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FALL 2016 VOL 6, ISSUE 1

a literary journal

Academic Medicine 4 Gratitude Revisited 5 Sailors Ebb 12

letter from the editors
One of the most treasured aspects about a
place like Duke is the drive and energy to achieve
better. A new day is a new opportunity to take
a few more steps on the neverending quest for
improvement. Therefore it is with the greatest
pleasure that we share our enthusiasm for this
issue, as it marks a milestone in Voicess journey
to reach more individuals. With this issue, Voices
joins forces with the Trent Center for Bioethics,
Humanities, and History of Medicine, in a syn-
ergistic effort to raise medical humanities to a
larger platform and spread Voices to a broader
audience. And so we expand our leadership team
of editors with Vinayak, Dr. Karen Jooste, and Dr.
Ray Barfield.
We begin the issue with a description of the
academic medicine journey by Alex Vaz. It is a
long and arduous path for a career of service and
self-sacrifice. Marissa Happ then brings us to a
moment of triumph and a firm reminder of the joys
inherent in a healthcare career. Similarly Vinayak
Venkataraman describes his experience with a
patient on cardiothoracic surgery. This compares
carefully with the reflections of Ashley Adams and
Jania Aria Ramos in their community partner es-
says during their first year of medical school. After
all, we are reminded that our lives will one day be
memories of the journey that we traipse, as Kel-
ly Ryan Murphy sculpts a patients past into the
present. After we pass, we are memories that can
always be brought forth by recalls of our loved
ones as Mary L. Bernard does beautifully in two
persona poems.
We hope you enjoy this issue as much as we
have working to put it together. And as always, if
you have any interest in writing for or joining Voic-
es, please let us know at dukemedvoices@gmail.

Your co-Editors-in-Chiefs,
Rui Dai
Vinayak Venkataraman
table of contents
2 Letter From the Editors
Rui Dai, MD/PhD student & Vinayak Venkataraman, MS4

4 Academic Medicine: Being Lost in the Journey

Alex Vaz, MS2

5 Gratitude Revisited (25 Years Later)

Marissa Happ, LCSW

6-7 Game of Orbits Universe Jong Park, MS2

7 Bernhards Letter Mary L. Barnard
8-9 Community Partner Essay Ashley Adams, MS2
10-11 Young Heart Mending Vinayak Venkataraman, MS4
12 The Sailors Ebb Kelly Ryan Murphy, MS4
12-13 A Sonata in Red Kristian Becker, MS4
14 Through My Community Partners Eyes
Jania Arcia Ramos, MS2

15 Carolines Letter Mary L. Barnard

associate editors
Ashley Adams MS2 Bilal Ashraf MS3
Gireesh Reddy MS2 Kun Wei Song MS4
S. Tammy Hsu MS3 Kelly Murphy MS4
Madelyn Stevens MS3 Neechi Mosha MD 14

faculty editors
Raymond Barfield MD, PhD Karen Jooste MD
Background Photography Credits:
Credits/Contents: Aarti Thakkar, MS2
Academic Medicine: being lost in the journey
I can barely remember what day However, I increasingly found edgment left a bitter taste why
of the week it is. I just spent the last myself dissociated from where I couldnt I be emotionally invested
3 hours trying to debug the code I was. Being emotionally connected in where I was currently while being
was writing, only to remember that to loved ones who were far away professionally invested in where I
I had already accomplished this and intellectually connected to wanted to be in the future?
last week on a different computer. research projects that were also I knew the right words to say. Its
I check my watch to find that it is occurring elsewhere left too little the journey, rather than the destina-
3:15 am, giving me about 5 hours of myself available to my medical tion, that makes us who we are. The
before my last anatomy exam. school experiences. Nihilism, the experiences we have now consti-
Needless to say, my first year of ugly cousin of exhaustion, took tute not only the types of physicians
medical school to that point had residence in my mind, and made that well be in the future, but also
been less than ideal. In short, my committing to any individual en- the caliber of men and women that
mental capacity had been split deavor all the more difficult. well be in our everyday lives. But
between my long-distance girl- The very essence of the path of putting these platitudes into prac-
friend, my single mother an equal a physician or physician scientist is tice mostly was lost upon me.
distance away, several manuscripts one of delayed gratification. Checking my watch again, it is
in varying stages of review and In this context, medical students now 8:15 am. I get up, promptly trip
preparation, and the various clinics, and professionals ostensibly and over the piles of research articles on
labs, and exams associated with the invariably view their training as a the floor, and eventually make my
basic science training of medical price to pay now in order to reap way to the bus stop. Bleary eyed,
school. the rewards later. What often goes I wonder about things far in the
At first it was fun. After all, the unsaid is that this price comes with future, with the present only as a
people I look up to balance seem- a heavy tag, including anxiety and a weight to be unceremoniously shed
ingly endless arrays of disparate loss of meaning and self-esteem. upon the eventual addition of the
projects. I remembered reading I could justify that my disso- letters M.D, Ph.D. to my white coat.
early on of Elon Musk sleeping 4 ciation from my classmates and
hours a night while coding during all the more genuine experiences of Alex Vaz is a second year medical
of his waking hours and toiling away medical education was the price of student who enjoys cooking and playing
in a rented office that doubled as a getting ahead in the world of aca- guitar in his free time.
home. Isnt this the stuff of legend? demic medicine. But that acknowl-

