Myself [n=149] 72% 9% 19% Friendships [n=149] 45% 36% 19% Familial relationships [n=149] 32% 25% 44% Sex life [n=147] 11% 46% 43% Signicant other [n=149] 16% 35% 28% 21% Children [n=147] 1% 8% 12% 80% Religious/Spiritual [n=148] 22% 24% 28% 26% Have you ever considered dropping out of medical school?[n=149] Have you ever wished you had chosen a different career?...[n=149] How concerned are you about being in debt? Not concerned 1 2 3 4 5 Very Concerned [n=149] 28% 19% 20% 15% 18% Y 34% 31% N 66% 69%
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Selected Correlations
Of the 24 people who considered the healthcare system to be excellent or adequate or satisfactory 22 were in favor of for-prot healthcare, 2 were not 12 believed healthcare is a right, 11 said it was a privilege, 1 did not respond 12 were in favor of direct to consumer advertising, 11 were not, 1 did not respond 6 believed the future will be better for doctors, 13 said worse, 3 said same, 2 did not respond 13 believed the future will be better for patients, 7 said worse, 4 said same Of the 122 people who considered the healthcare system to be inadequate or beyond repair 40 were in favor of for-prot healthcare, 76 were not, 6 did not respond 108 believed healthcare is a right, 10 said it was a privilege, 4 did not respond 24 were in favor of direct to consumer advertising, 76 were not, 6 did not respond 44 believed the future will be better for doctors, 40 said worse, 35 said same, 3 did not respond 44 believed the future will be better for patients, 46 said worse, 29 said same, 3 did not respond Of the 11 people who do not exercise 11 eat fast food, averaging 1.8 meals a week 10 do not smoke, 1 smokes a pack a day Of the 26 people who smoke 25 exercise, 1 does not Of the 122 people who considered themselves to be spiritual 67 considered themselves to be religious, 55 do not 40 voted Bush, 67 voted Kerry, 3 voted Other, 10 did not vote, 2 did not respond Of the 71 people who considered themselves to be religious 67 considered themselves to be spiritual, 4 did not 31 voted Bush, 30 voted Kerry, 3 voted Other, 6 did not vote Of the 35 people who were pro-life 24 were pro death penalty, 8 were anti death penalty, 3 did not respond 29 were religious, 6 were not religious 23 voted Bush, 5 voted Kerry, 3 voted Other, 3 did not vote, 1 did not respond Of the 104 people who were pro-choice 49 were anti death penalty, 51 were pro death penalty, 4 did not respond 37 were religious, 67 were not religious 17 voted Bush, 76 voted Kerry, 1 voted Other, 8 did not vote, 2 did not respond Of the 91 people who had been victims of discrimination 49 were for increasing minority representation in medicine, 38 were not, 4 did not respond Of the 126 people who believed racism and sexism are still a problem 73 were for increasing minority representation in medicine, 48 were not, 5 did not respond
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Andy Gulbis
UNTITLED
Though life will come, and minds may search, the path is long to fame and glory. And though its far and time may pass, its hard to sit and wait without worry. Can I make it? Will I fail? These questions come today without answer. And hard it is to make each daywaiting, sitting for that answer. Although I know my time will come, whos to say it isnt here? For what is to come tomorrow that cannot come today? And whos too afraid to change today that which scares tomorrow? Great minds have passed and certainly followI may not be one of them. But what greatness I have hides within, waiting for tomorrow.
Grandmother and Child Marilyn S. Brodwick

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R. Dennis Bastron
SIR WILLIAM OSLER

I was introduced to Thomas Carlyles On Heroes, Hero Worship, and the Hero in History when I was a young cadet in military school. I dont have a clue what Carlyle was talking about, but what I took away was that there are a few people out there who are worth emulating and being role models. I have a number of such heroes both in my private and professional lives. When I was about to begin medical school in August, 1959, my father, one of my medical heroes, gave me his copy of William Oslers Aequanimitas with other Addresses. (I passed that copy on to my daughter in 1993; I missed it so much I had to buy a copy for myself.) Dr. Osler soon became one of my medical heroes and I would like to introduce him to you. William Osler was the most famous and loved physician in the world at the end of the 19th century and beginning of the 20th century. A Canadian, he began his teaching career at McGill, moved to the University of Pennsylvania, became the founding Physician-in-Chief of Johns Hopkins, and nished his life as Regius Professor of Medicine at Oxford and only the second Canadian Baronet of the United Kingdom. He was claimed by three countries but was truly a world gure. Among his accomplishments are founding a number of medical societies, humanities organizations, and several journals. In addition, he had nearly 1400 publications. Oslers Principles and Practice of Medicine went through 12 editions before he brought in a helper; it was so popular that it was the major textbook of medicine from 1892 until the late 1940s. I believe the latest edition, the 24th, was published in 2001! It was also translated into Russian, French, German, Chinese, Spanish, and Portuguese. One of his proudest accomplishments (every medical student should thank Sir William for this) was to introduce teaching medical students at the bedside to the North American continent.
Course Change 26
Kelly Sandburg
Cliff Martin
UNTITLED
In the middle of the night, the call for a doctor, is that me? How did I get to this place? How did I miss learning this part of the game? I am barely awake. I can barely even walk. I want to escape. But here I am, and this man is going to die, and I am his doctor. I call the code, I feel his ribs crack, ...but he still breathes his last. I sign the death certicate. Is this for real? I want to sleep.
Stalins Bunker
Kelly Sandburg 27
La Tanya Simone
HEALING
for Kevin
is not a linear achievement it is not a substance to be captured in time it is an enduring process that affects us at times unnoticeably through the mists of dreams hazy remembrances and gusty winds of reality experiences, moments become part of us they are felt and preserved sometimes pushed away, deep and far away nevertheless they remain we are healing even when we dont know it sometimes the only evidence is the fact that we are surviving we are thriving we persist
BLOOD
more alike than I care to tell sisters beyond those moments of fear
Running Through 28
Christina Menor
Charles W. Putnam
NOT MUCH BLOOD, REALLY...

It wasnt much blood, really, I told myself. I mean, it really wasnt that much blood. It just seemed that way, mixed in with and diluted by the frothy tracheal secretions. Patients often bled some when their tracheostomy tubes were suctioned, suction trauma, it was called. But this didnt seem like suction trauma, a little too much bleeding for that. I stared out through the ceiling-high windows, black dominos etched with frost, stared at nothing. There was nothing to see, nothing to stare at, except the aluminum vanes, like vertical wing aps piloted by the sun, opening and closing to shield the hospital from direct sunlight and nighttime cold. Shut tight, they reminded me, as if I needed the clue, that it was the middle of the night, 3:25 AM to be precise. This isolated corridor, anked on one side by the expanse of windows, was my place of retreat. In daylight, I could often see the Rockies and at night, it was a quiet place of escape, a haven where I could think or not think without fear of interruption. The nurse in the Intensive Care Unit had paged me sometime around 2:45 AM. One of her patients, Mr. MacDonald in Bed Seven, had bled when she suctioned him, a new thing for him. It wasnt my patient; as the Red Service Intern on call for General Surgery, I was cross-covering the White Service. And it wasnt like the nurse had woken me up. Getting some sleep was still an amorphous concept at that moment. I hadnt come close to crossing off everything on my scut list compiled on afternoon rounds. I had stopped by the ICU a few minutes after the page, taking time only to place a blood sample I had just drawn on the dumb waiter which shuttled between patient oors and the clinical lab. She was right of course to worry; it could be a sentinel bleed. Even I, an intern, knew what a sentinel bleed was. At least, I had heard of it. A bleeding episode, mild in volume and brief in duration, which might recur several times, signaling the presence of an erosion between a bronchus and the aorta, the mother of all blood vessels. The textbook continued, when the erosion becomes large enough, and the tissues separating the arterial blood stream and the airway sufciently weakened, the bleeding discards its modest, self-limiting style and becomes catastrophic; arterial blood pounds through the erosion, lling the bronchial tree and erupting out the tracheostomy tube, a geyser of froth and blood. Its a race, but the issue under contention is whether the patient drowns in blood before he dies from exsanguination. As a medical student I had stumbled upon such an event in progress. A worldrenowned surgeon on the faculty was crouched at the poor girls bedside; she was paper-white, her wide-open eyes hazy from tears and blood-froth, her face frozen in an expression of sheer terror, and the pattern on her heart monitor looking more like a seismographic tracing of The Big One than a recognizable EKG. The surgeon was covered from head to thighs with scarlet cappuccino, large clots dripping down his shirt, foam in his hair and all over his arms. His expression was one of anger but the white-knuckled grip, left hand on the tracheostomy tube, the right on a suction catheter, betrayed his fear and frustration. The latter slurped and choked on bright red, congealed blood; her life-blood inexorably lling the plastic canister attached to the suction outlet, like a giant thermometer caught in a beam of sunlight focused by a magnifying glass. Well, what do you want to do? the nurse had asked, after I had completed my examination, which had revealed nothing but the obvious, that when you suctioned the patient, you got tracheal secretions and blood, not a lot of blood, just enough to qualify as more than expected, worrisome, cause for concern, or no big deal, you take your pick. What do I want to do? I thought. I want to dump this problem on someone who knows what hes doing, thats what: a senior resident, better yet, the Chief Resident, or maybe even an Attending. I want them to deal with this, not me the Red-Service-General-SurgeryIntern-On-Call-for-White-Service-Patients. I
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made some sort of pathetic but plausible excuse (I need to check on Mrs. Blodgett on 5 West Ill be back in a few minutes page me if anything changes.) I had learned, as a medical student, to always have an exit strategy. Indeed, I had honed exit strategies to an art form on my orthopedic surgery rotation at the County Hospital. Each night on call, I would see twelve, fteen even twenty fractures. Id examine the patient, most often a child, who fell off the jungle gym, tripped over a root while running after a football, or was pushed on the playground, (or the occasional adult, pushed down the stairs by her drunken boyfriend) reassure the parent (or the boyfriend), order the appropriate x-rays, and carefully supervise the radiology technician, usually to his self-evident displeasure. Then the exit strategy: Ill review the x-rays, then well discuss Jimmys treatment. In the clinics back room, next to the x-ray view boxes, was my stash of textbooks on the treatment of fractures. I would thumb through them until I found a picture resembling Jimmys x-ray, and quickly read how to set and cast the fracture in question. Reappearing in the patients room, I would condently announce: Jimmy has a Colleas fracture in my experience, a closed reduction and sugar tongs splint is the appropriate treatment. The only time this strategy backred was when an overly helpful x-ray tech brought the lms right back to the patients room. That necessitated Strategy #2, surreptitiously tripping my pager as if to signal a call and excusing myself to answer the page, having committed to memory a visual image of the radiograph. In my current plight, though, there were no books to read, journal articles to consult; I already knew what there was to know about handling an aortobronchial stula. Next to nothing. Yes, the books said to remove the tracheostomy tube, replace it with a longer endotracheal tube, and slide that down the good (right) bronchus, since the stula was nearly always between the aorta and left bronchus, by virtue of physical proximity. Then, blow up the donut-balloon of a cuff around the end of the tube and pack all around the tube with gauze, thus securing the airway and tamponading the bleeding. No one I knew had ever pulled off this stunt; in fact, no one I knew had ever heard of anyone successfully executing this maneuver, except for one or two instances in which patients
had bronchial bleeding emanating from some less ominous source than a stula; in other words, the patients didnt need the procedure to begin with. Nonetheless, I ran through in my mind the steps to secure the airway and tamponade the bleeding, making mental notes of every instrument and item I would need and where each was stored in the ICU. I had already ordered eight units of blood to be ready to transfuse if all hell broke lose. So much for being prepared; now what? The answer obvious to anyone except an intern at 4 AM was to call someone. Easy to say. Okay, whom should I call? The senior resident (Im going to bed, dont call me unless someone is dying or, more importantly, needs to go to the operating room.); Mr. MacDonald, at least for the moment, unked both tests. The Chief Resident, at home, scheduled to start a pancreatic resection at 8 AM not the brightest idea. Chief Residents can quite precisely calibrate the interns quality of life on the service, tweaking it from pretty okay, to tolerable, to miserable, by reassigning an operative case, penciling you in for an extra night of call, canceling a vacation, or simply racheting up the harassment on rounds. How about Mr. McDonalds Attending? Calling any attending, much less Dr. Morgan, at this hour evoked a mental image of a caveman stumbling around in a cavern dimly light by his aming torch only to discover that it was already occupied by a now half-awake and quite displeased saber-tooth tiger. Better think this one through. It was only after a decade or so of taking call myself, as an attending, that I came to appreciate that all calls at night can be assigned to one of three categories: Type I calls no action is required, no thinking is necessary; simply acknowledging or acquiescing to the content of the call is all that the caller demands. Mrs. Smith just passed on, or Ive admitted at 56-yearold accountant with painless jaundice and, by ultrasound, a mass in the head of the pancreas; hes scheduled for a CT scan in the morning. Good news (for me, not the patients!), I can roll over and go back to sleep. The occasional wrong number, even at 3 AM, is a Type I call. No, Tanya is not here I dare say, your chances of ever reaching Tanya at this number are exceedingly remote And, if I could offer you just a word of advice, you might wish to defer talking with your Tanya until
30
you are a bit more coherent. Have a good evening. Bye. Its hard to be annoyed by Type I calls they demand so little from you. Type II calls require action but no heavy thinking Weve (the we is a dead-giveaway; time to get up) got a 23-yearold, intoxicated white male with a gunshot to the upper abdomen, BP 85/50 after 4 units (of blood), typed and crossed for 8 more, ORs ready, were on our way. Nothing to think about get up, get dressed, get to the hospital. It sometimes can be kind of fun, actually. At 6 AM what normally is a 15 to 20 minute drive can be done in about 8 minutes my record was 7 minutes 49 seconds (I ran a few red lights, very carefully, I might add). But Type III calls things to fret about. Mr. Jones (yesterdays liver resection) is febrile, temperature 39.5 C. Ive drawn all the appropriate cultures, chest x-ray is clear, anything else you want? Now, you have to think and worry. You are wide awake now, absorbing all of the data, running through every possibility in your mind, cross-examining the resident. The white count? 16,000. Left shift in the differential? Yes. The two of you formulate a plan, the conversation ends but you do not go back to sleep. You lie there, reviewing the call, re-playing Mr. Jones operation in your mind, going over the possible complications, considering additional tests, discarding them as unhelpful or adding them to your mental to do list, chastising yourself for not having done suchand-such during the operation or, for that matter, having done this-or-that. Sometimes, minutes or hours later, you call the resident back, lets get an ultrasound in the morning, or, more often, hows Jones doing now? When I was a junior attending on the transplant service, one of the fellows, now Chairman of the Department of Surgery at a highly regarded medical school in the Midwest, began one such particularly ominous 4 AM discussion with This is not a social call, instantly defusing my anger and frustration with the patients plight. These Type III calls are the bane of every attendings existence, anxiety unrelieved by action, the patients problem engendering guilt, frustration, and anger. All compounded by the monsters under the bed or in your head in the early morning hours. Of course I didnt appreciate all this as an intern. But a dry run of the likely conversation with the attending sufced. Mr. MacDonald is having
some bleeding from his trach. How serious? Not that much bleeding really, but Im concerned it might be a sentinel bleed. Any evidence for that? Well, no, I guess. Well then, what would you like to do? That damn question again. Maybe get an aortogram. Yeah right, getting a radiologist to do an aortogram at this hour would require either an act of God or, no more realistically, the go-to-the-mat support of my attending two equally unlikely scenarios. So drop that answer from the script. Instead, insert Watch it, I guess. Well, you do that. Good night. Thinking back on it now, my conversation with the attending if played out that night would without a doubt have Type-IIId him. But back then, the idea of calling seemed to me well, non-productive. I looked out the window again to be precise, I looked at the silvery vanes still closed tightly against the freezing night air. The vanes wouldnt open until the rst rays of sunlight hit the sensors. In winter, rounds began even before the hospital faade had opened its eyes. And only when it was time for rounds could I sign out my White Service patients du jour or more correctly de la nuit, including Mr. MacDonald, to the White Service intern. Echoing in the quiet corridor, my pager went off; holding my breath, I pushed the red button and listened to the hospital operator intone an extension number 7010 5 East, not the ICU, thank god. Mrs. Rosenberg cant sleep, the nurse informed me when I called the extension. Well, that makes two of us but at least her problem is treatable. Give her a Seconal. Ninety-ve minutes until rounds, but whos counting? Pretty soon I should head over to the ICU and start reviewing my patients charts in preparation for rounding. Another glance shutters still closed. My pager jerked me to attention again this time a different, more ominous sound, the shriek indicating a gang page, all in-house pagers triggered at once. Again the operators voice, the same unemotional monotone but carrying the last message in the world I could possibly want to hear: Code Zero, ve-north, Surgical ICU cardiac arrest Code Zero, ve-north I was already running toward the ICU, perhaps 100 feet away. Rounding the corner to 5 North, I nearly crashed into one of the medical students, who was throwing on his white jacket over rumpled scrubs,
31
as he burst out of the call room looking dazed and confused, trying to gure out in what direction to run and perhaps even what he should do when he got there. Into the Unit. Already at the beside were three nurses, and Tom, the Chief Cardiac Surgery Resident; on my heels were a pharmacist and a respiratory care technician. The monitor was at-line, Tom yelled for epinephrine; I grabbed a syringe of it off the crash cart and tted a sixinch long, 20 gauge needle onto it. Tom plunged it through the chest wall, into the left ventricle of the heart, drew back some blood to be sure he was in the chamber of the heart, then emptied the syringe-full of epi into the heart. Nothing. Tom didnt need to mention sodium bicarbonate I had already started to empty two of the large glass vials into the intravenous line. More epi nothing. More bicarb nothing. Debrillator paddles stand clear, shock the heart nothing. Epi bicarb increase the wattage shock, still nothing. It then started to sink in this was Bed Eight, not Bed Seven. The incision over the patients sternum informed me that he had had open-heart surgery; it was one of Toms patients, not Mr. MacDonald. A wave of relief washed over me. Feeling guilty about my good fortune, I threw myself even harder into the resuscitation effort. At Toms behest, I prepared another syringe and needle, this time lled only with saline. Tom probed for any accumulation of uid or blood around the heart. Nothing. Next, just as expertly, he threaded a pacemaker wire through the subclavian vein and into the heart. A temporary pacemaker hooked up to the wire etched its own signature on the monitor but not a single cardiac complex echoed in return. I liked and admired Tom; he had befriended me when I was still a college student, working in the research lab and hanging around the wards. But now, seeing him in action, I was in complete awe of his skill and it was incomprehensible to me that any heart could fail to respond to such nesse. But no maneuver, no drug, nothing worked. And, after forty minutes or so of frantic activity, with blood, syringes, and assorted paraphernalia littering the bed, oor and tables, Tom called the code. Time of death, ve fty-eight AM. I mumbled sorry and drifted out to the charting desk and tried to focus on reviewing my rst patients chart. I didnt dare admit, even to myself, that I was relieved, even grateful that it was Toms patient, not mine, who had died. I tossed down the chart I was
holding and picked up the one with black MagicMarker letters on adhesive tape: MacDonald. Thumbing through it, I could see that nothing new had happened, no more bleeding, vital signs stable. Joe, the White Service intern, walked in. Anything to report? he asked, seemingly uninterested, not even pausing at my desk. Yeah, Mr. MacDonald had some bleeding from his trach; its stopped now but Im concerned it could be a sentinel bleed; you might want to get an aortogram. Shit, you serious? Yeah. What did old-man Morgan have to say? Didnt call him. Why, for chrissake not? No point, gured you could ll him in on rounds. Thanks a whole shit-load! and he stormed off to join his team and I headed in the opposite direction to nd mine. A week or so later, all of us general surgery residents were sitting in the cafeteria gorging on our usual breakfasts of scrambled eggs, bacon, french toast and pancakes and slugging down juice and coffee. One of the third-year residents sitting at the far end of the table, heretofore intent on demonstrating his hand-eye coordination by spearing pieces of French toast with his fork as they oated about in a sea of imitation Maple Syrup, looked up at Joe, sitting directly across from him: Joe, you look like shit. Bad night? Yeah, a patient of old-man Morgans in the unit blew an aorto-bronchial stula. Fuckin bled out in two minutes at. Not a damn thing I could do. I nished off the last of my eggs, drained my fourth cup of coffee, pulled on my white jacket, and headed for 5 East. I was on call. Maybe if I got an early start on my scut list, I could get some sleep tonight. Unless, of course, something happened.
32
Untitled
Bruce Vaughn
33
Anonymous
CALLING
i cut to the chase i cut to the quick inict wounds and wince when they bleed because i didnt really mean it. youve seen it, im sure. felt it. whats more, youve done it too. i know you, with your unspoken intentions unwritten reections. clue my ass in. your silence is a sin not against some dipshit deity but against my frailty yes, ive framed you, seethats where the power is at, in the softness underneath, for which these fortresses are built because, goddamn, it takes a tough motherfucker to feel. so if the digging that is my calling sends you reelingyingfallingits not that i slice to watch you bleed but to administer a dose of the truth i need directed back my way indeed, i hold these mirrors up to you so i can learn to see.
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Anonymous
BLACK MARKET ORGANS UNDO THE DAMAGE