Photo Credit: Jania Arcia Ramos, MS2
Gratitude Revisited (25 years later)
As a clinical social worker were threatening to take over. of her admission, when I heard
teaching and working within In contact with our pediatrician discussion in the hallway about
higher education and medical throughout the night, we had policy, Dr. Schulmans voice
systems, I have seen the cour- tried the steamy shower mists rose above the others with the
age and tenacity of patients as and the bundledup walks out- definitive word on the matter.
they face illness, injury and pain, side in the crisp night air; each He informed the staff that to
moving always in the direction of had provided only temporary minimize trauma for our baby, I
health. relief. should be allowed stay around
I have also observed profound Dr. Daniel Schulman personally the clock rather than be forced
heroism in physicians who prac- took each phone call and ad- out after visiting hours, and that
tice excellence in their work and vised us to proceed to the hos- furthermore, I had his permis-
truly understand the vulnerability pital where he would meet us. I sion to crawl into the croup tent
of the patient. knew that he heard the panic in with her. Separation would only
The finest example of what my voice; his calm and steady complicate my babys journey
medicine can be is best ex- directives helped me function back to health; presence could
pressed if I return to a moment effectively when time was of the streamline it. Attachment mat-
where I faced a life-threatening essence. tered to Dr. Schulman and he
issue and was met with medical Racing down the road, I kept refused to let it be disrupted.
expertise coupled with empathy. assuring myself that we dont I climbed into the tent with the
Soon after our youngest child lose babies anymore to croup assistance of the charge nurse
celebrated her first birthday, we but I could see the terror in my and over the following 72 hours
found ourselves en route to the babys eyes as she struggled for came out only to eat and go to
local Emergency Department air. the bathroom.
with a baby who was struggling Alerted to our imminent arrival, Triumphantly, we both emerged
to breathe. A bad cold had taken the ED staff flew into action and three days later: Deborah was
a sudden turn and the unmis- the rest is a blur to me. What breathing well and I was shaped
takable barky coughs of croup I do remember is the support- like the letter Z. No matter; my
ive and professional manner in baby was alive!
which we were served and the Do doctors get thanked
voice of my doctor. enough? I do not think so. Dr.
I could surrender my baby into Schulman, I will never forget
their competent hands because you.
I knew their highest priority was Cheers and kudos to the physi-
saving her life. cians who understand the med-
Our daughter was admitted to ical needs of their patients and
the Pediatrics unit, and yes, she the emotional needs of the ones
did survive. The following three who love them: you showcase
days included potent medica- medicine at its finest.
tions, frequent respiration ther-
apy treatments and constant Marissa Happ, LCSW, is an As-
surveillance. sistant Professor of Social Work at
I felt like the entire world re- Aurora University (IL) and coordinates
volved around the welfare of our the Health Care and Gerontology
baby, no questions asked. Specializations
This would not have been
possible if our physician had not
advocated for us. On the night FALL 2016 VOL 6, ISSUE 1
Game of Orbits Universe
Patts excitement burned we were on the same frequency heard that his pure-mech oppo-
through the exhaustion that already. nent had long ago abandoned
usually accompanied the sec- You idiot. That converter was the second-gen Monte Carlo
ond dawn on XAer. Ah, fatigue your own invention. Anyway, and third-gen Riviera search-
would not be something that a hows my dad doing? es. It instead used a modified
pure would have to deal with. An uncharacteristic pause. Shenkov-Maruyama-Bronstein
She waved her hand over her Uh slow start. Down by algorithm, the same base code
chest sensor, cycling through 15G. that had cracked P vs NP in one
her outfits. She settled on her What?! masterstroke. But this was the
most formal one, tightened her Game of Orbits. It still belonged
Log, move 18 (145.33): Aldeba-
bionic limbs, and boosted out to the bio-mechs. Her father just
ran, Sector3. Gravitons +2/-1.
the door. had to prove it, one more time.
Log, move 19 (Edet Surr):
Edet Surrs first 10 draws
WASP-52, Sector3. Gravitons Log, move 57 (Edet Surr): Ke-
zoomed up from the Gravitas
+3/-2. pler-214, Sector7. Gravitons
machine: 3 giants, 3 class IVs,
2 coms, a yellow, and a red. At Patt nervously scanned the
Log, move 58 (145.33): Castor,
least the coms are useable. Edet board. The translucent surface
Sector8. Gravitons +6/-9.
picked up a small gray stone extended out from the center of
from the pile and placed it down the Gravitas machine, represent- Patt could hardly breathe now.
in the bottom right corner of theing the astronomical scales of She saw her father calmly sur-
board. As soon as it touched the spacetime on a 10certa x 10cer- veying the center of the board,
ta grid. As the two players took
surface, its tail sparked to life. where the pieces were arranged
Only a 1G opening. But Edet turns placing their pieces on the with the greatest precision,
was saving the gas giants, and board, the fabric of spacetime where the ripples in the fabric of
wasnt risking any of the dwarf warped according to the gravi- spacetime were the most exqui-
stars or class IV planets on the tational strength of each piece. site. She recalled his voice from
Her fathers best moves not only
first turn. After all, Edets oppo- when he had first taught her the
nent today was the only other warped a large portion of the game as a child. All curves lead
undefeated Game of Orbits fabric, but also caused his op- to the center.
player in the universe. ponents pieces to orbit around Edet Surr waited as the next
his own. Each players warps 10 draws came up. And final-
Log, move 1 (Edet Surr): Comet
and orbits were translated into ly saw it. A class I rolled out
X/2455, Sector7. Gravitons +1/0.
a Graviton count, a quantitative of the Gravitas machine, and
Hey Patt! Youre late! measure of the influence the a confused hush fell over the
Her friends voice boomed into players had over spacetime. audience. It was a piece that
her left earpiece and made her Edet had chosen counter to
Log, move 32 (145.33): Alcyone,
wince. established theory, which re-
Sector5. Gravitons +4/-2.
Way to make me feel guilty, garded it as one of the least
Log, move 33 (Edet Surr): Den-
Trake. And deaf. valuable planets in the standard
eb, Sector9. Gravitons +7/0.
Patt quickly ducked into the repertoire. But Edet had calcu-
open seat next to her friend. Patt felt her pulse quicken. lated that this piece would be
They were in the front row of a The calculations became much critical against this particular
completely packed stadium, the more difficult at mid-game, and opponent, at this specific time.
largest on XAer, and she was for the first time in her life, she Edet placed the class I straight
feeling a bit self-conscious. suspected that her father was into the center, between two
Oh yeah, sorry. I forgot that at a disadvantage. She had gas giants circling around one
Bernhards Letter
another. With a flash of blue and from my grandfather Bernhard D., who died in 1919, when my
green, the tiny planet began to Mom was nine.
sparkle. Then its axis tilted ever
so slightly, pulled just enough Dear Granddaughter Mary, like a germ. Folks didnt rightly
by the force of a dwarf star on
know in-flu-en-za nor e-pi-dem-
the other side of the twin giants. You only knew my wife Lizzie ic
The delicate tension governing during her bad patches. til it knocked on their own front
the middle of the board shifted,
warping the fabric slowly at first, Her troubles began when our and knock on mine it did.
but then with increasing speed, girls
as star after star toppled into got old enough to catch the eye You got your red hair from me
one majestic orbit. The rippling of Uncle Leo. If Ida lived, your love of sports,
of spacetime between the play- he wouldnt a dared. and your fate, to be an exile
ers mirrored the waves of shock
within your own family,
rushing through the crowd, But dont you judge all as I was for reasons
which quickly overflowed into all them Holtermanns on account I was never to know
of the hundred worlds. of Leo. Sister Mary sweet on earth.
as they come with a true faith-
Log, move 71 (Edet Surr): Ter- calling to be a nun. Whats a letter from the grave,
ra, Sector1. Gravitons +45/-45. Your Great-Aunt, the maiden my dearest granddaughter,
Tesuji. Mae without a mention of death?
Log, end (145.33): Resigns. who sent you birthday cards There at the last,
Patt slowly stood up. Her eyes and stayed in the background in the darkened bedroom
met her fathers. They both knew which made you love her more. off of your Moms kitchen,
that this was a moment they you heard Lizzie moan
would never forget. Education was different between sips of brandy.
A pure-mech had finally solved in them days, country folk Moans dont always mean
it. and immigrants not prized pain though,
by schools and such. Twas youll know that well
Jong Park is a second year medical Lizzie who taught them girls when your time comes.
student who loves science fiction, nicer ways with words and
board games, and gravity. This sci- manner. Twas Lizzie I loved, Always and Forever
ence fiction short story was inspired first and last, such a fine lass. Your Grandpa
by two recent scientific break-
throughs: the experimental confirma- And, dear granddaughter,
tion of gravitational waves, and the she loved me back nice and Persona Poem by Mary L. Barnard,
Go match between Lee Sedol and equal. who is a Chatham County NC
AlphaGo. I got off the farm for her, for us, resident. When Mary steps onto her
and drove that delivery truck, gravel road for an early walk, she
every turn taking me closer doesnt know yet what image or
to the last drop-off, when Id thought will inspire her next poem.
get to go back home to her.