i would like to borrow some parts, doc. hearts, perhaps, not so scarred or quite so large. a tad less soft. a harder heart, if you would, doc, to protect me from the pain brought upon myself. tough enough to maintain its health, pumping on relentlessly, endlessly, like maybe its my ticket to immortality. but i wonder, would anyone recognize me if i could really x all of my disease if i was as stable as you please, if my insecurities, my emotional hypersensitivities could magically be xed would i really be me after all this? or would i be just like the rest of you? would i walk through this world half asleep, too, to avoid incurring any wounds in this brand new heart ive been given? the sin, i think, is to not feel. to not drink in all the delicious pain that leaves scars on hearts and other parts and attempt to get through this life unmarked because even the dust of old stars has some destruction in it. i guess thats life, huh, doc? so ill live it.
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Eva Shaw
EATING FROM THE INSIDE

The most successful life form on earth, he said A compulsion more than symbiotic, no conscience, no nerves Like falling in love Bilharzia, Schistosomes, Tapeworms And Blood Flukes: Innitesimal missiles seeking for human esh, Absorb through the skin at once like butter Entering multiple times until penetrating the liverhome. And certain isopods, hard crustaceous water bugs Latch to and eat slowly tropical sh tongues Growing into their shape until Fish swimming, are unaware of the invaders eyes staring out of their open mouths. And late in a day, spurred on by an intoxicating chemical reaction, an ant climbs high with an overwhelming desire to reach the tip of a blade of grass. Immediately devoured by one of a grazing sheep herd, its sacrice leaves a now freed parasite sated in his host of a cud-lled stomach. Leeches, bloodsuckers, scroungers and freeloaders Parasites The most successful life forms on earth instinctively nd their way to eat us from the inside.
City of Havana 36
Chloe Becca
Ron Spark
NECKTIE ASSOCIATED IATROGENIC INFECTION? KNOT!

If theres anything that bugs a pathologist interested in microbiology more than Pseudomonas, its pseudoscience. A May, 2004, abstract presented at the American Society of Microbiology meeting inferred that physicians cravats had the potential of Typhoid Marys. The study, performed by a medical student, Stephen Nurkin, found that physicians ties were eight times more likely to harbor pathogens than a control group of hospital workers without patient contact. Nurkins study was triggered by the observation that physicians dangling neckwear often came in contact with patients or their bedding. And although the doctors would wash their hands after the examination, they readjusted their neckties, potentially recontaminating their hands. The study involved swabbing 42 physicians neckties (unstated as to the ties age, design, or color combinations) and 10 worn by security personnel (likely to be rather uniform and boring). The resultant cultures grew 20 pathogens from the physician samples, including Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Aspergillus. In contrast, only one culture plate from the security guards nine tie samples yielded Staphylococcus aureus. A second and even more alarming study was published last spring in the Proceedings of the Royal College of Surgeons from a hospital in Sussex. Nigel Cumberland, a consultant Microbiologist and others found that all the tie cultures worn by their Orthopedists carried MRSA, a pathogen associated most frequently with wound infections. The most unfortunate comments by Dr. Cumberland are found in his discussion. The tie is a decorative but functionless item of clothing, worn by most male (notice the sexism here) Doctors....It hangs freely, makes contact with numerous objects and it is regularly handled by the owner, tucking into his shirt....It is rarely washed and is often worn outside the hospital. The most dyspeptic and heretical part of the paper was in the authors summary recommendations: We would suggest the abandonment of the outdated and impractical necktie as part of the expected male hospital doctors uniform. Shades of Ignaz Semmelweis! Such hysteria and misuse of the Germ Theory of Disease. I dare any researcher to try to prove Kochs postulates with one of my vintage late 40s cravats. Certainly theyve never been washed! That would ruin them (and might sterilize their vintage ora, too.) Damning of a mans prideful neckwear by raising the specter of iatrogenic MRSA infection is sinking to the lowest level of pseudoscience. Besides, the fact is that, as a pathologist, many of my patients are beyond worrying about MRSA. Id rather have bacteremia than be collared for wearing one of my inammatory neckties. The staying power of the cravat is that it immediately identies the wearer and, hopefully, calls attention to his individuality. Who can read the identity card dangling from a Docs neck at a distance? But, boy, give me a distinctive necktie at 20 yards, and I know who that physician is. Im hoping this wave of overzealous hospital infection control passes. Id hate to be thrown off the staff because of my ties Staph.
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Bruce Parks
ISCHEMIC HEART
(with apologies to Hank Williams)
Ischemic heart, scourge of the West Obstructed ow, pain in the chest If blood ow stops, infarct will come Or sudden death, from an arrhythmia If you make it through the rst few days Complications then will make you pay Cardiogenic shock or ruptured wall Without no luck, youll get them all Ischemic heart, please stay away And let me live another day Ill exercise and smoke no more A drink or two a day or maybe four
Mountangular 38
Keven Siegert
Mary Foote
EMPATHY
Since the beginning of medical school, I have been taught that to be a good doctor, I must learn how to emphasize with my patients. In fact I was graded on how well I could put myself on a level with pretend patients and feel their pain. How plastic it all seemed! Since then I have sat with many patients, listening to the tragedies of their lives, nodding in feigned understanding with nothing to say to ease their pain. The idea of trying to placate them with my empathy seemed absurd. In fact often times I was so distracted going through my mental checklists, afraid I would miss some vital piece of information that I listened to but didnt really hear the stories they told me. Finally, last week as I sat in the hospice talking to the wife of a man dying of metastatic cancer, I nally shook myself out of the med student zone to actually let the signicance of this womans story percolate into my analytical mind. Last week this woman had a husband at home with painful arthritis. This week she has a beloved partner who will never come home again. Oh, what a blow to my composure that interview was. Yet, as I reect, it was not the elusive empathy that I felt for her. I could never understand her pain or experience. Ive never lost someone close to me, but I could still sympathize and try to imagine how great her loss will be. So instead of pouring myself into the ear-holes of this strong, beautiful woman and the countless others I have yet to meet, I will hold their hands, slip a pillow under their heads, and for a moment help them shoulder the burden of their pain.
Young Girl from the Village of Huei Thamo, Laos
Chloe Becca 39
Lane P. Johnson
THE CHRISTMAS GIFT

For many years one of my morning rituals has been to scan the obituaries in the newspaper. As one wag said, any day you dont nd yourself there is going to be a good day. A doctor colleague once said that he always looked for his own name to see if he needed to go in to work today. The real reason I scan the obituaries, though, is to look for any of my patients. Faint scents of fate, treatment errors (usually fantasized, thankfully), and sometimes even an I told you so, bubble up from that murky pot of history. Furthermore, in almost any patient obituary there is usually some intriguing tidbit of information that, no matter how long Ive known the patient, or how careful a history Ive taken, has managed to elude me. Not so long ago I saw that Bert had passed away. I hadnt seen Bert in the ve years since I left the clinic. Bert and his wife Lucinda had been a regular part of my medical practice for a long time. Back when Senior HMO plans were still something new, Burt and Lucinda were among the rst patients assigned to me at our new family practice clinic. Bert was a tough old bird in his late 70s. Hed beaten three different cancers before Id met him: colon, lung and skin. He didnt appear to be afraid of much of anything. Bert was a workingman through and through, from the battered baseball cap over his craggy sunbeaten face down to his well-worn work shoes. At clinic visits he was freshly bathed, and his clothes, though worn, were always clean. He spoke simply and frankly. He had a mischievous twinkle in his eye and never failed to ask me how I was doing. He ended each of our visits with a new off-color joke, which never failed to draw an accented Ooohhh, no, Bert, and an embarrassed look from Lucinda. Then she would smile. They always came to appointments together and were clearly devoted to each other. Lucinda had a sort of European sophistication and genteel demeanor that made me wonder how she and Bert had ever gotten together. She had the supercial appearance of a delicate ower, but made of steel underneath. She had to be, I thought, to keep up with Bert. During our rst year together we dealt with the usual assortment of minor acute problems and preventive issues. About that time Bert and Lucinda asked me if I would be willing to see their two best friends, Oscar and Evelyn, as patients. They were both in great health, Bert told me, and I would really like them. Were like four peas in a pod, Bert told me with a wink. I had been the poster child for our clinics advertising scheme and my practice was pretty full up. But sure, I told Bert, Ill be happy to see your friends. Oscar and Evelyn were exactly as advertised. Oscar was an elegant South American gentleman, cultured and rened. He had worked hard at running his own hardware business, and at 78, still climbed up on the roof to x his cooler. Evelyn was a lovely lady, salt of the earth, always laughing, and with something pleasant to say. The two couples often went on outings and long road trips together, and it was clear they truly enjoyed each others company. Over the next few years the vagaries of geriatric practice manifested themselves. Bert contracted bladder cancer, and after a protract bout of chemotherapy, nally beat it. The arthritis in Lucindas left knee ared badly. It took months, and a severe bout of depression, before we got her under control. Sometimes when the pain was really awful shed come in alone and cry in my ofce. Dont tell Bert, shed say to me, I dont want him to think Im a baby. Oscar fell off a ladder xing the cooler and broke his hip, resulting in a stay at the nursing home, which none of us tolerated well. Caring for Oscar ared Evelyns back pain, and she had to go to bed for a while. It wasnt until Oscar came home and was doing better that Evelyn started to do better,
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too. Four years later, slightly worse for the wear, but still aging gracefully, things nally settled down for all of us. Somewhere during the course of the many comings and goings, the tests, the treatments, the earnest conversations, the hand holding, and the tears, someone, I think it was Bert, let it slip that many years ago Bert had been married to Evelyn, and Oscar had been married to Lucinda. Like many a great opening acts that physicians get to witness, I never got to hear about what Paul Harvey used to refer to as the rest of the story. When the holiday season came around that year, Bert came in with Lucinda. In a plain brown wrapper he had a Christmas present. I dont really know if youre a drinking man, he said. He handed me a large bottle of Jagermeister with a small, etched shot glass. I thanked them profusely, but after they left, I pondered the gift. We never really get to see ourselves through anothers eyes. Other than an occasional appreciation or admonition, we really dont know what our patients think of us, or what kind of a person they think we might be. I wondered if somehow this unusual gift was a funhouse mirror reection of my persona. Most gifts from patients are pretty prosaic, cookies, tamales, a bottle of wine or whiskey. But Jagermeister? Was it simply the most convenient thing Bert found on the Walgreens shelf, or was there some deeper signicance? What is this stuff? I hadnt really ever seen it advertised. I examined the bottle. Imported from Germany, hi-octane fuel. A stag with a huge rack of antlers enveloping a radiating cross was proudly embossed on the label. Very Teutonic. I twisted off the cap and took a sniff. Dark stuff: a whiff cacao, a hint of anise, but no clues as to any hidden meaning. That night I took a sip. A ery, raw, viscid uid jazzed down my throat. Yow! Like a Germanic Kahlua. I dont know. Puzzled, I put the bottle away on a shelf and forgot about it. Eventually they closed the practice, and with a great many hugs and tears, I bid Bert, Lucinda, Oscar and Evelyn, along with all the other patients, farewell.
Some years later I was walking up 4th Avenue when I saw a slightly punked-out Gen Xer slouching towards me wearing a faded and oversized black T-shirt emblazoned with the Jagermeister logo. Thinking this might be an opportunity to unravel my little mystery, I accosted the fellow in what I presumed to be a collegial manner. Dude! I cried out jovially. Indicating his shirt I added, Jagermeister! hoping he might have some fraternal secret to share. He looked at me incredulously. Cha! he replied, lowering his arms to his sides and opening his hands in a gesture of complete dismissal. Without another word he skulked on. So much for any pretense I might have for cultural competency. One again I shelved my curiosity along side the unusual bottle. When I read Berts obituary, it turned out he ran one of a series of huge pumps that push natural gas through enormous pipes that stretch from the gas elds in Texas through New Mexico, Arizona, and into California. A job we dont think about at all, and yet it plays an important, if unseen, part in many of our lives. Bert manned that station for decades. Never left his post. Fixed the pumps when they broke down, and lovingly maintained the equipment over all those years. If you used natural gas during that time, it was because Bert was on the job. With that occupation I have no idea how Bert ever met Evelyn, Lucinda or Oscar, but it certainly explained his propensity for travel once he retired. When I got home from work that night I pulled the bottle of Jagermeister off the shelf, poured myself a shot, and held the glass out in front of me. Heres to you Bert, I said aloud. Im glad I got to know you. And I drank it down.
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Norma J. Leslie
GRIEF
Grief is that hollow word that howls emotional pain and lack of control. It is the price I pay for loving and attaching to an idea, a belief, a thought, a wish, a feeling, a thing, a relationship, a person, a state of being; and then having that attachment ripped uncontrollably from my life. What is the purpose? Is it to allow me to become and view my being from a different perspective? Is it a way for me to learn how to love and treasure myself? Is it a way to begin a journey of self-acceptance? But questioning why is easier than accepting. How do I attach to the idea of acceptance? Will it too be ripped away? Someway, I have to trust and know that I am not alone and will be shown the path. That a journey toward acceptance is difcult, yet peaceful. That acceptance allows me to live in a cradle of love. Let the journey begin.
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Susan Ferguson
I REMEMBER LULA
I am like a very old lady whose sharpest memories are those from her distant past. The patients I remember best are the ones I rst encountered as a new nurse nearly thirty years ago. After all these years, I can still vividly picture them, smell them, hear them, and even feel their skin under my hands. In those days there was rarely a layer of latex between my hands and my patients skin. My memories are in my ngers, my nose, my eyes and my ears. Perhaps those memories are sharpest because I was young and impressionable. I always wanted to be a nurse. I read every book I could nd about nurses real and ction. I wanted to be Cherry Ames, Sue Barton, Florence Nightingale, Clara Baron. I wanted to work in every eld of nursing and make a difference in the lives of the patients I cared for. I wanted to do it in a crisp uniform, white cap and navy cape. I loved nursing school and graduated from an oldfashioned diploma program in that uniform. You cannot imagine how proud I was to be a nurse. My rst job as a medical-surgical nurse was in the old wards of an inner city hospital. It was a huge dose of reality shock, but exactly the kind of challenge I thought I wanted. One week after I started, I was in charge of the womens medical ward the only nurse for thirty patients on the night shift (and some nights I covered two wards with sixty patients). I can still remember the fear in the pit of my stomach every night as I walked to work, praying I would not make a terrible mistake. There was so much I didnt know. CPR was not taught to nurses then. One night a patient coded and I had no idea how to use an ambu bag. I did mouth to mouth. I could even taste that patient. We had ventilators and monitors and peritoneal dialysis but no competencies or classes or inservices. Learn on the y. Sink or swim. I mostly swam. Then there was Lula. Lula was on my ward for nearly a year. She had ALS (amyotrophic lateral sclerosis). The disease was slowly taking its dreadful toll. She was a fragile, brittle little Italian lady with thin skin stretched tight over her birdlike bones. She was hooked to her old MA-1 ventilator via her tracheostomy and could not speak. She would rattle the rails with her tin cup or disconnect the vent to get my attention. Her nights were long and sleepless. She grabbed my hand with her bony one, whenever I was near. She followed my every move with her giant brown eyes. As time passed, I spent more and more time with her. Sometimes talking, sometimes singing softly, sometimes just charting near her bed to keep her company. The family who never visited Lula wanted everything done. It was with Lula that I learned to talk about death. I asked her what she wanted done. She wanted to die. I went to the patient care meeting every morning to advocate for her wishes. I promised her I would do everything possible to allow her to die with dignity. I was on duty the night her heart nally stopped. Those were the days of the slow code. Lulas might have been the slowest code in history. I sat with her for quite awhile holding her hand, keeping my promise until her hand was cold. Then I picked up the phone. That was a long time ago. Ive spent the last 26 years in emergency nursing. I love it. I love the noise, the adrenalin, the camaraderie, the excitement, the variety. But I learned so much about the human spirit in those long nights in the dim wards when I was barely out of my teens. I remember those women their faces, their names. I remember the thirty-eight-year old slowly turning to stone from scleroderma. And Ora Lee, who dipped snuff and puffed out great clouds of black dust when she spoke. And Frances, a young thirty-year-old dying alone of the cancer that literally rotted her away. I remember their fears and their courage and their laughter and their tears. I remember the pride I felt because they looked to me for comfort and company. Most of all I remember Lula.
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Maison Hiver
Dalila Ayoun
44
Sue Quigg
MOTHER
and the mother said: I have reached the end of my journey. And now I know the end is better than the beginning, for my children can walk alone, and their children after them. And the children said, You will always walk with us, MotherWe cannot see her, but she is with us still. A Mother like ours is more than a memory. She is a living presence. Your Mother is always with you. Shes the whisper of the leaves as you walk down the street; shes the smell of bleach in your freshly laundered socks; shes the cool hand on your brow when youre not well. Your Mother lives inside your laughter. And shes crystallized in every tear drop. Shes the place you came from, your rst home; and shes the map you follow with every step you take. Shes your rst love and your rst heartbreak, and nothing on earth can separate you. Not time, not spacenot even death.
This work was submitted by Juanita Francis and was found through work with the Susan G. Komen Foundation.
Flower after Rain, Antigua, Guatemala
Chloe Becca 45
Dan Shapiro
ABLAZE
Theres a harpist in the ICU today. The smooth melodies are otherworldly, churchlike. We are all quieter. The sneakered feet patter softer, we whisper instead of speaking. Now, Im phoning the house to talk with my new patients husband. The phone rings three times and then the click, and I hear my patients sing-songy voice telling me to leave my name and number at the tone. Theres a smallish dog barking behind her voice, a childs chatter, and then her apologetic laugh is cut off by the indifferent beep. I introduce myself, from the hospital, I say, I leave my pager number. I need a family member to call me back. Her voice will never sound like that again. Now shes sprawled eight feet from me, a sea of bloated gauze. I was unprepared when I grabbed her chart moments ago. I like going to the chart rst, I like the precision of lab tests, the clarity of disease processes and articulated mechanisms. But someone from the burn team has stapled eight crisply focused polaroids in the progress notes. Swaths of pink, brown, and crimson. I shut the chart, I can get to that later, I falsely promise. The machines surrounding the patient beep and whir, clean yellow gowns hustle busily by, and the harpist keeps her eyes on the oor while her hands pluck and dance. My patient has an eight-year-old, just like I do. We will need to get her daughter help, I note. Right now my child is in school, she told me an hour ago that today they are making masks in art, at this second she is elbow deep in papier-mch. Before she caught the school bus we argued about brushing her hair; were battling about her refusal to bathe lately. What will my patients daughter think when she sees her mothers oating eyes and the rush of adrenalin rocks and shakes and batters her? What help can possibly inoculate her from the coming assault? Whose ofce can contain the rage and sorrow that will blast away the daughters life forever? Today I am glad for seasoned numbness that ickers in my chest, offering me moments of reprieve. I want to feel only bewilderment, and not anguish. For I will never understand how this mom stole down to the basement, poured paint thinner on her belly, and lit herself ablaze.
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Eve Wood
OUR CAPACITY TO HEAL: A MESSAGE OF HOPE