Funny how strong young men

can fall to such a small thing
Community Partner Essay
As he opens the door to find us He was found to be HIV+ in his when he discusses how he now
on his doorstep he yells, what 30s in 1989. His voice remains always independently research-
do you guys want?!, even steady as he explains that he es his physicians advice before
though he fully knows who we was shocked at this diagno- making medical decisions, I
are and why we are there, and sis, as he had been previously reflect on how he has grown in
it works to break the ice. We all married to a woman and had confidence and self-efficacy as
laugh as we awkwardly shuffle only been with one man up until both a patient and as a person
to take our shoes off and settle the time of his diagnosis. We through his experience with
in on his couch. He explains that ask him how he responded to illness.) After ten years in the
this is where he and his partner this news and he goes on to mountains he made the decision
are staying while they recover explain that he moved to the to come back to Durham, where
from a fire that took place in western part of North Carolina he has been receiving treatment
their home months prior. He to immerse himself in the beau- at Duke. There have been lows
apologizes for the place, though ty of the Nantahala River. He (literally, with a CD4 count <300
this takes me off guard, as it is worked for ten years guiding as well as the fear accompa-
much homier than my apart- people on kayaking trips, living nying the broach of the term
ment. We sit in an open living in various places, including a AIDS by his doctors) but also
room with photography books minimalistic living community at the highs of finding his partner
piled on coffee tables. Framed one point and with a physician of over 10 years and receiving
paintings of figures in peace- friend at another. We detect a clinical trials and treatments that
ful meditation are propped up thread of regret in his voice as have kept both his CD4 count
against the wall I suppose this he reminisces, and putting two- and his spirits up.
living arrangement is too tran- and-two together, we sheepishly He is taking more frequent sips
sient for them to be hung and ask about his medical treatment from his water bottle now, which
his two cats ignore his protests during this time post-diagnosis. he apologizes for, saying that
as they find their way onto our This is my first time speaking his medication makes his mouth
laps. with someone who is HIV+ and dry. My fellow student and I
So, how are you doing?, we the moment encompasses ev- stumble over each other as we
ask, after some small-talk as a erything I both love and fumble jump at the opportunity to talk
desperately subtle way to invite over when I talk with patients: about his physical symptoms,
him to talk about his illness. dive into any discomfort of their something we have more ex-
During this initial meeting we are story without causing them to perience doing, but we quickly
only months into our first year feel as though they need to rush learn that theres no divorcing
of medical school, and we hold back up for air. the physical from the mental. His
onto these stock phrases out of The doctor he had been living lack of energy has led to an in-
our uncertainty in this new role with at the time prescribed him ability to work, leading to a lack
in which we can ask the most a slew of antiretroviral medi- of confidence in his image of
invasive of questions and re- cations in an irresponsible and himself as a man. On more than
ceive an answer nine times out detrimental manner, taking him one occasion he laments his
of ten. We know nothing about off of them only weeks after protease paunch and skinny
him other than his name at this starting when he determined arms that he cant overcome de-
point, and in true medical stu- they werent working. He spite healthy eating habits and
dent fashion we are uncomfort- shakes his head in disappoint- working out on good days. I find
able with not knowing. Luckily ment, maybe equally at himself it remarkable how open he is to
he understands and begins to and at this physicians practice discussing such sensitive topics:
tell us his story. of medicine. (At our next visit, a suicide attempt during his time
at Nantahala and consistent I do a quick Google search on times. It becomes clear to me
dysthymia since his diagnosis. my phone to fully understand that chronic illness resets ones
These admissions float in the air the implications of that. I con- life to consist of a constellation
as we consider how to respond, sider that I have no idea how his of highs and lows. While I am
the difficulty of which reminds us family and friends must feel if I surprised that he would think
that we are people first, medical am capable of feeling concern of us as being so meaningful, it
students second, or maybe third for a man Ive met once. solidifies the point that patients
or fourth. I think we just nod and *** gain so much from simply being
let our silence reflect our respect It isnt until April that we see heard through those highs and
for what hes overcome. him again, but the difference lows.
He glances at the clock to find between this conversation and Around 4pm, he realizes that
that its been an hour and a half. the first are palpable. He is he has to meet his realtor at the
He remarks that he is getting chattier, overflowing with confi- new house he and his partner
tired, so he makes a genuine dence over having successfully are buying. He excitedly talks
attempt to end on the positive. weaned himself off of Metha- about the new furniture they are
He notes that his diagnosis has done. We talk about how hurt he going to buy and all of the space
led him to recognize the uncer- was when his partner confided they are going to have. As he
tainty of life, and the importance that he felt like more of a care- walks us to the door to see us
of living with intention each day. taker than a husband during his out and thanks us for the time
Its changed his life and rela- withdrawal, but also how much weve spent with him, he apolo-
tionships for the better, he says, more free he feels with relying gizes for talking too much he
and I believe him; hes been so on a spinal cord stimulation gets nervous when he thinks
honest with us. Its also easier implant for his pain rather than a about the new house, he says.
than the alternative. drug. Hes concerned that something
*** He is visibly animated on will come up, preventing the
On a brisk March afternoon his feet showing off his new deal from closing.
we show up on his doorstep pain device, teaching us how As I walk to my car, I smile,
for our second meeting with it works. In the most difficult noticing how normal of a worry
him. We have more knowledge moment of our conversations for that is.
now, including specifically me, he tells us that before his
about HIV/AIDs, and Im feeling diagnosis he had always wanted Ashley Adams is a second year
more confident in my abilities to become a doctor. I begin to medical student who prefers study-
in talking with patients. Ten, feel self-conscious, I guess for ing to the soundtracks of Pixar
fifteen minutes go by, though, having an opportunity that he movies.
and no answer at the door. I half had lost, until he reflects on how
expect him to open the window great of a life he has. He medi-
curtains and shout something tates daily, he says, has a sup-
outrageous at us again. He portive partner, and the energy
doesnt, and we spend a few to do things that are important
days in vague concern until we to him, such as working out
receive an e-mail from him. Hes and being politically active in
so apologetic, explaining that the LGBT community. He also
he forgot to add the appoint- reflects on the wonderful people
ment to his phones calendar. He he has to rely on, and includes
also adds this: withdrawal from us as people he is thankful for in
Methadone has been really hard! helping him through the difficult
Young Heart Mending
We first met when I was mid- ent. The infection and resulting family gnocchi recipe. After
way through my rotation on the inflammation had caused bits college, he had moved with his
Cardiac Surgery service. Most and pieces of diseased tissue to mom down South to chart a new
surgeries I had seen involved break off, travel up his carotids, life journey.
older patients whose hearts had and cause a stroke. He needed A true lover of science, he had
grown weary with old age, ge- emergent heart surgery to have a degree in biology with plans
netics, or decades of damaging any chance of surviving. Thats of pursing graduate school, but
lifestyle choices. Many patients where our paths crossed. he changed career paths to try
were getting coronary artery **** his hand in business. A bud-
bypass graft, in which superfi- The surgery was very success- ding entrepreneur, he told me
cial veins were harvested from ful, but his hospital course was about the two companies he had
their leg and connected from the long and complicated due to the started a couple years prior. One
aorta to the ends of the coro- extent of his injury and his Type was a comic book and memora-
nary arteries. Other patients had I diabetes. Every afternoon, Id bilia e-commerce company; the
surgeries to replace heart valves come up to the CTICU to spend other was a sales and market-
that were no longer doing their some time with him. Many of our ing consulting firm. They were
job of regulating blood flow. conversations were pretty sim- both one-man operations, and
Today, I was seeing another ple, sometimes slightly comedic: he recounted some of his recent
aortic valve replacement. But the Hows the food? I would ask. successes and setbacks.
patient today was different. He Oh, I just got the broth today. I think we connected because
was not elderly, nor did he have Its pretty good, hed say with we were the same age, and I
years of damage to his heart. He a smile. But man, the broccoli could understand his fear and
was my age. He was the same and cheese soup, that ones by his frustrations. He was an in-
height and build. When we cut far the best. dependent man, in his late 20s,
into his chest and split apart his Ha Ill bet, Id reply. Know living his life on his own terms,
sternum, I couldnt help but feel what youre getting for dinner? accountable only to his dreams
a vicarious sensation of pain He was alone during the day, and expectations. Without warn-
under my surgical gown. but his mom would come ev- ing, his world had turned upside
He had suffered a lot in the ery night after work. She would down. And while he had a good
days leading up to Christmas. occasionally bring food from his prognosis and was making pos-
Born with a common congen- favorite restaurants, like Which itive strides each day, his recov-
ital defect, he had lived a fairly Wich or a sushi place nearby ery was slow.
normal life. Although he had a their hometown. Other times, His busted heart had caused
long history of Type I diabetes, hed resign himself to the whim liters of fluid to collect behind
he never had issues with his of the hospitals chefs. his lung, which took extra days
heart. While he was driving to his You know, man, it was a tough to drain. Because of his stroke,
moms, he suddenly lost con- one, hed say. But I think Im he had to work everyday with
sciousness. When he woke up, going to go with the veggie lasa- occupational therapy to relearn
he was in the trauma bay being gna. simple activities of daily living.
treated for femur and wrist inju- Aside from food, we also talked Because of his skeletal injuries,
ries from a motor vehicle acci- about life. He was originally from he had to work everyday with
dent. More emergently, his heart a different state, where most of physical therapy to get back
was not working. The culprit his extended family still lived. He his stride. And after leaving the
was likely a bacterial infection of told me about them especially hospital, he had months of neu-
his aortic valve. It had become his grandmother, whom he had rologic and physical rehab ahead
so diseased that on imaging, it lived with during college and had of him.
did not even appear to be pres- taught him her world-famous He was also stuck in limbo
with his care. He was not a pedi- was always mindful of continued and allowed me to connect with
atrics patient, and he was not an struggles and limitations with his someone very similar to me on
adult patient at least in spir- chronic illness. a personal level. He inspired
it. Few could understand what I didnt really know how to me to think more about my life
he was going through because handle these existential conver- goals and mend relationships
most did not understand what it sations, having had very limited that had previous been fraught.
felt like to be a heart surgery pa- practice so early in the year. I Because well, you never know
tient far sooner than you ought would try to mimic my surgeons what can happen to you. Youre
to be. Though I barely knew ways -- channel my inner coach. only young and invincible until
enough medicine at that point to Im scared, man, he would something flips your world up-
provide medical advice, I could frequently tell me. But Im hope- side down. When it happens, it
provide someone to talk to who ful. takes you by surprise and few
(obviously) understood what it You should be, I would reply, support networks exist to help
was like to be in your late 20s. with confident demeanor. you through it. The abstract
It helped that his surgeon was He would smile and nod. systemic void I knew to exist at
young and spoke to patients and I know how hard this is for its transitions had been per-
students as a HS football coach you, man, I would continue, Its sonified through him. I tried my
would. He would spend a few slow progress every day. But best to fill it for him in the acute
moments each day with him and youre going to get out of here setting, but I also observed how
keep him motivated with nec- and on with your life. much more work needed to be
essary realism. I know it sucks Yea, I have to focus on the done. In all, it was an incredi-
what happened, man, but youre positives, he would say, trying bly emotional, educational, and
ready for the future. Its going to to pep himself up. Plan for the humbling experience, and I look
be a couple months of rehab, future. Away from here. forward to many similar ones.
but youll get through it. Start He talked about going back
planning what you are going to to school and pursuing his new Vinayak Venkataraman is an MS4
do three months from now. passions. He did not know if he who enjoys writing, home brewing,
Further complicating things, could afford it, but he resolved cooking Indian food, playing tennis,
he was facing not only his acute to at least explore the option. drinking coffee, and cheering for the
challenges, but also transitional He hoped to mend relationships Buffalo Bills.
challenges as a lifelong Type I with family members living in his
diabetic facing his condition as home state. He had lost touch
an adult. Growing up, he had with many, but the accident had
access to a supportive pediatric sparked new perspective in him.
endocrinologist. As an adult, he He also wanted to try to become
had difficulty establishing care, closer to his step-dad, who
navigating a complex system, would visit him with his mom.
adhering to his medications, He knew he had to live with both
and staying afloat financially. His of them for a few months while
illness left him isolated from his recovering, but he adamantly
peers and feeling limited in his refused to become a burden.
ability to pursue his dreams. In He was used to being free and
the hospital, he found it helpful independent since moving to the
to talk with me about his pas- South, and he very much wanted
sions and brainstorm ways to to return to that life as soon as
confront his immediate post-sur- possible.
gical challenges. However, he Getting to know him was a joy
The Sailors Ebb A Sonata in
At present Cast out, with evenings tide Whence Nature all creates,
Lying flat, still afloat. Into dark and murky waters. and multiplies
We survey the forecast, And on and on and on And fosters all, and whither
Standing at ready. The sailor teased. she resolves
Still with hope Oh, how hard Each in the end when each is
Waiting still. to see. overthrown.
This ultimate stock we have
Before us, Drifting on devised to name
How hard to see. and on endless ocean. Procreant atoms, matter,
The sailor tattered, Precariousnewly delicate. seeds of things,
Tossed against, waters rough. Against winds, sent easily Or primal bodies, as primal to
With evenings tide, there goes astray. the world. ~ On the Nature of
His Self. Leaving behind But we see not just a buoy Things
The sailor tormented. Fighting rough waters.
Oh, how hard For we remember I celebrate myself;
to see. The forgotten And what I assume you shall
Antidote The sailor For every atom belonging to
Sigh, we have not. the purple heart me, as good belongs to you.
But anecdote, a many, of the Battle of Anzio.
Salvaging the once was Once brawn, once bold ~ Song of Myself
Replacing the once time well spent.
what is. Left here, with us Act I
to follow the sun Scene I
A glimmer! Alas, an account of and chase the
times past. horizon. Events are set around Sep-
A sign of recognition with Hope tember 2008, and Act I cen-
renewed, Kelly Ryan Murphy is a fourth year ters on the impending suicide
In plenty, in bounds, with praise medical student who began her of actress Choi Jin-Sil (Oct.
for our care days as a volunteer at the Durham 2, 2008). Although the event
VA while an undergraduate student has yet to happen, a pall is
But a mirage. at Duke. She wrote this poem about felt throughout the scene with
All for naught a recent patienta WWII veteran grey lighting, grey furniture,
A flash in the water. with deliriuma patient she will and minor keyed music.
For again goes the Self, always remember. Scene I opens on a Seoul


West Point
Photo Credit: Rui Dai, MS4
apartment, two rooms split by a from where she lives now, and and hear it if youre not already
scrim running the full length of theres really no reason for her playing when he comes.
the stage, bisecting it vertically. to go there, but its what she J: He wont be home till 9:00,
One a kitchen, sterile and orga- knows. Ive got 2 hours until he would
nized, the other, a living room J: Is this Mi Cha or Mi Ok? even step in the door. The train
with modern Scandinavian furni- M: No, its your fathers sis- has been running really slow
ture. A Korean woman age ~50 ter, the oldest one, Ae Cha, these days.
stands in the kitchen separating the accountant who is living in M: All the better for you to
leaves of cabbage and inspect- Songdo, which is full of Chinese practice and impress him when
ing them one by one. She wears laborers pouring concrete and he gets here. Youve got the
an apron, and stares intently at a crooks selling plated dinnerware notes down but not the timing,
cutting board. as silver and pickpockets taking wouldnt you say? And the train
M: (in Korean) And they all advantage of the tourists as they has not been running slow, its
were talking about how the stare off into space at the steel being delayed with all these
food was no good anymore, struts being lifted up and float- students throwing themselves
and how the service has really ing in air as if they had never in front of it. All these engineers
gone downhill since Soon had seen a tall building before. As if getting their term grades back
that heart attack and died three the city was on the moon and and leaping from the walkway at
years ago, and that Incheon made of ice. Bongcheon, slowing your dads
was full of crooks now and J: Right. Do you need help with train from getting into Sadang
(switches to English) Jimin are dinner? Are you starting kimchi? and him transferring over. It
you listening as Im speaking to I can help if you want, Im not should only take him an hour but
you? really busy. every time it happens they have
A young man about twenty sits M: No, this can wait, this cab- to stop the train and see whats
on a long couch, glances up bage is not very good, covered happened.
from a book. in dirt and bite marks from bugs. But why am I telling you this?
J: Hm? Yes, Im coming, I was And you should be practicing It happens every year at this
just reading. your piece for the recital next time and you know as well as
M: I didnt ask you what you week, dont you think you still I do why he is late. I still think
were doing, I asked you if you need to work on the fingering for he should start taking the bus
were listening. the last three bars on page 5? or riding his bike, although it is
J: Oh, oh yes, but I missed the J: I think I have it now, but slower than the train when it is
last part. youre right, I could go prac- running on time.
M: I said youre aunt said that tice, are you making kimchi, do J: Or maybe someone should
her neighborhood is really going you have the right fish sauce? I help the students and prevent
to the dogs, and that her favorite could go get some of the right them from throwing themselves
butcher is not very good any- kind of fish sauce if you dont in front of the trains.
more since the wife who ran the have it, the squid kind you know M: Oh, wouldnt that be a nice
counter died of a heart problem, its better than the one with the thing. Now go practice please,
but she still goes back because laughing Buddha on the front. your father should be home any
its what she knows and she M: No, this fish sauce is fine minute.
likes the cuts of pork belly they and the shrimp are fine and the
get because the husband knows only thing that I want you to do Kristian Becker is a fourth year
a farmer out in the sticks, but if is practice, Im sure your father medical student who enjoys reading,
it wasnt for that she would go wants to walk in and hear the writing and arithmetic.
somewhere else because its far Mazurka and how can he walk in
Through My Community Partners Eyes
Watching the stars on a clear loss has progressed to a point we asked what the biggest health
night sky. Seeing the faces of your that she can no longer do any of challenge has been for her, she
loved ones at a distance. Reading these things. Loss of her inde- answered the vision loss associated
a book before you go to sleep. All pendence was one thing, but with age-related macular degenera-
of these things and more are possi- loss of her passion was another. tion. She mentioned that when she
ble when you have good vision. For Mrs. F has great humor and was diagnosed with liver cancer,
Mrs. F, these are no longer possi- outlook on life to match. At 87 she never believed that it would kill
ble. Mrs. F suffers from age-relat- years old, she feels fulfilled and her. Her family was worried, but she
ed macular degeneration; a dis- ready for whatever may come said that even if the worse were to
ease so common that before I met next. Her vision changes have happen, she was ready and that at
with her, I didnt even think twice strongly changed the way she that point she made the decision to