Gillie came to me in August of 1988a 42-yearold widow with three young children, a troubled woman with multiple personality disorder. She was severely depressed and chronically suicidal. She had made at least ten near fatal suicide attempts. She had not lived a single day of her life, since age ve, without cutting herself or burning her forearms with a hot iron. Having been in intensive psychiatric care for many decades without much progress, she asked me to help her heal. As a nave new psychiatrist, I took on this monumental challenge. I worried constantly about my new patient. Would she make it to the next appointment or would she take her life rst? I required regular safety commitments. So when I found her unconscious outside of my ofce three months into our work togethershe had taken an overdoseI stopped working with her. We had no trust between us and no ability to partner. A colleague became solely responsible for her care until she committed to resuming care with me without engaging in any self-destructive behavior. She understood that cutting, burning and suicide attempts would not be tolerated. I would help her in any way I could as long as she agreed to talk to me, reach out for help, establish goals for treatment and refrain from self-injury. Who was I to demand the impossible? And what made me think it would work? I really saw no choice. Were I to be able to help Gillie, she needed to choose to partner with me. She needed to choose life over death. I needed to support her through the ongoing hopelessness and despair. Today, Gillie no longer suffers from multiple personality disorder. She is no longer clinically depressed. She has not cut herself, burned herself or made a suicide attempt for 13 years. Although she didnt believe she could stop these behaviors, she agreed to my terms! What a decision! Although her healing journey has been long, challenging and often overwhelming, Gillie now says: I used to have mental illness! She is now healed. What is the lesson of her tale? I believe in the deepest recesses of my being that where there is a will to transform a life, there is always a way to do so. This belief guided me in my work with Gillie. In fact, this belief guides me in all my work. If we each do our part to heal ourselves and one another, the greater healing power in the universe will enter in to guide us through the challenging times. Thats what I experienced in my work with Gillie. I have routinely had that experience with other patients. Having spent 28,000 hours in the care of troubled individuals from all walks of life, I have learned that we can all heal from the most devastating of traumas, and transform our pains and depressions into experiences of joy and fulllment. Chris came to me in his early 50s. He, like Gillie, had been in psychiatric treatment since childhood. His referring psychiatrist had given up on him. She actually told me: Chris has been with me for years. He is poly-addicted, has an acerbic personality, a history of no intimate relationships and no current friends. I have hit a wall with him. I hope you can help. I see no endpoint to his therapeutic need! I thought I would nd Chris to be a recalcitrant and uncooperative fellow. I was truly surprised by what I found. He was open to change and willing to work very hard. Our journey together was fraught with challenge. We needed to tackle addictions, family-of-origin issues, spiritual bankruptcy and much more. But, over the course of ten years, Chris was able to transform his life. He ultimately graduated from my care a married man with children! He no longer needs psychiatric treatment. Both Chris and Gillie participated in a stepwise journey to healing. Their paths involved identifying and working creatively on biological, psychological and spiritual issues. Both experienced ts and starts, ups and downs, and moments of hopelessness. Yet each was able to triumph and graduate from psychiatric care.
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I believe in every individuals capacity to heal. I believe each of us can take charge of our emotional life. Every psychiatric diagnosis is made on the basis of the individuals story. There are no diagnostic tests in psychiatry! We have only screening tools. Therefore, if we know enough about the symptoms of common disorders, we can determine whether or not we might have a particular problem like depression or anxiety disorder. We can become the best stewards of our own healing journeys. We can begin to nd right-enough-t providers to help ourselves heal. We can take on our family of origin and spiritual dimension issues in a similar way. We need to
educate ourselves and trust our gut. We have amazing potential! Like Gillie and Chris, we can transform our lives. What ingredient is most crucial to our healing? Our belief in the power of the possible. We need to keep searching for those providers, partners, mentors and guides who nurture us. We must use what makes sense as long as it makes sense to us, continue to ask for help and never allow ourselves to give up. Where theres a will to transform a life, theres a way to do it. I believe in your innite potential!
Hope 48
Kelly Sandburg
Joel Meister
CROSSING THE LINE

(This excerpt is from a work of ction about a border town called Ro Lindo, its health concerns, and an activist group for cancer survivors called HOPE (Help our Poisoned Environment). The protagonist, George Martin, moved to Ro Lindo after the death of his wife, with support of the university with which he works and an endowment from the Fairchild Foundation.)
The border had become an environmental hot spot. There was the anencephaly outbreak on the TexasMexico border not long before those were the babies born without brains, and there were reports of other kinds of birth defects and stillbirths all along the border. A few cases of a very rare eye disease were reported right in Ro Lindo, Mexico. Now there was a lot of anecdotal evidence that not only myeloma but other cancer rates might be much too high. Researchers, students, and activists were heading south in greater numbers, and foundations like Fairchild were showing interest. This was the kind of thing that terried the health departments, politicians, and every local chamber of commerce along this vast 2,000 mile border. As a new resident of Ro Lindo, my outsider status had not changed, nor would it ever really change, no matter how long I lived here. But Louie and the other HOPE members welcomed my move, and we were slowly building up some reserves of trust. They felt they were getting what they wanted from me, which was a connection to the academic and foundation world that could bring them expertise and more money, and the legitimacy of having a kind of in house expert of their own. I thought I was getting what I wanted, too, which was a reconnection to the original sources of my own work at the grassroots level and rich data for future research and the grants needed to support it. Louie Beltran had appeared suddenly and unexpectedly in my world, and yet it felt as if a script was already written for us, with his entrance highlighted. He was in treatment at the universitys cancer center for the rare cancer that is supposed to attack much older men than Louie was. Five years earlier I had been treated for a variation of the same cancer. I had survived mine and considered myself cured. Louie was not doing as well and had already been through several courses of chemotherapy as well as radiation treatment. He had read what he could about his disease and discovered how little anyone knew about it. But he remembered that there was some evidencenot much but more than a shredof an environmental link to this type of cancer. I had once read the same about my own type, and my doctors had speculated that my earlier eld research into pesticide poisoning of farm workers had exposed me as well and was linked to my subsequent illness. Louie had been standing on the front porch of his mothers house, as he often did during the early days of his illness, looking down Medina Street, and then focusing on Matas place, with its silly little fountain that never had water in it, when it hit him, the revelation that his entire neighborhood was sick, that so many of his neighbors had cancer that something had to be wrong, wrong far beyond the malfunctioning of his own body. The environmental threat came to life for him in that moment, exploding from the pages of the medical journals and setting off sirens in his head. He and his neighbors and who knew how many other people in Ro Lindo were under attack. He was sure the enemy was somewhere nearbyin the air or the water or the ground. It had to be, because nothing else made any sense to him from that moment on. He didnt know what to do about it, not yet, but now at least he understood why he was so sick, and why Eddie Mata and Henry Gould and Dorothy Archer and the others were also sick. At that moment the threat became as real to him as the threat of a gun pointing straight at his chest. No, it was worse, much more frightening, because he knew about guns and how to use them, but he knew nothing about this.
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Within two weeks Louie had imagined and created HOPE and called its rst meeting. He announced it on KRIO, the local radio station. Five people showed up for the rst meeting. Dorothy, the aging homecoming queen, was there. Henry Gould came. Two strangers from another part of town attended. One was a pharmacist, the other a woman whose husband had died of myeloma. Yolanda Cordova, a family friend, was there. Her mother had died of breast cancer and her daughter had leukemia, and Yolanda was dedicating the rest of her life, as she often declared, to helping others battle the disease. The group quickly decided that Louie would be president, Dorothy vice-president, and Yolanda secretary-treasurer. Dorothy wanted to make HOPE a support group for cancer survivors. But Louie was clear that HOPE would take action for Ro Lindo and somehow force the outside world to save them. Nothing less would work. They would go to the press, to the government, to the doctors, wherever they could nd help. They would expand; numbers would be crucial. At his next appointment at the cancer center, Louie told his doctor that he needed to speak to someone at the university who knew about environmental health. Fred Fisher, the director of the cancer center, who also had been my physician, gave Louie my name. So Louie presented the opportunity for me to connect, and I went down to Ro Lindo to meet with him for the rst time. Jackie ORourke, who was still at the university, and Barry Levinson, a cancer epidemiologist, and one of his graduate students came with me. We met at the border eld ofce on Los Lobos Avenue. The ofce, which was once a clinic for Ro Lindos poor, is in an old adobe house, just off Pan American Boulevard. Its only identication is a small painted sign, with the universitys logo and Center for Border Studies displayed above the front door. The morning we met the ofce was empty except for Angelica, the secretary, who had brought in a box of pan dulce and coffee from up the street and turned on the heat in the back conference room. Louie came with Dorothy Archer, Yolanda Cordova, and a reporter from the local newspaper, which published twice a week and had just started to cover the Cancer Scare in Ro Lindo. Louie brought a large bulletin board with him, which
he propped up at one end of the conference table. There was a map of Ro Lindo, with the various neighborhoods outlined in blue and the major streets in red. The map was covered with colored push pins, some red, some green, and others black or yellow. There were a lot of them, some densely clustered in one area of the map while others were isolated, only one or two in the same neighborhood. This is what is happening right now in Ro Lindo, he began. We went to the mortuary in town, and we got them to show us all their recent death certicates. Thats from two years ago and this year. The red pins are myeloma, the black pins are the other cancers. Just deaths, though. Dont forget that. The yellow pins are people we know of who have cancer now . . . like me and Dorothy here, and he pointed to a cluster of pins that identied his neighborhood, the Loma Lobo district of town. Louie was using a pointer, and he was giving us a good facsimile of a lecture. Barry Levinson was chewing on his ngernails, something he did whenever he was excited. His student was taking notes. Jackie was observing intently, glancing rst at Louie, then at the map, then at Louie again. Now these green pins are people weve heard about, who we think have cancer, but we havent had time to check that yet, Louie announced. There were a few green pins on the map, scattered in what looked like a random way. We know theres a cancer epidemic in Ro Lindo, and we want to know why. We want our city cleaned up. We need help for our sick people. Some of them dont have insurance; they cant get the treatment they need. We want to know how you can help us, if you can help us, or if research is all you can do. Thats why were here today. There was both a plea and a threat in Louies voice; that was clear enough. But what to say? For a long moment, no one spoke. Barry looked at me. There was so much to say, and I didnt know where to begin. Then Jackie spoke. Before the professors go to work on you folks, I want to congratulate all of you for what youve accomplished. You are the real experts on Ro Lindo.
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Barry Levinson shifted abruptly in his chair and turned toward Jackie, but said nothing. Im really impressed by this map and the detective work youve done, she continued, and I bet my good friend Dr. Martin is, too. I took the opening she had made for me. Yes, I am impressed. I meant it. Youve made a strong case that this is something we need to look at carefully. Youve raised several issues, some about the illnesses, some about getting treatment, and of course theres the environment itself. Perhaps we could start with the illnesses. Thats why Dr. Levinson is here today. A quick hand-off to Barry. Louie . . . may I call you Louie, Mr. Beltran? Barry began, clearing his throat nervously. I think you may be onto something here. Starting with the death certicates was a good idea. Of course, thats incomplete data. It includes only those who died and were, uh, sent to this particular mortuary. Then there are the death certicates themselves. Theyre not always accurate about the actual cause of death, in case you didnt know. Especially for some of these cancers that can be misdiagnosed. So they need This is exactly why we need you, Louie broke in. There was a hard edge to his voice. We know theres problems, but just tell us, do you think theres too much of this cancer or not? What do you think right now? Jackie came to the rescue. I think we can agree on several things, cant we? she said. First of all, we know theres a lot of disease here in general, right? And we know that both Ro Lindos are polluted. Everyone knows that. So lets all get going. Barry and George, start thinking about how to do the study. Start looking for the money. Louie and you folks from HOPE should keep looking for the cancers. But you really need to get political, too. Its politics thatll get you what you need. The science is important, but it wont do the trick. You need visibility, you need to organize, HOPE needs to grow. Thats where its at. Can we all agree on this? Jackie was in her element now.
Barry nodded. Jackie smiled. Louie smiled. Everyone smiled. The meeting was over. The alliance, however tenuous, was formed.
51
Nyle Hendrickson
MEDICINE BY HORSEBACK
When it gets dark, it gets dangerous! Our warning to leave early, before sunset, revisited my mind as the last vestiges of daylight sunk away below the horizon. Although accompanied by two National Policemen armed with rusty AK47s, we were now traveling as fast as the horses would go, sprinting between the gates of the range fences that crisscrossed the countryside. I had the disconcerting feeling that even our horses had trouble seeing the ground in front of them now. Mine seemed to enjoy riding just off the trail, racing alongside the other horses, nearly throwing me off by suddenly jumping or otherwise just clearing the shadowy obstacles that arose out of the darkness. We were returning to La Bodega, a small city of one-room houses along a dusty spur of the Pan American Highway in the Northern Autonomous Region of Nicaragua. Our reintroduction to electricity, piped water and the all-to-frequent semi-trucks with their hauls of cattle and tropical timber. Here we tied our hammocks to the classroom window of the local school. Thankfully the school even had a nice cold shower out back to wash off the dust and sweat acquired throughout the previous days. That night, instead of counting sheep, I counted the various sounds oating through the night air in order to fall asleep. Cattle being stampeded by whooping cowboys, the ear-splitting whine of cicadas, the cacophony of horses, pigs, roosters and kids mixing with various truck horns to name just a few. A far cry from the quiet darkness of the campo, the countryside, we experienced while sleeping in the green, oneroom church at Arlin Sui the night before. From Managua we drove six hours north to Mulukuku and then another several hours to La Bodega. Here we left the roads and went into the campo by horseback, the major route of travel besides walking in these parts. For hours we rode through countryside of rolling hills dotted with the small wooden homes of ranchers and farmers. Across open elds interspersed with forests of towering palm trees, giant ginger groves and various colorful heliconia owers we nally arrived at the church of Arlin Sui. There we were greeted by multitudes of welcoming people seeking medical treatment or fullling their curiosity of these new visitors. While eating a fabulous meal of pinto gallo, rice and beans, which always appeared just as we would arrive in any community, Ill never forget watching the giant tarantula observing our groups lunch from the ceiling above. For a community that had never seen a gringo before, it felt great to be able to introduce a positive aspect of the United States as opposed to all the war we exported here in the 1980s.
Teaching about Tuberculosis
Nyle Hendrickson
52
Arlin Sui is a small agricultural community that saw some of the ercest ghting during the civil war between the Sandinistas and the Contras. Young men who knew only of growing beans and corn were forced to drive tanks and take up arms against each other for over ten years. Now they are back to growing their beans and corn although the poverty that rages here has not abated. Poverty is a disease that always seems to have TB close on its heels. With a third of the world infected with tuberculosis, over 5000 people die from this treatable disease each day. TB is a disease that is only theorized to have a high prevalence in this area. One goal of this project is to answer this question and determine the local prevalence of tuberculosis. We were here with a Nicaraguan doctor and Brigadista, the local volunteer health coordinator, to take part in the rst of hopefully many tuberculosis cough clinics in order to identify those infected with TB. Once they are diagnosed with TB, the program then acts as a bridge between the patient and the cure, which is supplied without cost by the Nicaraguan government. Weeks previously the call went out to anybody Gloveball with a persistent cough for over two weeks to come see the doctor this day. The doctor would then determine if the patient warranted further TB testing. We would gather sputum samples from the patient and have them deliver two other sputum samples to the Brigadista the next day. The Brigadista would later catch up with us so we could x the samples on microscope slides for the local governmental health ofcial to read in accordance with local Health Department laws.
Nothing was more comical than several gringos with mediocre Spanish convincing folks standing behind the clinic to produce a chunky sputum from deep in their lungs for these tests. A lot of great acting and visual mimicry was used to get our points across and with terric results as well as lots of laughs. When not gathering samples, we would play with the kids and pass the time talking with everyone there. Ill always remember the smiles of the kids chasing inated exam gloves trying to milk the ngers as they would with their cattle at home. After clinic was over, when the sun had set and with the cicadas singing, I would gather
Nyle Hendrickson
with the young men and in-between arm wrestling contests trade each other the inquisitive questions that boys everywhere ask of each other. That night I felt such a calm and welcoming sense of removal from our news-heavy forward racing culture. With no electricity we crawled into our hammocks quite early and let the sounds of the wind winding its way through the trees lull us to sleep. As we arose from our hammocks the next day around 5 AM, the church was already lled
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with more patients looking to be seen. Whether in a small clinic, house, school or the one-roomed church at Arlin Sui we would hold several cough clinics that week. If all goes well the local Brigadistas will be trained to recognize possible TB patients in their communities, perform the testing and if needed, oversee their treatment. This is no easy feat since these communities are usually a great distance from the governmental health centers and the weekly treatments can last six months or more. A grand vision of healthcare, these locally elected Brigadistas are trained in various aspects of healthcare, outtted with several medicines and a supply kit thereby becoming the medical leader in their community. This trusted leader soon becomes a bridge between the needs of his or her community and the resources of NGOs operating in the area. These volunteer Brigadistas set the stage for future projects that treat the health aspects of the whole community. Projects ranging from sanitation, composting outhouses, water use, personal hygiene campaigns, governmental organization, micro loan economic opportunities and others are limited only by the creativity and energy of those involved. Another aspect of our trip was spending time at the Maria Luisa Ortiz Cooperative and Womens Center, a small clinic that sees over 13,000 patients a year, supports a womens safe house and even a Law center that protects women and children from the physical and sexual abuse so common the world over. While there I met several visionary people whose ideas of healthcare both resonated with and challenged my own thoughts. In the future I hope that more of my fellow students will experience these revolutionary accomplishments in such an impoverished area so full of hope and vision for a healthier community.
54
Donald Sullivan
A REVIEW OF LIABILITY REFORMS SPELL RELIEF FOR TEXAS EMERGENCY PHYSICIANS PUBLISHED IN THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS NEWS, FEBRUARY 2005
Texas was the latest state to avert a growing crisis in its health care system. The legislature and voters approved a proposition and its underlying legislation that caps noneconomic damages in medical lawsuits at $750,000 and limits awards against individual physicians at $250,000. The legislation was enacted to limit the number of frivolous lawsuits, decrease hospitals malpractice insurance premiums, decrease physicians malpractice insurance rates, attract new malpractice insurance carriers to the state and attract new physicians to the state, particularly specialists including obstetricians and neurosurgeons. Sufcient time has passed since the law took effect, on September 1, 2003, to analyze its amazing effects in several areas.
Malpractice Insurance
Before liability reform, several insurance carriers stopped operating in Texas and there was no malpractice insurance available, particularly in some rural areas, according to the Texas Department of Insurance and several physician groups. Decades of steadily increasing liability premiums have plagued physicians and hospitals across the country and Texas is no different. Texas hospitals saw their rates jump more than 50% on average in 2003. Since the legislation took effect:
13 new out-of-state insurance carriers began operating in Texas by the end of 2004 and four in-state companies expanded their coverage
Frivolous Lawsuits
Its difcult to track the full impact of tort reform on frivolous lawsuits within the rst few years. Often a urry of lawsuits is led just before the law can take effect. As was the case in Texas, a record number of malpractice cases were led against physicians statewide between the time the legislature passed the bill and when the law took effect. However, hospitals did report the number of lawsuits led against them decreased 70% in 2004.
Black Cayman Hunting in the Peruvian Rain Forest
Joe Scionti 55
Texas Medical Liability Trust, the states largest provider, decreased its rates by 12% across the board in 2004 and planned to lower its rates another 5% in 2005 Hospitals malpractice liability premiums decreased 8% on average for scal 2004 and 17% for scal 2005
Access to Care
Hospitals and physician groups in Texas report increased success in attracting physicians to practice in the state. Many hospitals are expanding services and enhancing patient care as a result of the cost savings in insurance premiums and the expanded ability to recruit physicians, particularly specialists.
The US health care system is far from perfect. Tort reform will not, by any stretch of the imagination, solve all of our problems. Tort reform will positively affect access to care and the way physicians deliver care. Texas is a shining example that tort reform has dramatic effects on physician and hospital insurance premiums. Currently, tort reform is represented by several bills in the Arizona legislature and should be supported by all health care personal.
Editors note: This is one opinion of many in an ongoing and complicated debate. On this issue, prudence necessitates gathering more information to ensure a well-formed, thoughtful opinion.
Haitian Fisherman 56
Nyle Hendrickson
Sailboat
Nyle Hendrickson
57
Anonymous
THE SYMPHONY
The healer is a consummate maestro, deftly orchestrating the whole being, delicately directing its well-being. The maestro is adept at augmenting or reducing the volume of myriad instruments in the marriage of a single symphony. The healer is skilled at enhancing or diminishing the multifarious body functions in the harmony of health. The maestro aims to create a sense of unity and congruence with the musicians and their instruments. The healer seeks to nd a place of balance and beauty for and with his patient. However... The maestro will step down and music will continue. The healer will leave and wellness remains. But there are times when music withers. There are days when wellness fades. Just as the maestro is there to ensure its brilliance, the healer exists to maintain its continuity. At least that is our hope.... Can you hear the music?
Temple 58
Dalila Ayoun
Helle Mathiasen
LITERATURE AND MEDICINE: MOLIERE WAS NOT AN IMAGINARY INVALID

MR PURGON. The audacity! A patient in rebellion against his doctor! Unnatural! TOINETTE. Shocking! MR PURGON. An injection which I had deigned to make up myself! ARGAN. It wasnt me I MR PURGON. Compounded and concocted according to formula! TOINETTE. He did wrong! MR PURGON. An injection which would have had a wonderful effect on the bowels. The Imaginary Invalid, Act Three
Moliere (1622-1673), French playwright at the court of Louis XIV, was christened JeanBaptiste Poquelin. He authored both comedies and tragedies, in all about thirty-three plays. In addition, he directed plays, managed his own theater troupe and performed on the stage. His work is important to students of literature and medicine and the history of medicine. He authored four hilarious comedies with medical subjects: the best known are A Doctor in Spite of Himself and The Imaginary Invalid. In his doctor plays, Moliere satirizes both doctors and patients, and also provides useful information about medicine as practiced in seventeenth-century France. Clearly, Moliere was familiar with the major medical theories of his era, especially the theory of the four humours. Not only that, he had himself been a patient and thus had learned much about the ineffectual practices of physicians. Moliere was also well acquainted with the new discoveries about the physiology of the human body. One of the most moving stories about Moliere concerns his illness and death. He acted in many roles at the glittering court of his theater-loving monarch. There is a painting in the Comedie Francaise of him dressed in costume for the lead in one of his own comedies. On the night of February 17th in 1673, at the fourth performance of his play, The Imaginary Invalid, Moliere, already very ill, went on stage to play the part of Argan, the main character. His actress wife, Armande Bejart, who played Argans daughter Angelique, and his friends in the company, tried to dissuade him, but Moliere reportedly said: What am I to do? There are some fty poor workmen who have only their days wages to support them; what would they do if I did not act? During the show, he suffered a coughing t, then choked on blood coughed up from a broken vein. He died that very night. Molieres determination that the show must go on has been commemorated by the Comedie Francaise where you can see the chair, actually a commode, which Moliere occupied as the imaginary invalid. The Imaginary Invalid and Molieres three other doctor plays are funny even today, and certainly relevant as lessons to medical practitioners who pretend to know what they do not know. In his doctor comedies, Moliere often focuses on a quack who practices his pseudo medicine on a gullible and foolish patient, doing no real harm but on the contrary inadvertently promoting his enemys designs. The doctor or patient is not only ignorant, but also instrumental in foiling his own plans! In a typical comic plot, inspired by the ancient Commedia dellArte, this older, father-like character wants to block the loving union between a young man and woman whose marriage has been opposed by their parents or guardians. In Molieres Doctor Love, for instance, a young woman pretends to be sick in order to avoid marrying her fathers choice of mate for her. Her
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young lover disguises himself as a doctor, cures the patient, and elopes with her. The plot of The Flying Doctor turns on a similar theme of frustrated young love: a phony doctor intervenes and saves the young couple from an arranged marriage. In A Doctor in Spite of Himself, Moliere ridicules medical education. In this play, the alcoholic rascal Sganarelle becomes a doctor by getting a beating. Ironically, he goes on to perform miraculous cures, helping the young lovers to marry in spite of their parents wishes. The Imaginary Invalid is Molieres most important doctor comedy. The invalid is Argan, the father of young Angelique who wants to marry her lover Cleanthe. He is also the patient of the quack Mr. Diafoirus. The hypochondriac Argan manipulates his family by pretending to be sick. Being a hypochondriac, he wants to marry Angelique to Mr. Diafoirus so that he can have free and frequent medical care. However, his egotistical schemes fail through the intervention of the clever servant Toinette. He is forced to relent and allow the young lovers to marry. In a comic reversal, the patient Argan, possessing vast medical knowledge, nally graduates as a physician in a farcical university ceremony, receiving a license to kill with impunity throughout the world. This play also exposes the quackery and greed of pharmacists who work closely with the prescribing physicians. Argan thinks that the quantity of his medicines relates directly to the healing of his disease (which is imaginary). The more drugs, the better. And if they are expensive, they must be more effective. Moliere opens Act One of The Imaginary Invalid with a scene set in a room in Argans house in Paris: Argan is sitting at a table counting his pharmacists bills and talking to himself: Three and two make ve, and ve make ten and ten twenty. Three and two make ve. Item, on the twenty-fourth, a small injection, preparatory, insinuative, and emollient to lubricate, loosen, and stimulate the gentlemans bowels. Thats one thing I like about Mr. Fleurant, my apothecary, his bills are so extraordinarily polite! The gentlemans bowels thirty sous!
Just like todays pharmaceutical corporations, Argans druggist knows the importance of using the right, sensual language to describe his products, in this case an enema. Moliere knows two important things about his doctors: they resist the New Science, for example, the recent discovery by William Harvey (15781657) of the circulation of the blood. And they cling to book learning and memorization of their antiquated Latin texts. He particularly ridicules doctors for still cultivating the archaic theory of humours, developed by the ancient Greek physicians Hippocrates of Cos (c.460-c.370 BCE) and Galen (c.200-c.130BCE). Living as we do in a time of rapidly changing scientic developments, we naturally nd it difcult to understand the arch conservatism of the Parisian medical profession in Molieres time. But Molieres is an era when physicians prefer to study medical compendiums rather than examine the body. The practice of dissection is not yet widespread; patients are not given a physical exam as required today. Moreover, if you are not very bright and somewhat lazy, as is true of Mr. Diafoirus, it is much easier to memorize formulas from a book than to observe the body and analyze its symptoms. A Doctor in Spite of Himself presents a ludicrous example: The young Lucinde, daughter of Geronte, is pretending to be mute in order to postpone her arranged marriage to an older man she dislikes. Sganarelle, whose medical education was a thorough beating, now poses as a physician and tells Geronte: I consider that the impediment in the use of her tongue is caused by certain humours which we learned physicians call morbid - morbid, that is to say morbid humours so that the vapours formed by the exhalations of inuences which arise in the diseased region coming so to speak do you understand Latin? GERONTE: Not a bit. SGAGNARELLE: You dont understand Latin? GERONTE: No. SGAGNARELLE (accompanying his speech with various amusing gestures). Cabricius arci thuram, catalamus, singulariter, nominativo haec Musa, the Muse. Bonus, bona, bonum.
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Deus sanctus, est ne oratio Latinas? Etiam. Yes. Quare Why? Quia substantivo et adjectivum concordat in generi, numerum et casus. GERONTE. Ah. If only I had been a scholar!
A Doctor in Spite of Himself, Act Two

Sganarelle, babbling nonsense he has memorized from a Latin grammar, serves as Molieres satirical example of doctor speak. The playwrights message is that only foolish doctors believe in the humour theory and only quacks spout memorized Latin phrases. The humour theory is interesting, because it dominated medical thinking for over a thousand years. These are its main points: The body consists of four humours: blood, phlegm, black bile and yellow bile. In a healthy body, they rest in balance. An imbalance of the humours causes disease. Therapy consists in restoring balance by removing the bad humours. Hence, the popularity of purging and bleeding. Purging could be done by giving the patient an emetic, and bleeding was often done by the application of leeches or by cutting with the lancet. At Argans medical school graduation, ve physicians examine the former patient to test his knowledge about various diseases, for example, hydropsia, pulmonicis atque astmaticis, grandam evram, grandum dolorem capitis, grandum malum in the inside, and other ailments. The obedient patient/doctor responds with all the politically correct remedies: clisterium (enema) donare, postea bleedare, afterwards purgare. For all diseases, the cure is the same: purging and bleeding to restore humoural balance. Luckily Molieres king, Louis XIV, who believed in enemas, sometimes receiving up to four a day, was born with an iron constitution that protected him against the assaults of his royal physicians. He survived innumerable treatments of this nature and died at age seventy-seven. But Moliere knew that for a less vigorous patient, the cure might be worse than the disease.
Resisting the new empirical science coming from Dr. Harvey in England, Mr. Diafoirus in The Imaginary Invalid brags about his university dissertation, an argument against those who uphold the circulation of the blood. Argans maid Toinette requests a copy of this thesis with illustrations which she thinks will make inspiring pictures for her bedroom walls. Like Molieres other doctors, Mr. Diafoirus is proud of his ignorance, too stupid to recognize his world is changing as the genius of the Scientic Revolution replaces old book learning with new experiment and observation. Molieres countryman and contemporary, the mathematician Rene Descartes (1596-1650), supremely aware of the importance of medicine, had heard of a certain English doctor, but could not let go of his idea that a re in the heart heats up the blood and so propels it around the body. Some individuals living during the Century of Genius, among them the playwright Moliere, were ahead of the scientists and ahead of the universities in recognizing the new scientic discoveries coming from abroad. Moliere, a visionary artist, died at fty-one from an illness which is curable today.
All quotations from the plays are from Moliere, The Misanthrope and Other Plays, tr. John Wood (London: Penguin Books, 1971).
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Anne Welch
THE ARTIST
He bent over the bed, gently holding the stethoscope To the boys small bare chest, listening intently. With each new patient it was the same, Listen with the stethoscope, background questions, And then pen and paper came out. He drew every childs heart that day. Each picture showed a unique heart, Some with an extra opening or too little muscle, Others with the major vessels hooked up in reverse, But the drawings made each look like a small problem with a solution. With every sketch, he drew the parents and family in, Focusing them all on the common goal of healing the child. Where minutes before the room was a hierarchy of doctor, Patient, and impotent family members sitting anxiously by, It now held a cohesive team working together. That transformation, facilitated by the pen and paper Was his gift to every family he saw that day. Though years of medical school, residency, and fellowship Made him an expert on the pediatric heart, His drawings made him an expert on healing.
Master Craftsman 62
Joe Scionti
Paula Marchionda
Three Generations at the Gate
Water Calligraphy, Temple of Heaven, Beijing
Watchtower, Great Wall, Beijing 63
Paula Marchionda
Rock Wall Icon, Guilin Art Institute, Guilan
Pedi Cabbing in the Hutongs, Beijing
Out for a Walk, Great Wall, Beijing
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Joy Lippe
PERSPECTIVES ON PHYSICIANS
Editors note: The following essay reects on four poems read during Joys Medical Humanities course in her third-year Medicine Clerkship.
Four of the poems we read for this assignment spoke to me about perspective on physicians. The rst grabbed my attention immediately Doctors by Anne Sexton. It is a perfect expression of the physicians persistent desire to cure, to x, to make well, to heal. As the poem says, They would kiss if it would heal, implying that physicians would do anything they could to heal their patients. That is why they would like to be [Gods]so that they had the power to stop suffering and death. The poem states the reality clearly, that we are only a human trying to x up a human. This is one of the issues I believe doctors struggle most with inside themselvesfor when a patient dies, we often feel we have failed, that it was our responsibility to have done better. We do not like to accept the fact that maybe it was that patients time to go, and we denitely do not like to admit that we are not perfect, that we are human, because that implies we do not have the power to always cure, and to stop suffering and death, things we desperately wish to do. The concept of the doctor as the sun, in my white coat, from The Surgeon at 2 AM by Sylvia Plath, is very appealing to me. That is what I wish to be able to doto work my way through the hospital, or through the clinic, every day, making people feel better by smiling at them, comforting them, and hopefully healing them. Part of my ultimate goal in life is to bring light to others; that drive is part of what guided me to choose to become a doctor. The physicians I have worked with thus far who I most respect are those who are like the sun to their patients, and the patients respond as owers do (mentioned in the poem); this is, to me, the most beautiful example of the doctor-patient relationship. Even the most ill person can be touched at some level by human kindness, and we as physicians have a unique opportunity to do that. Emily Dickinsons Hope is a Thing With Feathers reminds me of the power of hope, and I instantly thought of the physicians ability to bring hope to patients. I pictured the thing with feathers uttering down from the physicians mouth to the patients bedside, to perch on the patients shoulder and then touch his or her soul (the poem says it perches in the soul), singing the tune without words. Patients put a great deal of faith and trust in their doctors, and the doctor has the power to either impart a hopeless or a hopeful attitude. I think that in many cases, hope can be found somewhere, even when the patient is quite ill. Likewise, I realize this is not always true, and it is very wrong to give false hope. But much of the time, it all depends on the frame the doctor uses, on his or her attitude. Hope, the little Bird that kept so many warm, can do great things for patients well-being on all levelsphysical, emotional, mental, and spiritual. Finally, reading Tell All the Truth by Emily Dickinson caused me to reect on an issue that I have always ponderedhow to deliver bad news to a patient. The nal two lines of the poemThe Truth must dazzle gradually or every man be blindmade me analyze my position on how this should be done yet again. My conclusion is that while a physician should not beat around the bush, per se, but deliver the bad news in a straightforward and clear manner, kindness must be used as it is explained, and then the patient must be allowed time for the news to set in, to dazzle gradually, before receiving information on further prognosis and treatment, so that the patient is not blind. I truly enjoyed reading these poems, as it caused me to reect on issues that are important to me and reinforced several feelings I have about medicine and being a physician.
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Almaicin
Dalilia Ayoun
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Roger Tran
THE RESURRECTIONIST
Editors note: This essay is a reection on work by Richard McCann studied in the Medical Humanities course for residents.
The essay, The Resurrectionist, by Richard McCann, is a story about a man with liver failure who undergoes liver transplantation and the impact of the process on his life. The essay not only gives details of the mans medical condition but also details of his life. Like so many of the patients we meet every day, a medical condition a person carries around allows us to a glimpse into his or her life. Although most of the time the polaroid captured with the encounter focuses on the medical condition we can see the details of the life in the periphery. In this essay, the liver failure tells us part of the story of a whole man. The liver condition allows us to see the mans habits, diet, family history, life style, and the acquaintances and friends he keeps. All of these factors help determine a cause and provide a glimpse into the mans life before the encounter. Once a diagnosis is made, the medical condition reveals the character of the person. The inner spirit of the man is portrayed through the mans ability to cope with the physical and emotional pain, illnesses, doctors, and procedures associated with his medical condition. Furthermore, the liver condition humbles the man and shows us his beliefs, faith, and view of life. In conclusion, this essay about a mans experiences with liver failure showed us more than just the medical condition. It showed us the man and his life and how the liver failure is a component that allowed us to get to know the person.
La Entrevista
Christina Menor 67
Sarah Daniels
BAD NEWS
Editors Note: This essay is a reection on Raymond Carvers poem, What the Doctor Said, which was studied in the Medical Humanities Course
So, they have us practice giving bad news. First year of medical school, during our semester long Medical Interview class, they bring in Patient Instructors who are given a scenario to act out and we, the doctors, are supposed to give bad news and respond empathetically to their reaction (the syllabus entitled this session Delivering Bad News.) I acted it out pretty well and meaningfully expressed my pseudo-sympathy to this pseudopatient. It was absurd, though I appreciate the sentiment and the lesson they were trying to teach. How to do you teach empathy? How do you teach dealing with suffering? Last month I had to explain to a tall man that his brother was dying. Did I draw upon my previous training in delivering bad news? Nope. I had to cock my neck back to look at this man with tears in his eyes and explain that his brother was going to die from the pancreatitis that we couldnt control and the numerous thromboses in his body that were blocking his circulation. It was a struggle for appropriate words: this man didnt know what the pancreas does, why it is important, why thrombosesor rather blood clotsare so deadly. His questions were incomplete sentences, and my answers felt like incoherent jumbles of words. I think somehow there was understanding on both our parts. In What the Doctor Said by Raymond Carver, the doctor perhaps talks in simple language: it looks bad in fact real bad. Or perhaps out of all the vocabulary words and medical terms the doctor used, that is what the dying patient heard. The patient didnt understand and didnt hear all of what the doctor said: he said something else I didnt catch and not knowing what else to do and not wanting him to repeat it and me to have to fully digest it, the patient reverted back to supercial pleasantries; somehow I think the doctor was relieved. I loved that this passage was written without punctuation. It gave the sense that words were just spilling out of the patient and the doctorlling the uncomfortable silences and preventing both participants from having to really deal with what is being discussed. It is easy for doctors to understand suffering; they see it and try to treat it every day. I think it is equally as easy for doctors to have empathy, but expressing empathy and dealing with suffering isnt as graceful as the hugs and handholding you see in the movies or on TV. Its saying something helpless and simple, like I wish I had some other kind of news for you, and its thanking a doctor who has just given you awful news. This passage was much more educational than the Delivering Bad News session. Literature can teach us about the humanity of suffering from an illness and it can communicate the reality and range of how doctors deal with disappointment. As Anne Sexton wrote: They are not Godsthey are only a human trying to x up a human. Instructors, other older, more accomplished doctors, dont often communicate that sentiment nearly as well as literature is able to express.
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Mark Mussari
KIERKEGAARD: IMPROVING MEDICAL PROFESSIONALISMONE PARABLE AT A TIME