about its implications. Adjusting to lives her life, but with supporting forgo any major surgeries or medical
her gradual loss of vision has been family and friends, she has found procedures in the future. However,
one of the most difficult processes ways to adapt and continue de- her vision change is something she
Mrs. F has had to overcome, even spite the challenges this poses. has to face every day, making many
above receiving a cancer diagno- For instance, her family gave her of the things she loves more difficult.
sis. a machine that magnifies text so From her perspective, blindness sur-
Mrs. F started noticing the chang- she can put a newspaper under passes a terminal cancer diagnoses
es in her vision over 20 years ago. the magnifier to slowly read arti- as the most difficult illness she has
At first, the changes were manage- cles that way. A friend also gave had to overcome.
able with no major adjustments. her an iPad so she can enlarge Age-related macular degeneration
Over time, however, her vision text and read more easily. Now is a disease that many people face
became increasingly worse, requir- she uses the iPad to read before as they age and its high incidence
ing major life adjustments. She first bed as she had always done. means it might be something I have
had to give up driving which meant She still manages to operate a to face in the future! Before meeting
losing independence, but with phone, live on her own within with Mrs. F, I never even thought of
good humor she overcame this the assisted community, and it as a disease, I thought of losing
loss. As her vision worsened, she most importantly, she maintains sight as something many go through
had to forgo further independence a positive spirit with everything when they get older. Now, I under-
and agree to live in an assisted she does. stand that it is a disease; one with
living community. When I first spoke with Mrs. F, many difficulties associated and
These major changes, which I it was a phone call. During that limited preventative measures. How-
imagine would be difficult for any- call, she mentioned she was ever, I also learned from Mrs. F the
one to accept, were not the worse legally blind. I naively assumed importance of staying positive. Not
part of her illness. For Mrs. F, los- that her blindness must be a once did I get the impression that
ing the ability to read has been the congenital problem little did I Mrs. F was defeated by her illness.
biggest challenge of dealing with know that her blindness resulted Instead, she kept pushing forward,
her chronic illness. Reading has from a disease that affects so finding creative ways to overcome
always been her passion. She used many people in the world! I was the difficulties. I hope that as I get
to read a newspaper every morning a shocked to discover that her older and have to fight whatever
to start her day. She used to read blindness was a result of age-re- age-related illness that comes my
books at night to go to sleep. Mrs. lated macular degeneration. As I way, I will remember Mrs. F and
F was a schoolteacher before she learned more about her medical model her positivity.
retired and reading was a part of history, which includes living
her daily job. Even after she retired, with diabetes and having been Jania Arcia Ramos is a second year
while her vision permitted, she vol- diagnosed with liver cancer and medical student, who is a Practice
unteered with local children to help been given only 6 month to live, Course writer in the making.
them learn how to read. Her vision it further surprised me that when
Carolines Letter
from my grandmother, Caroline B., who died in 1914 when my father was three.
My Dearest Granddaughter This morning the mist wid- walked me one last time
Mary: ow-walks to the windowed porch
in the high branches, to look upon the lake.
The first words I write must be: yet tonight the mist a squatter The trees so young I could see
on the surface of a lake. over their needled tops.
Thank You
for bringing my firstborn son Oh Mary Even on the darkest night,
to lie next to me. Tuberculosis look upon the water
I could feel the heat of the day such a loud death, where a reflection
and your feet alongside mine. that grappling for air. can always be found.
Your mother held back,
seeking shade under a tree I wanted to spare Both kinds of love to you.
from a sun untroubled by the walls of our cottage
clouds. the multiple agonies of my inha- From your fathers mother,
lation. Caroline
You dropped a small purple
flower I wanted to spare Persona Poem by Mary L. Barnard,
the color of a plum the clean white linen who is a Chatham County NC
for your father to take with him. the bloodied spittle of my exha- resident. When Mary steps onto her
Down it dropped lation. gravel road for an early walk, she
the earth shook with its weight. doesnt know yet what image or
I could feel the shudder. The little beach house thought will inspire her next poem.
finished on the day you were
Your mysteries are meant to born
inhabit you. wasnt there when my sisters

Taking a Break
Photo Credit: Jania Arcia Ramos, MS2
PHOTO CREDIT: Aarti Thakkar, MS2