Sren Kierkegaard once proffered this either-or for lifes paths: The Two Ways: One is to suffer; the other is to become a professor of the fact that another suffered. The musings of a nineteenth-century Danish philosopher may seem far from relevant to the task of becoming a competent doctor, but the parables of Kierkegaard serve as a useful tool in reecting on the human side of medicine. Throughout his writings Kierkegaard used the parable to emphasize the importance of indirect communication: in this approach the necessity for reection and interpretation forces the reader into higher states of self-awareness. Thus the parable reads the reader who discloses her value systemher very selfin her response to the parable. Kierkegaard was not particularly enamored of Cartesian notions of mathematical truth. Instead his battle cry became Truth is subjectivity. All decisiveness, he once observed, inheres in subjectivity. For burgeoning medical practitioners, trying to retain information and nd specic, utilitarian answers, this philosophical approach may seem lacking. For Kierkegaard, however, knowledge learned is not knowledge applieda point he makes all too clearly in a brief parable about a storm at sea (taken from Thoughts on Crucial Situations in Human Life, 1845). A pilot has passed every examination with distinction and knows everythinguntil he faces the terror at sea when the stars are lost in the blackness of night. Pointing to the weakness of relying on mathematical truths, the parable adds that the educated pilot has not known how the blood rushes to the head when one tries to make calculations at such a moment. Yet, medical students know this feeling all too well when notes, illustrations, and lms suddenly manifest themselves as the all-too immediate reality of the operating room. This realization of knowledge changed when applied is reected in a medical short story such as Mikhail Bulgakovs The Steel Windpipe (1925-27). Educated as a doctor, Bulgakov paints the portrait of a young practitioner who suddenly faces a crisis in which his book knowledge is put to the test. A peasant family brings a young child with a dangerous case of diphtheria to the doctor, who must now perform a tracheotomy and insert a steel windpipe, thus endangering the childs life to save her. The childs face, the narrator comments, is more powerful than the load of useless knowledge acquired at the university. The reader rapidly realizes that clinical problemsolving is not the same as learned knowledgea direct reection of Kierkegaards parable about the storm. Commenting on the dichotomy between his scholarly achievement and actual medical practice, Bulgakovs narrator pithily observes that distinction is one thing and hernia is another which leads back to Kierkegaards metaphoric storm altering learned information. Having taught Kierkegaards parables for almost a decade, I can say that they are undeniably prismatic in nature: their own facets reect subjectively in those who encounter them. One of the most revealing is The New Shoes, which appears as a literary illustration in The Sickness unto Death (1849). In this most wry of parables, a peasant goes to the big city, makes a lot of money, buys himself new shoes and stockings, gets dropover drunk, and falls asleep in the middle of the road. He awakens to a wagon with a coachman telling the drunken peasant to move or hes going to run over him. Looking down at his legs and not recognizing the ne stockings and shoes, he tells the coachman: Drive onthey arent my legs. Kierkegaard constructs this parable, questioning how well we know ourselves, with metaphors that reect limited self-knowledge and narrowmindedness and that question ethical motivation. I have used the parable in conjunction with
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Richard McCanns The Resurrectionist (2000), a haunting essay about a liver transplant; Kierkegaards parable both reects and elaborates on the metonymic sense of self that appears in McCanns rst-person account of losing a part of himself and having it replaced with part of someone else. Like McCanns diseased liver, the sick part of any person carries with it much more baggage than its specic malady: it bears the burden of a lifetimea narrative of attitudes, focus, and morals that reveal a persons often hidden identity. The quotations from Kierkegaards parables come from: The Parables of Kierkegaard, edited by Thomas C. Oden (Princeton, 1978).
Sren Kierkegaard from Thoughts on Crucial Situations in Human Life
THE STORM
Let us imagine a pilot, and assume that he had passed every examination with distinction, but that he had not as yet been at sea. Imagine him in a storm; he knows everything he ought to do, but he has not known before how the terror grips the seafarer when the stars are lost in the blackness of night; he has not known the sense of impotence that comes when the pilot sees the wheel in his hand become a plaything for the waves; he has not known how the blood rushes to the head when one tries to make calculations at such a moment; in short, he has had no conception of the change that takes place in the knower when he has to apply his knowledge.
Tormenta
Christina Menor
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Editors note: The following three essays comment on The Spirit Catches You and You Fall Down by Anne Fadiman. The College of Medicines Class of 2008 read and wrote about this book before beginning medical school. Daniel Cucher
THE SPIRIT CATCHES YOU AND YOU ABANDON YOUR RESISTANCE TO MYSTICAL MEDICINE
What causes the common cold? Is it a virus? Bacteria? Chills from sleeping in front of a blasting fan? Or perhaps the cause is rooted more deeply in the spiritual world of souls, mystical beings, and demons. Maybe a sneeze is the result of a vicious sprite tickling the sinuses to lure the soul from ones body in an act of metaphysical theft. And if so, how does one treat it? Surely antibiotics and cold elixirs have no powers in the realm of the spirit. What can a decongestant pill do to counter soul-greedy negative energies? The Hmong people of Southeast Asia, and within the last thirty years, Northern California, may suggest the following cure: Insert a silver coin into the yolk of a boiled egg, wrap the egg in cloth, and rub the patients body with it until the egg turns black, indicating the egg has absorbed the illness. If the patients illness persists, sacrice a pig to guard the patients soul from the evil dab trying to abscond with it. Might such a treatment work? While our Western minds seek proof, we are unlikely to come across a New England Journal of Medicine study entitled, Ritual Slaughter in the Treatment of Lung Cancer: Pigs or Chickens? It is outside the realm of Western medicine, but not because it doesnt work. Maybe sacrices help, but no physician in the United States would ever dare write a patient a prescription to be rubbed with pigs blood, for the simple reason that Western medicine does not deal directly with the spiritual world. In the same vein, a mystical healer doesnt deal directly in scientic medicine. It is just as obvious to the modern American physician that AIDS is caused by a retrovirus as it is to the Hmong shaman that all physical illness is caused by a type of soul-loss. Maybe both of them are correct. The Spirit Catches You and You Fall Down, by Anne Fadiman, explores this spiritual-physical conict at the front lines of a battle over the life of a very sick little girl. The book describes the clash between two cultures: the Hmong ethnic enclave of Merced county, California (specically the sick little girls family) representing the backto-nature, spiritual way of life, and the American healthcare workers standing for good old-fashioned altruism and science. The book is written in the style of a Western mind, trying with all its might to understand and express sensitivity for the Hmong philosophy. Anne Fadiman does a ne job of introducing her reader to a culture that the common American might nd exotic, irrational, and otherworldly. Just as a simple translator serving a Hmong patient and an American doctor is so futile, so too would it have been insufcient for Fadiman to simply relate the actions and beliefs of the Hmong without much background. The author serves as a cultural broker between the stupefying world of the Hmong and the physically-minded American readership. The book is interlaced with snippets of Hmong folk tales, historical background, and anecdotes intended to put the reader into the Hmong mind-set. Yet, despite all this, one can still walk away from the book thinking of the Hmong as ignorant savages. The reason for this is that no one can make another person understand something to which he or she is either apathetic or resistant. Indeed, the biggest villains in the book are physicians who wish the Hmong would just shut up and take their medicine. And the books biggest heroes? They are simply the ones who seek to understand and empathize with their Hmong patients, regardless of their success. Without deep understanding, there can be no communication, and without communication, both sides of the spiritual-physical conict are left simmering in frustration.
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Through Anne Fadimans educated mediation, the reader, if he cares to, may come away from the book with newfound insights, not only about a spiritually-driven culture, but about the universe he lives in, as well. When asked, What causes Down Syndrome? perhaps he will answer, Genetic abnormality, from a medical point of view, and continue on to ponder the matter on a deeper, spiritual level. One of Fadimans central points seems to be that the scientic outlook and mystical perspective are not mutually exclusivethey only appear to be in the absence of informed, facilitated communication. Yet, it would be limiting to say that the moral of this books heartbreaking tale is only that the medical community needs to make a better effort of communication with its patients. If the author wanted only to lament the poor quality of communication in healthcare, she didnt need to draw an example from the Hmong. Even an English-speaking doctor-patient pair is hard pressed to mutually cross over the scientistlayman vocabulary boundary. Rather, Anne Fadiman chooses the clash between the Hmong and American doctors in order to take Western medicine to task for its lack of soul. Her goal is to awaken American healthcare workers to the spiritual dimension. Even though Cartesian Western medicine is not equipped to treat the soul directly, those who care for human beings should be aware that their patients are physical manifestation of something well beyond our scientic comprehension. And even though a surgeon does not directly operate on the soul, he or she should not consciously ignore it. To the contrary, the physician should be aware at every moment how a patient is innitely more than a human body. Fadiman is not saying that oncologists should abandon treating patients with chemotherapy in exchange for herbs, incense, and acupuncture. She is, however, saying that physicians should not roll their eyes at such treatments or disregard them as ineffective. Maybe, she says, there is more to it than meets the eye (or the X-ray).
The Spirit Catches You and You Fall Down ends with a detailed description of a shamans ritual. After all has been tried, and no treatment has succeeded in restoring awareness to the little brain-dead Hmong girl, when medical science has thrown in the towel and the patient is as good as dead, a Hmong shaman performs a healing ceremony with all of his strength and concentration: spirits are summoned, pigs are sacriced, holy water is sprinkled, and incantations are recited. It all ends with a desperate plea to the little girls errant soul, Come home. Even the reader is left beseeching the girls soul to return to her, and hopefully, even the skeptic is troubled with at least one lingering thought: Maybe, just maybeit will work.
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Jared Robbins
CHANGING PERSPECTIVES, IMPROVING CARE

When a patients health is compromised or a prescribed treatment plan fails, the burden of blame is usually placed either on the doctor for not effectively diagnosing and treating the problem or on the patient for not fully complying with the doctors requests. Aside from these obvious scapegoats, what factors might be inuencing the doctors on actions and a patients noncompliance? A probable and often overlooked answer might be a clash between the philosophies of Western medicine and the patients own cultural background. In her book, The Spirit Catches You and You Fall Down, Anne Fadiman explores how the cultural chasm between American medicine and traditional Hmong beliefs contributed to the illness of a young, epileptic, Hmong girl named Lia Lee. Although Lias story is a tragic example of cultural misunderstandings, it illustrates how greater consideration for each others perspective would have helped Lias family and doctors work cooperatively to overcome cultural differences in order to help Lia. Perspectives strongly inuence the human decision-making process. We tend to base our choices on what we perceive to be true. Although perceptions are very important, sometimes they are based on surface images, misconceptions, or cultural biases. For this reason the adage, The more sides we see, the better decisions we make, supports the value of understanding how different people or cultures may view an issue. A slight change in perspective can result in seeing the same object differently or seeing an image in a different light. In talking about her perception of the Hmong people Anne Fadiman declared, Sometimes I felt that the Hmong of Merced were like one of those visual perception puzzles: if you looked at it one way you saw a vase, if you looked at it another way you saw two faces, and whichever pattern you saw, it is almost impossible at rst glance, to see the other (pg. 237). Were the Hmong people a vase or were they two faces? It may all be relative to the personal biases that we hold. For example, the staff of the family practice clinic, who became acquainted with the Lee family after Lia was incapacitated, applauded the Lees for their outstanding parenting, quality care, and the love they gave Lia, while the hospital staff viewed Lias parents as noncompliant, ungrateful, and abusive. The same parenting skills that were applauded by one group were scorned by another. These perspectives were different because each group viewed Lias parents in a different light. Our ability as physicians to deal effectively with different perspectives can determine how effectively we can treat patients, especially those with a cultural background different from our own. One doctor, Roger Fife, had some success with Hmong people by changing his practice of medicine when working with Hmong patients based on the notion that its their body (pg. 77). Dr. Fife generally did not perform episiotomies on Hmong womenHe avoided cesarean section whenever possible, and he had particularly endeared himself to his Hmong patients by handing them their babies placenta in plastic bags whenever they requested them (pg. 76). Although Dr. Fife won the hearts of his Hmong patients, he did little to understand their culture or perceptions and was not well respected in the medical community. Since Dr. Fife did little to better understand his patientss perspective, he may not be the best model for future physicians to follow, but he did demonstrate the power of not compromising a patients cultural mores. Unlike Lias doctors, Peggy Philip and Neil Ernst, who were respected and honored in the medical community, but very rigid in their treatment plans, Dr. Fife changed his methods to cater to his patients. This same spirit of change can help span the differences between optimal care and individual needs, if cultural understanding and respect are nurtured. By understanding the cultural reasoning and perspectives surrounding a patients actions, doctors can learn how to treat them more effectively. Bruce Bliatout, a Hmong medical administrator who understands both the American
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medical system and Hmong culture suggests changing (not compromising) medical standards to coincide with the cultural needs of the patient: To improve Hmong health care in general, arrange for female doctors to treat female patients, and male doctors to treat male patients. Involve the patients families in all decisions. Use interpreters who are both bilingual and bicultural. To persuade Hmong people to undergo surgery and improve the outcomes if they consent, enlist the support of family and community leaders. Minimize blood-drawing. Allow relatives or friends in the hospital room around the clock. Allow shamanic ceremonies in the hospital roomBe careful not to undercut the fathers authority in Hmong familiesand practice conjoint treatmentthat is, integrate Western allopathic medicine with traditional healing arts (pg. 266). These suggestions will do more than just change how medicine is practiced across cultures; they will change the perception of both patient and doctor alike. Such a perception shift could move medicine to a new level where it becomes more of the two-way exchange that anthropologist Dwight Conquergood envisions. As part of the two-way exchange both doctors and patients receive culture lessons and gain greater understanding of each other which fosters an environment of mutual love and respect. For any type of cross-cultural medicine to be effective and for perspectives to change, both parties must learn to love and trust each other. Anne Fadiman noted as she spoke about Francesca Farr, a hospital social worker, [she] loved them, I should say. That was something she had in common with everyone I knew who had ever worked successfully with Hmong patients, clients, or research subjects (pg 265). Later as Anne expounded on the role of love, she stated, But love, unlike etiology and diagnosis of pediatric seizures, cannot be taught. It can only be grantedIn its absence, is there anything else that doctors can do to take better care of their Hmong patients (pg 265)? If we want to truly prevent scenarios of cultural misunderstanding like Lias from happening, we must shift our own
perceptions, remove our cultural biases, and seek to develop love for those people we work with from any culture. The cultural lessons learned from the Hmong people can be extrapolated to all cultures, and allowing cultural differences can become a strength as we understand each other and make decisions based on a sound understanding of everyones perception of any medical situation.
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Kelly Sandberg
PERSONAL REVIEW OF ANNE FADIMANS THE SPIRIT CATCHES YOU AND YOU FALL DOWN
At times I stopped reading the book for a week at a time. To read of the Lee familys escape from Laos conjures up vivid memories. Anyone who has spent more than the vacationers glance in a developing country knows of the effects of malnutrition and the false hope of a better life. I sided with the Lee family in their ght for control of their daughters health care, convinced that the health care professionals were mainly at fault. After all, they were referring to the Lees and other Hmong as ies and as a people out of the Stone Age (73). Unfortunately, I cant eliminate the possibility that I could have been one of those health care practitioners who inevitably gives up trying to understand the Lees own form of medicine. Anne Fadimans book The Spirit Catches You and You Fall Down has recreated this uncomfortable dilemma in a way I would equate to a doctors probe, leaving myself vulnerable and exposed. In actuality, that probe has helped me realize the differences between saving a life and healing a soul. What does Fadiman reveal about my perceptions of western culture in medicine? Doctors are the healers of the nations sick. They are the elite, who, trained in the absolute paradigms of science, have now graduated from a rigidly controlled training institution as demigods. Hospitals are the premier places of healing, complete with high-tech diagnostic equipment and modern therapies. The patients role is simply put: to comply, follow, and obey. We uphold this biomedical mold in various places in society: as the doctor-patient privilege within our courts, as laws that protect physician autonomy from outside government inuence, and as we encourage or allow our children to play doctor. The physicians words are, traditionally, valued and followed without question. The major culture conict of Lias story is precipitated when this model is forced upon her family. In Dr. Dan Murphys words: the Hmong didnt t the pattern [the nurses] had been trained to deal with (74). The Hmongs history of rejection to be assimilated or submitting to Chinese authority yields understanding to their refusal of medical compliance to doctors orders. Had these physicians understood this, Lias outcome may have been different. The tragedy of Lia Lees case, as Fadiman reminds us, is that the conict should be avoidable. I assume that not every medical student begins her career with the notion that she will grow into a walking encyclopedia with special appendices covering her specialty. Rather, I suspect that, as medical students, we are socialized into the role of doctor by our instructors and peers during the latter half of medical school and residency. Undoubtedly, the degree of this assimilation is dependent on the individual and how she relates to the new role. Therefore, I contemplate which attributes could be worth changing from the traditional biomedical scheme of the model role of physician. For example, I cannot possibly know everything about each of my study subjects and it would be preposterous to assert this. It would be better for the patient-doctor relationship to acknowledge the exact point when my knowledge stops and where my conjecture begins. Coercion is another attribute that harms the bond of trust between patient and doctor. Stemming from a desire to control a given situation, the traditional physician takes all measures necessary to ensure that he makes the medical decisions. This would anger patients, such as the Hmong, who culturally exhibit strong opposition to authority. As Minnesota physician Kathleen Ann Culhane-Pera noted, [the Hmong] are especially confused and enraged when they are stripped of their power in a country to which they have ed because of its reputation for freedom the way we [Hmong] feel, the United States is more communist than our country is (84). Humility is an attribute that would counter these two primary vices. If, as physicians, we would humbly take a more equal role, asking questions that value the opinions of patients and
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acknowledging the cultural differences present, patients could feel more open to discussing our ideas of treatment and healing. Questions remain. How much do I include the patient in the acts of doctoring? Should they make all the medical decisions? How can I gauge the appropriate amount of intervention in a patients life (i.e., how much should I invade)? How can I foster a relationship of trust without understanding my patients culture or religion? My hope is not to understand everything about a particular culture, though Fadimans examination of the Hmong is certainly satiated with enough material and references to allow for a full doctoral dissertation. Rather, I hope to go forward with an understanding of myself and of my relationships with other people of differing cultures. In so doing, I hope to increase my capacity to heal both body and soul.
Prayers, Jade Buddha Temple, Shanghai Paula Marchionda 76

Allison Kleine
THE STUFFED CAT

Im the stuffed cat in the waiting room In the doctors ofce for younger friends Sometimes its full of sadness and gloom But I try to make sure that the sadness ends Normally, its a bright, happy place Look, Mommy! Look! Im not sick at all! With a smile on almost every face Look, Daddy! Look! Ive grown three feet tall! By the puzzle pieces and plastic blocks I sit in my box in the corner there Until grubby hands and dirty white socks Yank and toss me around everywhere Its really hard with the younger years Their ngers small, but still quite strong Their cries and screams just hurt my ears And they all seem to want to pull me along When kids are coughing, they look for me They pick me up and hold me real close I am the one they most want to see They whisper to me where they hurt the most Sometimes when the nurses call their name They take me with them, though they are old The nurses and doctors will give no blame An exam is scary, and Im soft to hold And children are not the only ones I nd myself hugged by parents, too Sometimes a parent will hold me tight Because they dont know what else to do This is where I belong, down this little hall You might think its a terrible place to live But, as I am only a stuffed animal Hope is all that I own to give
Tabby
Allison Kleine 77
Patricia Stanley
ALYSSA NIKOLE
The day you arrived you took my breath away Totally unaware of the impact you made that day Your perfect body, beautiful face Skin so soft as if touching lace Now you are growing at a very fast pace Each day I strive to see you Amidst this crazy race In a world you dont know much about But, as you continue through your quest of life I hope and pray you know no strife And so you are loved by all around What a great miracle youve become Without making a sound Alyssa
ELISE
I see her face in the morning sunlight as it breaks upon the world I hear her laughter from the children waiting by the school bus each morning as I drive by I feel her presence with every good deed that someone bestows upon another I am touched by her love that reaches far beyond the oceans and across the sky For she is Elisean angel shining brightly upon each of us.
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Betsy LeRoy
DANDO EL PECHO
Last year I knew it as the Angle of Louis: the fusion of the manubrium and the sternum. Now it is the place where you put your hand during our quiet moments on the sofa. I sit cross-legged, cradling you close on this winter morning in the minutes before daybreak. At one time, my emotions encompass both protecting you and giving all the worlds glory to you. I question I may not be doing enough, or may be doing too much, to either end. And fears Ive never known, joys I never knew could be felt, exist at once. Synergy: You need me as much as I need you right now. But will I be giving you what you need later today? Tomorrow? At any given day in the future when we wont have these moments nurturing one another? You just put your hand on that place on my chest to tell me that no matter what worries I harbor, were going to be just ne. As if to say, savor this moment we give and share; it is unlike any other.
Mother and her Two Children, Village near Khong Phapeng Waterfalls, Laos Chloe Becca
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Baby in Mercado, Antigua, Guatemala
Chloe Becca
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Nicky Teufel-Shone
LEARNING TO BE A TRADITIONAL NAVAJO WOMAN IN 2004
Helen and Sierra Sierra Badonie is a young Navajo girl who lives on the Navajo Reservation in Pinon, Arizona. Her clan is Bitter Waters (Todichiinii) and she is born for Coyote Clan (Maii Deeshgiishnii). Navajo children are members of their mothers clan and are born for their fathers clan.
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Sierra and Libby As with most six-year old girls, Sierras interests include reading, playing with Barbiestm and Polly Pocketstm and watching Sponge Bobtm. Yet, Sierra is also learning the skills important to a Navajo woman. In Sierra and Libby, Sierra is holding a small lamb brought into the household for several weeks, to bottle feed and to protect from the severe cold of early winter. In Helen and Sierra, Sierra is helping her grandmother make kneel-down bread (Nitsidi goi) to celebrate the harvest of fresh corn at the end of summer. Sierra also enjoys being the teacher when she plays school with her aunt who visits on the weekends.
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Jess LeBlanc
GROUNDED
We oated down the Salmon River, a warm beer buzz creeping over our eyes. Trevor, a man Id known for six months, rowed our rubber vessel. I ate peanuts and watched the oars dive perpendicular into the green water, push the liquid behind us, then glide parallel forward to their origin. They worked this dive, push, glide pattern levered by his arms. Alison rowed ahead of us with her black sheepdog, Jake, keeping guard of the bow. She pulled in on river-left and Trevor followed. I was slow to tie up and sensing my own lethargy, I merged with the river. I followed Trevor up a steep but manageable grade of rocks. I watched for his secure footholds, but his 67 frame enabled him to take strides that I could not equal. He carried a CD player inside an ammunition can, looking back occasionally to check my progress. A moment and I found myself naked in a hot spring, seated on rocks covered with soft moss. Alison sang trio with June Carter and Johnny Cash while the stone tub lled with bodies: Nicole, a full-gured, dark-skinned woman with a large smile that rarely faded, Whitey, a short millionaire who insisted on keeping his wetsuit top on while standing bottomless in the water, and Alisons partner Chris, an expert storyteller, ski patroller and carpenter. There were more: Clay, Clays brother, and another guy who is a nameless, bearded face. The sun was lost over the crags of gray rock above us. On an upper ledge, Trevor was exploring for hidden pools. The heat permeated my tissue, warming vessels, so blood owed freely into ngertips. Alisons rosy cheeks glowed as she spoke to me. She told me that the rst time she ran this river she was fourteen years old. Her mother dropped her off at a trailhead in the Frank Church Wilderness Area. She hiked into a campsite and hitched rides on raft trips. At fourteen I spent summers in sweaty socks and stinking pennies, training to be a varsity basketball player. My mom dropped me off at local colleges for week-long camps. From 7am-6pm we took hundreds of shots, ran ladders, boxed out defenders, screened for teammates, and dribbled gure eights around our ankles. I wondered if so many childhood summers were wasted on one sport, and if my college years were wasted on hours of practice, weights and running. The heat was overwhelming, so I stood slowly, preventing dizziness, and took a drink from a jug of warm ltered water. I could see Trevors head bobbing about the paradise and I could see the trees turning orange across the river. I didnt want to climb nor did I want to descend. I only wanted stillness. Trevor called me up and I went. He surprised me with a bucket and soap. Keeping the suds away from any water line, we bathed and returned to the tub to nd people draining the spring and scrubbing the rocks. White buttocks bordered in bronze bounced as Nicole, and Alison used brushes to remove our oils from the rocks. I took over for Alison so she could get down to her boat. Darkness came quickly and my eyes confused shadows for rocks on the way down. Harlan greeted me near the shore. He was the youngest on the trip at twenty-one years old, but the most adept in the skill of kayaking. Harlan had been raised in Flagstaff, Arizona, skiing and boating with legends in his youth. This evening he had stayed behind to play in a wave and had more energy than the rest of us. Trevor rowed to our camp down stream only a few yards on river right. Harlan made quesadillas for us by headlamp light while we passed around a bottle of Dickel. The sharp whistle before each shot of whiskey echoed down the valley. There was little sand for bedding down so none were allowed privacy. Nooks between rocks and logs were burrowed into, and at granite slabs were chosen hastily in the urgency of sleep. Two pads lay beneath us, and one unfolded sleeping bag lay over us. I was learning that Trevor sequestered covers so I dressed in warm clothing. He fell asleep quickly. I looked up at the sky. I was sleeping
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in contours of ages; boulders and their pinpoint remains moved by the river that was the only sound. A deep breath was lichen, wet wood, soil, and trout. Stars lit the column of night. I felt the same wonderment three years prior during an earthquake in Cuernavaca. A Mexican family as my host, we sat for a two oclock meal. The thin arm of my host father, Carlos, stirred onion soup in the kitchen. I froze at the dinner table, watching the sunlit windows rattle. Teresa ushered her sons and me onto the back lawn, but her husband would not leave his stovetop. One of my Mexican brothers knelt then lay prone on the grass, arms outstretched. I did the same. The swimming pool, inhabited by pet turtles, built waves that sloshed over onto the concrete. The beats of the earths force drummed like a heart. I thought of Jack clutching the shirt pocket of an angry giant. The waves became ripples, a murmur of earth, then stillness. I awoke to yells and the violent rustle of our sleeping bag. Trevor was up and running toward the water. I heard sharp slaps of horses hooves and cracks of gunre from the sky. I took the nylon bag and pulled it over my head. Then I heard the words in the yells, ROCK FALL! I ran to the shore and crouched behind a boulder. Gazing upwards, I briey saw orange sparks created by granite kissing granite, a farewell to its cliff dwelling. Without the sparks there was black. I strained my eyes in the night but I could not see where the rock was making its path. I heard the deranged spacing of descent, then a splash of water grinding stone in the riverbed to my right. Alison began calling out names, and I realized she was next to me, feet in the river, hands on our shield. Harlan Yeah! Whitey Up here. With each name there was a pause, and with each pause there was fear that the name would not answer.
Kookaburra
Vincent Fulginiti
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Brooke Vezino
KNOWING US
im all in a skirt today she writes, and I can see clearly the moving vibrancecolorslegsarmstride I remember a yellow hooded hug I stole it, held it tight against the confusion the sad.ness Bare feet bright sun knowing eachother and loving eachother (from the inside.)
UNTITLED
feeling wind ful joyful bountiful overfull thankful and like there is so much room past full. with you.
CHAPSTICK
Like a misplaced kiss I still dont know what I need and keep coming back for more. Strange Closeness to you.
Inside the Pyramid
Chuck Gawad 85
Jennifer Suriano
RUMI POEMS
You are with me in my dreams. I am oating, ecstatic, lucky, spinning. My heart has your name, inscribed inside. I open my eyes, but I am already awake.
Composed in response to poems by the muslim theologian Rumi (1207-1273 CE) studied in the Medical Humanities course.
There is a mist encircling my thoughts. My insides ushing, the same color as the wine. The warm elixir crosses my lips, Whispering its soft lullaby.
Your mind is your only playground now. Memories running endlessly in reverse. The speakers are broken, the world is quiet. Trapped, you want no more.
Sleep is waiting for me around every corner. It beckons and teases, drawing me closer. It comes relentlessly, attacking, harassing. It is a battle I ght, but dont want to win.
Old Capitol 86
Chloe Becca
Georgia Hall
AMERICAN INDIAN ELDERS: REFLECTIONS
The Last Sheep I Have Left, Navajo, 1974 David Lundberg
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I Remember How My Grandmother Made Pottery, Tohono Oodham, 1979 Georgia Hall
The Children are Gone, White Mountain Apache, 1980
Georgia Hall
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Michelle Morrison-Galle
BEAUTY
Where all of progress Has yet to pollute The deep ringing of bells, Upon the lazy necks, Of full-uddered cows, Blends with that from a church And the laughter of German children Strange to these ears. Wooden houses built by dead hands Cling to the green hills Like a suicidal man Attempts control over life By tempting One long fall of ending Quiet What does the man think Who spreads manure On his small, vertical elds Of minuscule, Yet complete, sustenance When the train of aliens Roars through the canyon of his life? Does he long to follow those tracks Or does he simply breathe out His fattened bodys exhaustion Into the sky With mountains painted upon it That quietly embraces The perfect lake In a sort of copulation of the elements That births the land Which dances, green, upon the water.
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SOMEWHERE BETWEEN ROME AND POMPEII

This white, walking skin cries out, No More, After greedy days, both hot and cold, Have sucked it hollow, Burnt it red. Still mind overcomes And the knee muscles inch enough To send a lounging y To a preferred domain. Rhythmically we lean, Left and right, Against the jars of the train With the heat sitting upon the backs Of necks and knees Breathing in quick tastes of the Mediterranean Which come through the cracked window Like raindrops in the desert Returning, without words, from the City of the Dead There, ashen bodies Felt greater ames than these And cried out into the grayness Filling their mouths Just trying to stand or die But frozen The train comes to a stop The loud children from the next car vanish Their music transformed into Still silence And the stranger across from me Meets my eyes Some understanding amid our foreign tongues
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IDEOLOGY
Beating breasts, The voices join together Swell Words inaudible In the frenzied cry of Victory. Meaning lost For the greater Good, So dened, By the Word Not truth, not reason They march forward Flames in their wake Smoke swirling round the faceless forms. The Howl driving, Pushing, To unspeakable acts, Of which the crushing wall called Unity, Holds them unaccountable. I cower to the side Trying to escape My ears ringing Steam dripping down my burning cheeks Struggling to nd the woman or man The son, the daughter Sister, Brother Lover Hidden in the shapeless mass, The deafening drone. My small voice weeping; A small white bird, Flying broken winged, Seeking a branch to hold. I watch, As stubborn force meets stubborn force And the hand of the divine Finally Reaches down to split the Earth between them, Lifes foundation shaking beneath my feet. And when I fall, Into that great divide Darkness embracing me Swallowing me whole Along with the children, the old, the innocent, The angry, vengeful, and righteous, The pieces of yesterday And tomorrow, There is quiet.
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THE PAPAYA WARS

the arrival of the Colorado Low sky pushing forth oating multitudes and his lips brought to mine, owering in paleness, baring the pocked back Demanding touch suddenly The Hair burst forth Soliloquy lounging on the drooping discoloured esh of fruit placed before me Rejected for four days in a row singing songs with babys crying bills beat upon the mailbox door i opened my mouth against his cold lips reluctantly allowing the serpent in understood then Falling Plaster Bruises blueing her eye and why, for years i sat against the vent Lined face listening to mumbled shouts monitoring Love
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Laila Halaby
A DAY AT THE PARK FEW DAYS BEFORE

March, 2003
pink mouths talk loud and fast about husbands discount buying clubs cloth diapers diaper rash good schools test scores due dates selsh fact after great selsh fact attens tensions into circles of chatter no aches no loss spelled in heavy words no Indian movies just minivans sleep patterns poop patterns eating preferences refused vaccines fat emptiness translated into purchasing on-line Gap quality at discount prices forgotten pedicures longed-for massages a solitary father appears and that dowdy self-conscious mother smoothes her hair her legs her tummy but remains thick
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and maternal while those two tight-jeaned hiply-dressed mothers watch him match their neat son daughter baby perfect production and source of endless conversation paint pictures of their completely dilated cervixes struggle to pull out breasts bursting with milk
no talk of the war thats coming those thoughts lie hidden inside somewhere smothered by routine or lack of interest
Hitlers Victims
Kelly Sandburg
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Laila Halaby
DAY 4: THE IRAQ WAR, PENMANSHIP

Its all mapped out, planned like a trip from start to nish (a trip to Hell). Anticipation loosens bowels, tempers, missiles shit ies ofcers throw grenades tantrums and its all part of the plan the scheme the reinvention of the Middle East (middle of what? east of whom?) Money holds the pens has all the relocation done by people who have never heard of Mont Blanc and would think it ridiculous to waste that kind of money on a pen, no matter how powerful the ink. Ashes and dust and re spew overhead dribble down knotting themselves into peoples lungs like hatred. Beautiful hills are still beautiful only now theyre littered with shrapnel and death, the kind that makes people see crooked breathe rage swear revenge.
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Ron Grant
THE OTHER SIDE OF THE CURTAIN

(excerpt)
When I was seven I calmly witnessed a neighborhood boy get hit by a car. The scene unfolded before me like a video in slow motion: The boy chasing an errant baseball into the street, a gunmetal gray Fairlane bashing into his thighs just above his kneecaps, and then, at the moment of impact, the simultaneous look of shock on both the drivers face as well as the boysseconds before the boys look slowly changed into a pained grimace as he was sent ying across the pavement. Then the moment proceeded in a more normal fashion: The driver leapt from his car and threw his jacket over the boy, people who were watching the baseball game at the schoolyard dashed over to help, someone scurried away to call an ambulance, and my mother, who must have seen the boys red hair and thought him to be my younger brother Richard, came screaming from our lawn which was three doors down the street. I, however, remained quite calm, watching with curiosity as the help cleaned the blood and gravel from the boys face, and then soaked his forehead with a wet T-shirt until he regained consciousness. And though my mother (who remained quite upset) held onto me tightly as the men from the ambulance took over the scene, I watched the paramedics strap him to the body board and load him into the back of the wagon as coolly as if I were watching cartoon characters try to kill each other. Despite all the bloodsome spattered over the boys clothes and some staining the streets asphaltI stood by watching the scene with the same awe-struck look I might have had inside a science museum. My parents viewed this lack of squeamishness on my part as a sign that my future would include some form of medicine. How can you stand to watch that, they would say while turning their heads away from the television during some graphic video of a surgeon performing an open-
heart procedure or when a predator ate prey on Animal Kingdom. Nothing gory bothered me. I loved medical documentaries, I was fascinated with any kind of medical procedure (I especially loved watching my blood squirt into one of those vacuum tubes during a phlebotomy), and when my little sister received a vicious bite several millimeters above her right eye by some unknown German Shepherd, I was the one who stood next to her in the exam room and watched her get sutured. The human body and all its inner workings fascinated me like airplanes and spaceships mesmerized most of my friends. When I was a freshman in high school, I fell on a broken beer bottle while running through the woods, splitting open a hole in the upper part of my right thigh. Realizing I was in no imminent danger, I sat on a log while my teammates ran for help, watching the red stain slowly spread out across my sweatpants, and then, when the help came and pulled up my pant leg, I stared at the white lining of my thighs fascia that was exposed by depth of the wound. I didnt get upset or show signs of panic; I simply sat and watched the blood dribble down into the snow each time it relled the gaping hole in my thigh. I decided that my parents were right about the career I should choose, or at least it seemed that way. It seemed that I had the perfect demeanor for a doctor: someone who was calm, cool, and detached in situations other people found grotesque; someone who didnt have to look the other way when it was important to be focused. And I believed medicine was the right choice until the moment I began my medical school anatomy lab. I can remember walking into the lab on that rst day of class, my heart going from a utter to a pound as we sat down on the oor and listened to the head of the department tell us about the
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upcoming dissections. Though we hadnt yet unveiled the cadavers, I remember looking around the room as the professor spokeat the way the walls picked up the brightness of the articial light, at the bony skeletons dangling in the corners, and at the sterile gleam coming from the steel tanks that surrounded us like sentinelsthinking only about the bodies that were lying so close to us. What did they look like? I wondered. What did they die from? What caused them to decide to donate their bodies to the school? Who were these individuals who sacriced a proper burial so we could learn human anatomy and become educated doctors? I wasnt quite sure how I felt in the room where the cadavers lived. I remember sitting cross-legged on the oor in the middle of all those tanks not sure where to feel thrill or apprehension, excitement or uncertainty, awe or dread. I couldnt wait to begin the dissection, yet I couldnt reconcile that desire with the knowledge that the people lying in those tanks were once real human beings doing real human behaviors. And though it wasnt very long before we were sliding our ngers through greasy human esh as easily as one separated chicken parts from a carcass, I never got over the anxiety that overcame me the rst time I saw our cadaver Bernie, hairy and naked, elevated out of his tank of murky preserving uid. I never got over the indignity of seeing the placid way he stared at the orescent lights in the ceiling, as we carved our way into his chest and abdomen. Sometimes, while studying the dissections of the previous morning, I would lie in my bed at night and wonder if anyone else in the class was as ambivalent as I was at having to continue dissecting a cadaver. Was my hesitation due to never having had human anatomy before? Was it because death bothered me more than most? Or was I just plain weird? Brian Rifkin, one of my tank partners, liked to temper the silence that often enveloped the room by positioning the skeletons in erotic poses, and by occasionally auctioning off cadaver parts that we no longer needed. While my colleagues plugged away, their arms immersed in an abdominal cavity lled with body fat and formaldehyde, Brian would walk up and down the aisles between the tanks holding Bernies most recent discard high in the air. Liver for sale, he
would say each time he passed a new group of students. Right here, get-cha fresh, clean, liver for sale! Barely used. Extra smooth lobes. And a great price. Who will buy this beautiful liver? Yo, Mark, how about it? Itll keep real nice in your freezer. Brian, who was later identied as the person in the class most likely to become a coroner, eventually became my study partner, and we split our nights and weekends between Memorial Library, where we would each get a cage in the stacks, Madison General, where we would hunker down in some private doctors cubicle, and the anatomy lab where we would sometimes re-exhume Bernie, and other times open the tank with the already-labeled body parts. Though the nights often had a surreal texture to them, and there was something utterly fantastic about shing through a tank of oating hands, arms, and legs, or tagging small muscles in the forearm as decapitated heads stared at us from the nearby counters, I sometimes stopped in the middle of a session because a great sense of sadness would well up inside of me. I would be standing with my ngers in Bernies upper chest trying to locate the individual branches of his phrenic nerve, and I would suddenly have a momentary recollection of what he had looked like the week beforewhen most of his body was still intact and he resembled what he looked like to the people who knew and who loved him. When we pulled back the ap of skin covering Bernies face, I let my partners continue the dissection of the muscles of expression and mastication because the ghastly sight it presented no longer looked like Bernie. Even though my brain told me that what I was looking at was just bones and esh, I couldnt help feeling that destroying a face was somehow unholy, as though Bernies identity was being stripped from him with each layer of skin and each section of muscle removed. When Brian cut through the masseter and removed the buccal fat pad to expose the buccinator, I remember thinking to myself that Bernie could no longer smile. And no longer kiss. His dignity had disappeared with his facial expressions. By the end of the semester, Bernie was no more. Left was an unrecognizable sarcophagusbones, skin, fascia, fat, muscle, organleaving me
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with a tremendous sense of loss and despair. The excitement I had originally felt in uncovering the miracle of human anatomy disappeared as Bernies body parts were discarded into the trash, making me realize that what was once sacred was now being burned in some crematorium-like oven deep in the bowels of the medical sciences building. Richard Selzer is a surgeon who wrote an essay called The Knife. In it, his scalpel takes a journey of both beauty and danger, a journey that ends deep in an abdominal cavity lled with metastatic carcinoma. Full of metaphor and religious imagery, his knife becomes more than a surgeons tool, and the surgery he performs more than a means to a cure. And if the surgeon is like a poet, he writes, then the scars you have made on countless bodies are like verses into the fashioning of which you have poured your soul. When I nally nished medical school, one of the reasons I chose a non-surgical specialty was because, like in anatomy lab, I found the practice of cutting into human esh inherently sacrilegious. Gore had nothing to do with it. I had no difculty with a venue that someone else might nd gruesome; as a matter of fact, the only time I came close to passing out or losing my nerve was in a patients room several days after the procedure that splayed open his chest. It was during my cardiovascular rotation at the VA hospital towards the end of my third year of medical school. The patient, a middle-aged man three days post-op from open heart surgery, was lying quietly in his bed, his head propped up on two pillows, the bed sheet crinkled at his waist. In the middle of his once hairy chest was a massive wound running from his sternal notch all the way to his umbilicusa wound so severe I couldnt keep my eyes off it. Though we had seen many other patients that morningsome smoking cigarettes from their trachs, some walking on their stumps, and some bandaged like mummieswhat I remember most about that hot, stuffy morning was not the patient in the ICU who was about to die, but the little bit of green pus that oozed from the staples holding his sternum together when one of the residents pressed on his rib cage. I dont know if it was partly due to the early hour, or the fact that the airconditioning wasnt working very well, but when I saw that ribbon of pus I felt a wave of wooziness
come over menausea and weakness that lasted until I excused myself to the chair in the corner of the room where I could wait it out with a couple of long, deep breaths. Later, I wondered what it was about that particular moment that caused me to lose my composure. After having seen many other disconcerting sightsa draining breast tumor, a rectum full of genital warts, a puncture wound to a childs eye, a neat little hole from a gunshot woundand others that were worse, I wondered why some insignicant amount of pus had almost brought me to my knees. Though I didnt fully comprehend my reaction at that one moment, I later came to realize that there was something atrocious about the nature of the wound on that mans chest and the way it violated his body so near to his heart something that reminded me of human weakness and vulnerability. Similar to the sensation that overwhelmed me on the rst day of anatomy lab, what I experienced that morning on the surgical ward wasnt fear, or revulsion, or even an aversion to being in the same room as someone who is ill and frail, but a sense that the patient lying there in front of me carried with him a great responsibilityand that I was charged with seeing that responsibility carried out in a dutiful and reverent manner. Like the reverence that we should have held for our cadavers as they willingly gave up every part of their bodies during our morning dissections. Not since my days in the anatomy lab have I desecrated human esh like I did when we cut apart our beloved Bernie, and not since that morning at the VA, has a patients wound weakened my knees like the young veteran with a stapled chest. But I did come to understand the difference between feeling a little bit squeamish and not wanting to partake in an act that violated the hallowed and the holy. I also understood why Dave Rifkin chose to fool around in anatomy lab. My way out of the impasse was to specialize in pediatrics, a specialty mostly devoid of morbidity and mortality, a specialty where children play together in rooms painted with brightly colored balloons and clowns, and where pictures of rambunctious dogs playing in open elds of grass hang on the walls. Though we chose a different methodology, Brian and I were both
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able to avoid distressing situationswe were both able to reconcile the sacrilege we had committed with the knowledge we had gained. And though I still nd myself captivated by having my blood drawn and by documentaries on television that show a live heart pulsing inside of an open chest, I can no longer stand with comfort and ease at the sight of a car accident, especially if a young child is involved. I can hardly bear
to hear a child sob, because the sound can be so unbelievably heart-wrenching. Having to drive a three-week old baby to the morgue, and having to care for a ve-year-old whose belly is rapidly lling with tumor will do that to you. Practicing a learned skill on real human esh with so much at stake will do that to you. Even if you think you have the right personality and the proper demeanor to handle all the blood and the guts and the gore.
Saint Pauls Cathedral, Side Entrance, London
Chloe Becca 99
Donna Swaim
MY REALITY
Formed by experience Shaped by interaction Reinforced by reading Enriched by challenges It enfolds me nourishes me amazes me Existence itself is miraculous Ultimate answers are mystical beyond the rational To recognize the element of coincidence To realize that who I am is the sum total of all I have been and all I have seen and all those who have been and seen before me To understand that I am the result of all the choices made by those before me and those around me Is to realize that I am an inextricable part of something much larger than myself to which I owe a debt of gratitude and love Therefore, my metaphysical reality cannot be dened by a single belief by a single faith by a single identifying term which would separate me from other human beings. My reality is encompassing, inclusive, and expansive continuing to grow continuing to be challenged continuing to amaze and delight me Thank you for being part of it
A Hair-raising Fun Time 100
Tessie OTalley
Bird Lady
Marilyn S. Brodwick
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CONTRIBUTORS
LA TANYA SIMONE AUTRY was born 1970 in Detroit, Michigan. As a child she also lived in Texas and Virginia. Her studies and adventures led her to Massachusetts, New York, Europe, and currently Tucson, Arizona. She is a senior at The University of Arizona majoring in art history. DALILA AYOUN is an associate professor of French Linguistics and SLAT (second language acquisition and teaching) in the department of French and Italian at The University of Arizona. World traveling and photography are two of her passions. R. DENNIS BASTRON, M.D., is Professor of Clinical Anesthesiology and a member of the American Osler Society. If anyone would like to learn more about Dr. William Osler, please feel free to contact him, and he will help you develop a directed reading plan. His email is rdbastron@comcast.net. CHLOE BECCA has worked at The University of Arizona since 1999, and has been employed with Mountain States Regional Hemophilia Center, The University of Arizona Health Sciences, for ve years, doing medical social services and as an HTC (hemophilia treatment center) counselor. Her research interests are in the medical psychosocial eld, and currently reect her activities within the hemophilia treatment center and greater bleeding disorders world community. She is currently working on her dissertation for her M.S.W. MARILYN S. BRODWICK, M.A., Galveston, University of Texas Medical Branch, exhibited her photographs: The Faces of Aging at The University of Arizona Health Sciences Center Library in October-November 2004 as part of 2004-2005 Speaking and Seeing: Perspectives on Aging, sponsored by the Kenneth A. Hill Memorial Fund, the Arizona Center on Aging, and the Medical Humanities Program at the College of Medicine. She has received numerous awards for her work which hangs in permanent museums, such as the Museum of Fine Arts, Houston. Brodwick is a geriatric researcher in the Sealy Center on Aging at UTMB and a freelance photographer. DANIEL CUCHER is a rst year medical student at The University of Arizona. SARAH DANIELS is currently a third year medical student at the College of Medicine. She was born and raised in Tucson, but left to attend college in New York where she received her Bachelors degree from Colgate University in 1999. Prior to entering medical school, she lived in Namibia, Africa, for two years as a Peace Corps Volunteer. She recently married; her husband is a teacher in Tucson. SUSAN FERGUSON has worked as a registered nurse since her graduation in Philadelphia in 1976. She has 28 years of experience in the emergency department as a staff member or a manager. She is also a yoga and meditation instructor and teacher-trainer and a community volunteer. She is a member of the ENA. MARY FOOTE grew up in Tucson, Arizona, before attending Northern Arizona University to obtain a Bachelors in Chemistry and History. She returned to Tucson and is now in her 4th year in the M.D./M.P.H. program at The University of Arizona. Being an avid traveler she is currently enjoying a leave of absence doing a research fellowship in the Peruvian Amazon and is looking forward to a career in international health and human rights. JUANITA FRANCIS is a registered nurse with an M.B.A. in Health Care Management. She worked for the AHSC, Phoenix Campus from 1999 through 2004. Her professional career includes the titles of labor and delivery nurse, childbirth educator, womens health manager, development director, and project manager. She has lived and worked in the Midwest and Boston, before moving to Phoenix in 1998. Her community volunteer work includes a pre-school start up and a teen parenting program in Chicago, Dressed for Success in Boston, and the Maricopa County Medical Interpreter Project in Phoenix. She and her
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husband, Phil, have been active members of the Alexis de Tocqueville Society of the United Way for 20 years. Her hobbies include homemaking and hiking. VINCENT A. FULGINITI is currently Professor Emeritus, at Departments of Pediatrics, School of Medicine, University of Colorado Health Sciences Center and The University of Arizona College of Medicine, AHSC. He was educated at Temple University where he received successive degrees of B.S. (1953), M.D. (1957), and M.Sc.(1961). In 1969 he became the founding department head of Pediatrics at the new medical school at The University of Arizona, remaining in that position for the next 16 years. He then successively became Associate Dean for Academic Affairs (1985-1988) and Acting Dean (1988-1989) there. For the next 4 years he was Dean of the School of Medicine at Tulane University in New Orleans, and in 1993 became Chancellor of the University of Colorado Health Sciences Center, resigning that position after 5 years in early 1998. CHARLES GAWAD is a native Phoenician, and he studied chemistry and microbiology at Arizona State University. He will be entering the eld of medical oncology where he hopes to study both the basic science and the pressing questions that arise from the clinic in pursuit of better diagnostic and treatment strategies for cancer patients. In his free time, he enjoys reading, cooking international cuisine, and traveling. LISA E. GOLDMAN has her undergraduate degree in History, Political Economy and Fine Art from Evergreen State College and her Masters in Social Work from Arizona State University. She raises ducks in her spare time. RON GRANT is a board-certied pediatrician who recently completed an M.F.A. degree in creative nonction at The University of Arizona. He has been published in The Oklahoma Review and Creative Nonction and is currently working on a memoir about leaving medicine titled The Other Side of the Curtain. This piece is an excerpt from that book. ANDY GULBIS grew up in Tucson and completed his undergraduate education at The University of Arizona. He is interested in improving global healthcare policy, searching for the ultimate taco stand, and understanding universal drives. LAILA HALABY was born in Lebanon, to a Jordanian father and an American mother. Her rst novel, West of the Jordan, was published by Beacon Press, 2003 and received a PEN Beyond Margins 2003 Award, as well as ForeWord magazines silver medal for Literary Fiction. She also writes poems, short stories, and childrens ction. Her work has been published in several anthologies and literary journals. Her education includes a B.A. in Italian and Arabic, with a French Minor, from Washington University, a Fulbright scholarship to Jordan, an M.A. in Near Eastern Languages and Cultures from UCLA, and an M.A. in School Counseling. She currently lives with her family in Tucson where she works as an Outreach Counselor for The University of Arizonas College of Public Health. GEORGIA G. HALL, Ph.D., M.P.H., is Clinical Associate Professor at The University of Arizonas College of Medicine, Department of Family and Community Medicine, Phoenix Campus, and Core Faculty of the Arizona Geriatric Education Center and Gerontology Program. In addition to teaching gerontology and geriatric care, and cross cultural perspectives on aging, her special area of interest is aging among American Indian Populations, and she works extensively with tribal groups and elders in Arizona. NYLE HENDRICKSON is a University of Arizona medical student who loves to dive, dance, eat, climb and otherwise explore our world. If you are interested in joining the spring trip to Nicaragua please email nyle@email.arizona.edu. CHARITY JACKSON is currently a rst year medical student at The University of Arizona. She enjoys writing when she can nd the time to do so, and has found that learning medicine has given her both ample issues to consider and the strong desire to write about them.
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LANE P. JOHNSON, M.D., M.P.H. received his M.P.H. from the University of California at Berkeley in 1979, his medical degree from The University of Arizona in 1983, and went on to complete his Family Practice Residency at the Arizona Health Sciences Center in Tucson. He is an Associate Professor of Clinical Family and Community Medicine and in the College of Public Health. Current responsibilities include Directorship of the MD-MPH Dual Degree Program, the Clinical Preceptor Program, the College of Medicine curricular revision project, and Principal Investigator for a study of herbs used by Hispanic patients with diabetes. His interests include public health and alternative therapies. ALLISON FRACLOSE KLEINE graduated with a degree specializing in Creative Writing in Fiction and has completed several correspondence courses with The Institute of Childrens Literature in Connecticut. She has written a number of short ction, nonction, and poetry submissions for popular childrens magazines such as Cricket, Jack and Jill, and Highlights for Children. She currently works for the Head of the Department of Pediatrics in the College of Medicine and lives with her husband and their two cats. CHRISTINE KRIKLIWY was born in Lahore (formerly known as Paris of the East). She has traveled half the world and would like to come full circle. She has worked in arts administration and health and is the voice for those trying to be heard. JIM LAUKES fools about in several genres including video, gardening, comedy and interactive media. He is an Information Specialist at the Rural Health Ofce and a doctoral candidate at the University of Plymouth. JESS LEBLANC has got Oregon roots and Arizona branches. In April, Trevor and Jess celebrate their twoyear wedding anniversary. Her writing guru is Robert Baldwin, a man committed to the growth and creative spirit of young people. She does not put a word to paper without thinking of him. Peace. BETSY MCARTHUR LEROY is a mom, wife and second year medical student who has breastfed her daughter Claire, among other places, in the MDLs while viewing pathology slides. She frequently leaves class with her pink pump bag and wants to encourage and demystify the privilege of breastfeeding. NORMA LESLIE is a graduate of Oklahoma University and is a Womens Health Nurse Practitioner, Licensed Marriage and Family Therapist, and a Certied Sex Therapist. She is on the faculty at Phoenix Integrated OB/Gyn Residency Program and has a counseling practice in Phoenix. JOY LIPPE is a third-year medical student, currently considering a career in Med-Peds. She grew up on a dairy goat farm in Arizona, and loves animals, the outdoors, ballet, theatre, reading, cooking, watching movies while eating popcorn, and playing games. CLIFFORD MARTIN is a second year internal medicine resident at The University of Arizona, who also completed medical school at The University of Arizona. He did his internal medicine internship at NYU/ Bellevue in New York City. He plans to do an Infectious Diseases fellowship at The University of Arizona after residency. PAULA MARCHIONDA, R.N., B.S.N, EMT, FF1, MT, BUS, BSA, is the third offspring of a rocket scientist and RN union of considerable longevity. She is currently enrolled as a second year medical student at The University of Arizona College of Medicine. She likes margaritas better than pia coladas, but does enjoy walks in the rain. She has a checkered past of various careers, schools, degrees and philanthropies with a noted paucity of legal entanglements. At present, she resides in Tucson with her spousal equivalent, Mike, enjoying the winter sun and abhorring the scorching summer. Mike and Paula love to peregrinate anywhere and everywhere and are known to search for deals to exotic places instead of doing what they really should be like studying. Whilst traveling, she carries her trusty camera to capture interesting simulacra to keep for posterity. Paula also has a marked fondness for palindromes and palavering.
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(SHAD) FARSHAD FANI MARVASTI has had a long-standing interest in the humanities and served as the founding Chief Editor of Harmony Magazine. His research activities at the NIH and Stanford School of Medicine have resulted in four publications. Shads volunteer work at Las Fuentes Health Clinic in Guadalupe, Arizona, led to a successful grant proposal to St. Lukes Health Initiatives to build a treatment center and address the chronic head lice infestation among the communitys children. He has been an active member of the Bah International Community and was elected Chairman of the Spiritual Assembly of the Bahs of Tucson in April of 2004. Shad is trilingual and enjoys poetry, the performing arts, and spending time with his parents. HELLE MATHIASEN holds a Cand.mag. degree in English and Ancient Greek from Copenhagen University and a Ph.D. in English from Tufts University. She emigrated from Denmark in 1965 and has taught at The University of Arizona since 1993. Her research interests include medical humanities, Danish women authors, and Danish World War II history. In 2003 she became founder and director of the Medical Humanities Peogram at the UA College of Medicine. http://humanities.medicine.arizona.edu CHRISTINA MENOR is a travel and photography enthusiast. She is originally from Indiana and has lived in Arizona for 15 years. After completing a B.S. in Microbiology and an M.S. in Nutrition, she began medical school at The University of Arizona College of Medicine. Currently an MSII, she aspires to enter a career in womens healthcare, working towards providing continuing prevention and care for female patients of all ages. JOEL S. MEISTER is Professor of Public Health in the UA Mel and Enid Zuckerman College of Public Health and Director of the Colleges Concentration in Public Health Policy and Management. He has been working in and with border communities for over twenty years. During that time he became involved in one communitys struggle to deal with an apparent cancer and Lupus cluster, a struggle that brought national attention to the area and its residents and led Dr. Meister to write a book length work, a short piece of which is being published here. MICHELLE MORRISON-GALLE is a second year medical student at The University of Arizonas College of Medicine. She attended McGill University in Montreal, Canada where she studied English Literature and Anthropology. Coming from a family full of musicians, she has always been interested in the arts and writes poetry and paints in her spare time. She also enjoys traveling, and so far her travels have taken her to Europe, East Africa, and throughout the United States and Canada. Traveling is denitely one of her main sources of poetic inspiration. She hopes eventually to do international work in womens health. MARK MUSSARI has his Ph.D. in Scandinavian Languages and Literature. His articles have appeared in numerous magazines and academic journals. He has taught in the Medical Humanities Program at The University of Arizona. TESSIE OTALLEY runs the Learning Resource Center for the Arizona Health Sciences Center and comes from a family of amateur artists and craftspersons. Her hobbies, in addition to photography, are genealogy, art, exploring different crafts, playing with her two cats and puttering around the house and yard. BRUCE PARKS is the Chief Medical Examiner of Pima County and a Clinical Assistant professor of Pathology at The University of Arizona. He has been working as a forensic pathologist for Pima County since completing his fellowship in 1987. He received a B.S. degree in Chemical Engineering in 1978 and graduated from The University of Arizona Medical School in 1982. Dr. Parks completed a pathology residency in 1986 at the UA. He is married to Dr. Rosalia Kame whom he met in medical school. They have two teenage children, Mario (15) and Jeneva (13). Fritzy, their dachshund, completes the immediate family. Dr. Parks hobbies include bicycling, singing, and playing the guitar.
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ESKILD A. PETERSEN, M.D., D.T.M.&H., is the current Chair of the Quality Safety Board at University Medical Center in Tucson, AZ. He was Chief of Staff from 1999 to 2002. He is a Professor of Medicine, Family & Community Medicine, and Public Health. He is an Associate Department Head of Medicine and the Chief of the Section of Infectious Diseases. Dr. Petersens background in quality control efforts has been originally based in the area of infection control where he has been involved both locally, in Tucson, as well as internationally with reform efforts in both Central Asia and Russia. He has rsthand knowledge of different health care systems in countries around the world. After attending Hamilton College in Clinton, New York, CHARLES PUTNAM received his M.D. degree from Northwestern University Medical School in Chicago. After a residency in general surgery, Dr. Putnam was a faculty member at the University of Colorado. He joined the Department of Surgery here at the UofA in 1977. After a 30-year career in surgery, Dr. Putnam entered graduate school and recently received his Ph.D. in Molecular and Cellular Biology from The University of Arizona. He is currently engaged in cell cycle research and undergraduate teaching on Main Campus. His story was inspired by experiences during his Internship at the University of Colorado. Born in Manchester, England in 1932 of Lebanese parentage, JOHN RACY received his primary, secondary, and higher education in Beirut, Lebanon, graduating with distinction from the American University of Beirut School of Medicine in 1956. He secured his residency training, followed by a Foundation Fund Fellowship in Child and Liaison Psychiatry, at the University of Rochester. In 1966, Dr. Racy returned to the United States and to the Department of Psychiatry in Rochester, where he served successively as Director of Residency Recruitment Head of Inpatient Services, and Director of Residency Education. In 1978, he became Professor of Psychiatry at The University of Arizona. Dr. Racy is married and is the father of three children, all of whom live in Tucson. His interests include reading, hiking, classical music, and international travel. JARED ROBBINS grew up as the oldest of six children in a small rural farming community in Southeastern Idaho. Before starting medical school, he attended BYU-Idaho, and ASU and worked for the Trauma Research Department at St. Josephs Hospital in Phoenix. He has been married to his lovely wife Nicole for 4 years, and they have an energetic little two year old son, Carter. Together they enjoy hiking, biking and camping. GONZALO M. SANCHEZ, M.D., is a Board Certied neurosurgeon who completed his medical education at the University of Puebla, Puebla, Mexico, and his Residency training in Neurosurgery in Madrid, Spain, and at New York University. In the spring of 1973 Dr. Sanchez joined the University of South Dakota Medical School, Department of Surgery, as Associate Professor of Surgery, combining this work with private practice for 25 years, retiring in mid 1996 due to medical reasons. Dr. Sanchez has been involved in the last eight years in Egyptological medical studies and the History of Medicine. Currently, Dr. Sanchez main pursuit is to produce an update of the Edwin Smith Surgical Papyrus in conjunction with University of Toronto Egyptologists. KELLY SANDBURG is married to a premier oboist, Carrie. They have one daughterEmelieand another on the way (August 05). They enjoy music, hiking, reading, and laughing together. He holds undergraduate degrees in Biochemistry and Russian. Photography, jaguar safaris, eating alpaca steaks, hunting the endangered black cayman, and tropical medicine have always fascinated JOE SCIONTI. If you are interested, he recommends visiting the Peruvian Amazon Basin. DAN SHAPIRO is an Associate Professor in Department of Psychiatry. He is the author of two books, Delivering Doctor Amelia and Moms Marijuana (Random House.) His essays have been on NPRs All Things Considered and appeared in JAMAs A Piece of My Mind and in the New York Times.
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EVA SHAW is an M.P.H. student with a concentration in policy and management. KEVEN SIEGERT is the Media Center Director at The University of Arizona Health Sciences Phoenix Campus. A recipient of the Pima Arts Council Artists Fellowship, and named Video Artist of the Nineties by the Tucson Citizen, Keven creates art in the mediums of video, photography, paint, sound and web. RON SPARK, M.D., an Associate Professor of Clinical Pathology, is Director of Clinical Microbiology at UMC. Spark has strong interests in Americana and Popular Culture, and he is author of Fit-to-Be Tied: Vintage Ties of the Forties and Early Fifties and is a recognized authority on that arcane subject. He drives a 1972 Checker Taxi cab. He also shares an open and admitted house sale-swap meet addiction with his wife. PATRICIA STANLEY is the Graduate Program Coordinator for the Medical Pharmacology Graduate Program in the College of Medicine. In her spare time, Trisha enjoys writing poetry and has had one of her poems published in the Downtown Tucsonan. One of her poems published here is dedicated to her cousin Eliza Romero Montano who fought an eight-year courageous battle with Non-Hodgkins Lymphoma. Her positive attitude and verve for life will never be forgotten. MARK STORY is a musician, digital artist, explorer, and dreamer. Mark has been a computer programmer for over 25 years working in many technical elds including developing high quality computer graphics, uid dynamics and physics simulations as applied to computer animation and scientic visualization. DONALD SULLIVAN is one of the elite, non-traditional med students who spends too much time wondering why East Coast drivers have bad reps, T. Cruise doesnt have an Oscar, it took 86 years to win the WS, the hottest state in the US has no beaches and he didnt attend medical school in the Caribbean. JENNIFER SURIANO is a third year resident in Internal Medicine. After serving as Chief Resident next year, she plans to practice general outpatient internal medicine in Tucson. Her professional interests include Womens Health and Nutrition. She enjoys cooking, playing tennis and traveling with her husband. DONNA SWAIM was born in Nebraska. She holds a Ph.D. in English from The University of Arizona where she teaches in the Medical Humanities Program. She has led discussions at Arizona Theatre Company, presented programs for the Arizona Humanities Council, taught classes and led workshops in prisons, taught several courses in the Adult Humanities Program, and worked as Facilitator of Spirituality and Medicine since the beginning of the Program in Integrative Medicine. Perhaps, among many other awards, the plaque from her prison students may be most highly valued as it presents her the august title of Honorary Convict. QUINN SNYDERs hands are a mess. He has broken every one of his ngers, often more than once, from a variety of colorful incidents. The left thumb was broken when his mother slammed it in the door of a doomed white Volvo outside his future elementary school at the age of three, the right thumb was broken when he himself slammed it in the door of his silver Honda Civic at a gas station in Scottsdale at the age of 17. Calluses rage after a long spat of bartending and now from countless afternoons of rock climbing. Blood stains the goat skin of his rst Djembe due to many evenings of drumming with reckless abandon. He plans to double glove during his Surgery rotation. Sierras aunt is NICKY TEUFEL-SHONE, associate professor in the Mel and Enid Zuckerman College of Public Health. Dr. Teufel-Shone has worked in community-based health promotion for more than 20 years with native communities through the Southwest. She enjoys backpacking, having hiked the Grand Canyon more than 25 times with her sister, and hiking on the Navajo Reservation with her husband Louis and Sierra.
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BRUCE M. VAUGHAN was born in Detroit, Michigan and grew up in Toronto, Ontario, Canada. He is a Space Planning Manager at The University of Arizonas department of Space Management. Bruce received his bachelors degree in Economics and Marketing from The University of Arizona. He is currently working on his Masters Degree in Fine Art. Bruce likes woodturning and metal sculpting. He has been turning wood for 6 years and has just started exploring metal sculpting. Bruce won second place in the 2004 Arizona Health Sciences Center Library show On Your Own Time competition in sculpture for his woodturning of a Jojoba bowl called The Scream. BROOKE VEZINO is between her 3rd and 4th year here at the College of Medicine and is looking forward to a residency in Family Medicine. This year, Brooke served as the AMSAs Director of Student Programming in Washington DC, where she focused on encouraging and empowering medical students to be active in their own lives, whether it be through commitment to personal wellness, curricular reform, or sociopolitical activism. ANNE WELCH is a rst year medical student. She majored in English Literature at Northwestern University and then returned to the desert to begin her medical career. EVE A. WOOD, M.D., psychiatrist, Clinical Associate Professor of Integrative Medicine at The University of Arizona, and author of the ground-breaking book, Medicine, Mind and Meaning, teaches at workshops and conferences nationwide. Uniting body, mind and spirit in an empowering treatment model, she helps people take charge of their emotional lives. She teaches the course Learning the competencies through Literature in The University of Arizona Department of Medicine Medical Humanities Program. www.DrEveWood.com.
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Buenos Aires National Wildlife Refuge
Eskild Petersen
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SUBMISSION GUIDELINES
Harmony is a literary journal of essays, short stories, art, photography, poetry, and other expressions of creativity. It is a publication of the Arizona Health Sciences Center. Students, faculty, and staff of the Colleges of Medicine, Nursing, Pharmacy, and Public Health are encouraged to submit original, unpublished work to our journal. Work on any theme or topic will be considered, but most of our published work speaks to medicine and health. 1. 2. 3. 4. 5. 6. All submissions should be no more than 3,000 words. Up to 3 submissions will be considered from each author or artist. Work should be clearly titled. Previously published work will not be considered. Submissions are accepted either via email or mail. Submissions should include the authors name, a biography of approximately 50 words, a mailing address, and an email address. 7. Any work submitted by mail should also include a copy on a CD. 8. The preferred le form for documents is Microsoft Word. 9. Artwork submitted electronically is preferable in a .jpg le of at least 300 dpi or a .tif le. 10. If any submitted material is to be returned, please include a self-addressed stamped envelope. 11. Each published contributor will receive two copies of the journal. 12. Thank you for your interest in and submissions to Harmony.
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Send submissions to: Harmony Editor Medical Humanities Program College of Medicine Arizona Health Sciences Center P.O. Box 245017 Tucson, AZ 85724-5017 Send electronic submissions to: harmony@medicine.arizona.edu Please direct any questions to harmony@medicine.arizona.edu. Thank you!
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Javanese Woman
Marilyn S. Brodwick
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God Bless My Universal Remote Control
Keven Siegert

Harmony Magazine, Volume 7 (2005-2006)

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V O L U M E

Art Essays Ideas Photographs Poetry Prose

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

Katherine Glaser Editor

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

OPEN THE BOOK

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

GRANDMOTHER CALLED A WHILE BACK

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

REFLECTIONS ON THOSE WHO DONATE THEIR BODIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

A NEUROSURGEONS ADVENTURE IN MEDICAL EGYPTOLOGY

I THE MEDICAL PAPYRI

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

of these features suggest case # 873 to be a case of Neurobromatosis I.11

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

Breasted. The Edwin Smith Surgical Papyrus. (1930), 49.

Breasted, The Edwin Smith Surgical Papyrus, 64,47.

S. Spawls, B. Branch.The Dangerous Snakes of Africa (1995), 121-123.

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

NO TURNING BACK NOW

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

(Shad) Farshad Fani Marvasti and Quinn Synder

TO FULFILL OUR SACRED OATH

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

Undecided 7% Other 3% Worse 38% 36%

Did not vote 8% Same 26% 23%

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

Y 59% 75% 55% 25% 44%

N 41% 25% 45% 75% 56%

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

Grandmother and Child Marilyn S. Brodwick

SIR WILLIAM OSLER

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

NOT MUCH BLOOD, REALLY...

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

BLACK MARKET ORGANS UNDO THE DAMAGE

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EATING FROM THE INSIDE

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

NECKTIE ASSOCIATED IATROGENIC INFECTION? KNOT!

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

Young Girl from the Village of Huei Thamo, Laos

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

THE CHRISTMAS GIFT

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HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES