Message From the Editors, 2013 Rubor Volume 1

Welcome to the inaugural issue of Rubor: Reflections on Medicine from the Wasatch Front. We are deeply grateful to the Division of Medical Ethics and Humanities at the University of Utah as well as the Associated Students of the University of Utah for providing financial support for this publication. Our hope is that Rubor will serve as a forum for people from all aspects of healthcare in Utah to share their stories and showcase their creative talents. Through fiction, non-fiction, poetry, and visual art, the publication will explore medicine by focusing not only on the promise of curing, but also on the art of healing. With each issue, we will aim to provide honest insight into the challenges and triumphs of health care. We envision Rubor as a way to encourage creative exchanges between providers and patients as well as among the various professions within the health sciences. Rubor greatly appreciates and depends on contributions from our community. To view additional submissions that were published online, please visit rubor.med.utah.edu. Thank you for reading, and we hope to hear from you! The Editors

Untitled Photo of Purple Water Lilies

Untitled, floral photo by Scott Allen
Untitled, floral photo by Scott Allen

Double-Blind Randomized Controlled Dating

As a surgery resident, dating can prove a difficult task. I finally broke down and went on one of those blind dates. Every time someone in the hospital approaches me with that look in her eyes, as if she is a fairy godmother about to deliver the best news with a shake of her wand — that she has the perfect friend for me — I am reminded of Vince Vaughn’s flawless monologue in Wedding Crashers, which he begins by saying, “I apologize to you if I don’t seem really eager to jump into a forced awkward intimate situation people like to call dating….”

Even with that Vaughn mantra constantly reeling through my head, I decided to go. It was seriously blind, which is kind of horrifying because I started drawing a picture of what she might be like based off the friend’s description, which, let’s be honest, is always a little…embellished. Ordinary eyes become “crazy exotic eyes,” and her personality becomes “so much like you,” and “she’s just gorgeous and hilarious!” Before I arrive, I’ve got visions of a Kate Beckinsale – Angelina Jolie fusion with the comedic timing of Kristen Wiig floating around in my head. So I picked her up, and she was very nice and attractive and a decent conversationalist — all the check boxes ticked. We went to dinner and had a nice time. Afterward, I asked if she wanted to go to a certain bar. She then asked if she needed an ID for that particular bar.

“Why? Did you forget yours?” I asked, stuffing the last French fry in- to my mouth.

“No, I’m not twenty – one yet,” she replied.

I feel kind of creepy right now. That’s what my mind said, as I felt like I had just arrived on set at one of those sketchy To Catch a Predator episodes.

So we went to Chuck E. Cheese’s, instead. I’m kidding. We went some-­ where else. But then we actually went out a few more times. Then on the fifth-ish date, we were sitting at a pizza place, void of anything else to talk about when I realized her eyes were fixated on something behind me. I glanced back and up to realize that I had been trumped by the E! channel’s apparently riveting discussion of the best and worst dressed girls of the Oscars. The ship had set sail into different waters, and I was too old to board.

People are always asking if residency is like Grey’s Anatomy . I can envision the romanticized pictures of Dr. McDreamy cuddling with Meredith Grey swooning through their minds as they envision the hospital and operating rooms as steam – filled saunas of sexual tension. Unfortunately, this isn’t the case.

There was a rotation during my intern year called Trauma Nights. I always thought this sounded as though it should be a trashy late night show on one of the lower-tier networks. It would take place in a southern city, like New Orleans, during the hottest part of the summer. Humidity would fill the halls and stairwells so that the entire cast of Trauma Nights would always be sweating and shedding their clothes. The title of the series would be read by a man with a deep raspy voice, as though he had either just recovered from a cold or had just smoked thirty cigarettes. He would let the second word, Nights…, drag on a bit. Something like this : “ Tonight on Trauma Nighhhhhhts, Dr. Blagg gets trapped in the stair- well by a little filly only to find that the man with a telephone pole through his chest bled out while the doctor got frisky.”

The scenes would be intense and dramatic, full of camera shots showing heavy breathing, sweat, and pure lust in the stairwell, bro- ken only by brief but breathtaking shots of scantily-clad nurses crying out for the doctor to hurry and arrive to save the dying trauma victim. I, of course being the main character, would stroll in through the double doors after the man had just passed away, my scrubs disheveled and my pagers hanging off my sweaty drawers. I’d see the disturbed nurse, tears and shock in her eyes as she stares at me. I would shuffle toward her as I pull a cigarette from my back pocket and stick it in my mouth. I’d lay a hand on her shoulder. “Well, you’d better get used to this when you’re working trauma nighhhhhhts…” I’d say in a deep and slow voice, as I then lit my cigarette and let out a series of perfectly shaped smoke circles. Suddenly the woman would transition from shock to pure animalistic lust. I’d have to wave my hand in the air and tell her I was tired. A man needs a break, so she’ll simply have to wait.

Cut! That isn’t how it happens. The reality is more like me rushing into the trauma bay with eyes half open, hair sticking up sideways, fumigating the room with bad breath as I fumble while putting in a chest tube, only to cover myself with the patient’s bodily fluids in the process as the nurses roll their eyes. There’s not much sexy about it, unless you’re into the body fluids sort of thing. The sweating and heavy breathing has nothing to do with lustful attraction and every- thing to do with trying to do actual medical work.

But there is the dream of Grey’s Anatomy and the steam – infested love of Trauma Nights . So maybe I’ll hold the cynicism and go ahead with the next blind encounter because when it comes down to it, what guy doesn’t need a good forced awkward intimate situation every now and then?

Conversation with a Cadaver in the Dissection Hall

I enter the room without knocking

I enter your space without permission

You laying there peacefully

Your eyes looking at me

You laying there lifeless

Your eyes staring through me

 

I wonder what could have happened

If life would have crossed our paths

In another place, at another time

 

We could have become neighbors

Waving at each other from a distance

We could have become friends

Even best friends

We could have become lovers

Vowing never to part as long as we lived

 

But it is death that brings us together

So goodbye neighbor, friend, lover

Forgive me as I begin to learn the secrets of life

 

Forgive me as I begin to bring down this knife

And cut you in a thousand pieces

On Holy Ground

It’s 1:30 AM. I’m just home from the ICU, where tonight, for a few moments in time (or was it out of time?), I remembered again that here at the hospital I am on holy ground. All the insanity of the hospital world, which much of the time makes so little sense, stood still for a sacred instant and the Word was made flesh and dwelt among us, as us, in every person present, each in their own unique way.

We knew not when our day began that we would, at its end be gathered to send one of our sisters on her way. Who knows how the Calendar was arranged, that called each of us to be in that place, in that moment, together. We marvel at the Wisdom that arranges the solar system, that ordains that the death of winter is followed each year by the resurrection of spring; how much more mysterious is the Divine Order that called these particular em- bodied souls to come together at this same instant. Interspersed with her extended clan that was gathered to see her out of this world were those of us from other clans, who, called to play our part in her drama, had an unspoken sense of our Divine Assignment. Despite all our machines, all our medicines, all of her family’s prayers, the shell in which her spirit had for so long lived, could no longer contain that which longed to be free. As the vigil continued, her spirit, her Divine essence slowly slipped away from the body that had in the recent weeks imprisoned her. Her moment of freedom was greeted by the sobs of her children; the wailing of the women filled the ICU. We closed doors to contain the sound but the heartbreak could not be contained.

Our long/brief journey together was coming to a close. How appreciative I am that after many struggles to understand and to try to change the other, our hospital system and our African clan had within the last week found a way to peacefully co-exist — no, not just co-exist, but respect, perhaps even appreciate each other. I give thanks for the perspective that our Ethics Committee guest speaker raised that allowed me to find the ears I needed to hear the words they could not speak. I am grateful for the curiosity that led me to research the world from which our immigrants had come, so that I might have some context in which to hold our differences; grateful for the compassion I had temporarily lost finding its way back into my heart; grateful for my willingness to become a stranger in their strange land instead of forcing them into my somewhat familiar world.

When I opened myself to who they truly are, I resonated with their devotion to the same God I love but which they call by the name Allah. I recognized the invisible bond that connects us to each other. When the son spoke of the need to just be in the room with his mother, I knew we are One — the same Spirit expressing as and through each of us. Were it my mother in that bed, I would not leave her side no matter the rules, the scorn, the pressure to do otherwise. I KNOW that love they feel. I know what it is to lose a mother, a father; they cannot be replaced. The day – today sorrow may lessen but the hole in the heart never goes away. What grace for me to be reminded, to see before me the love I have also lived. My heart was stretched, made larger by the gift of their presence in my life. I cannot just go on to the NEXT patient, the next family. There have been too many of late and I have not allowed myself to stop, allowed myself to love, allowed myself to grieve. Right now, just for this moment, I have to remember that knowing this family has changed me, has touched my heart. I have to put it into words that I can read on the days when there is no time to really feel, so that my heart does not become hard from the engorgement of unshed tears. There must be time to stop the doing and just be; stop the forward movement and just sit still, even though to do so feels like I risk being crushed by the incredible weight of all the shared and unshared sorrow. The image comes of trying to outrun a blizzard that has no end. At some point — this point — I must just rest in this protected place from all the snow still to fall, by embracing the storm I have already survived. Perhaps in this shelter, I will find respite, a place to be nourished before again trying to outrun the elements.

For these few weeks we have walked the path together, this clan and I, and it has been a rocky road much of the time. But tonight we sat by the side of the road and rested together. They have allowed me to serve them and I am humbled by the privilege. They have forgiven me, forgiven all of us for our earlier transgressions. In the midst of their deep, deep sorrow, they too seem to know that we are One.

My prayer is that I never allow myself to forget what I feel right now, what I have felt this past week as day by day, I have committed myself to just serving them. They have showed me the beauty of humility, they who humbled me with their quiet, gentle strength. As an assertive woman, I have allowed myself to sit at the feet of these who have mastered selfless love and found in them that which would serve me well to learn. They never backed down from what they needed to be in integrity, never allowed us and our silly rules to interfere with how their love HAD to be expressed. Yet, always they were gentle. Instead of forcing us to know their strength, they wore us down with their quiet perseverance. Instead of flaunting their knowledge, they disarmed us with the wisdom of their ways. And miracle of miracles, somehow our willingness to hear them, to try to find a way to meet their minimum requirements, opened their hearts to us. As they began to trust, the staff began to trust them. A new compassion was birthed in our ICU and I was privileged to be one of its midwives.

As we prepared for the end, I learned that it is the Muslim tradition to never leave the body unattended. The man at the mortuary that handles most of the Muslim ceremonies here said they are usually quite tenacious about that. I had experienced their tenacity and was determined that we find a way to give them what they needed. When the charge nurse needed to prepare the room for another patient (because there is always another patient), I offered the chapel as an alternative. She called the nursing supervisor who graciously agreed. When the mortician said they could not accommodate the family’s presence until after staff arrived at 7, I negotiated an agreement to bring someone in two hours early so we could empty the chapel before the calm of the hospital night surrendered itself to the hustle of a new day. As I took each option to the family, as they felt their needs honored every step of the way, another miracle — they decided on a different course of action. Wearied from their five-week vigil, they determined on their own that if two of the men could stay and accompany her body to the morgue until it was put in refrigeration, the remainder of the family would go home for the night. They would reconnect with her at the mortuary when the sunrise brought a new day — the day in which, according to their custom, her body would be buried.

Each of the staff in their section of the unit, was touched by their process — each in his or her own way reached out and wanted to help. Our clan united to support the passing of one of their clan. We were indeed all One. Gone were the past resentments, relinquished to the commonality of our experience of love and loss; of suffering and surrender; of grasping and of grace. Our clan gathered round the monitor, gripped by the drama unfolding in the ever changing numbers, the depth and breadth of the lines, while just a few feet away, their clan surrounded her body, offered their prayers, hearts breaking as the answer continued to be not the one they truly desired. Most members of our clan saw themselves in someone of the ‘other’ group as they might have seen themselves in one of us, had not their focus been only in one direction, toward the one they loved who lay dying. No longer did we reflect to each other the lowest and basest of who we are. Instead in that shared moment we mirrored each other’s Essential Goodness and all of us were baptized, some of us healed, by the Holy Water of their tears, mingled at times with our own. For a brief, shining moment we were an island of peace, the Peace that passes all understanding, in the raging sea of our normal lives.

I have no illusions that the cranky, grumpy, complaining witch that can too often be me died with this patient tonight. But I also know that just as a mind expanded by an idea can never return to its original shape, neither can a heart, expanded by an experience of compassion, humility and grace ever be the same. Tonight I experienced and embodied the gentle pleasure of being responsive only to what the other, the beloved other, needed. It was a priceless gift in and of itself. It was its own reward. And yet as I drove home I could hear my Creator saying, Well Done, Good and Faithful Servant. You too are my Be- loved in whom I am well pleased.

Bryce Canyon National Park, UT

Bryce Canyon National Park UT

Stopping by the Site of the Old Children’s Hospital

Travelling into the foothills

near the Lakeview graves within

sight of Lake Bonneville and

 

With the gulls of the Shoreline,

we spot the empty lot and

scattered bricks overlooking the Valley,

 

And sitting there stilled by the silence

of the missing red brick walls–

which hold the stories of the children

 

Of the Intermountain West-

who had the diseases of youth,

and their families who hold

 

The secrets that only parents keep

and store and share

for others who are to hear them,

 

And the walls which recall and reflect and deflect

the cries of those who are held for a spinal tap

or who can tell by the eyes of the resident

 

That another line must be placed or

who need another cutdown, another blood gas,

or whatever….they don’t want…(but need)

 

Or the words “I am afraid he has leukemia…

Down syndrome…a brain tumor…kidney failure…

she needs the heart surgery…the tumor removed…

 

We won’t be able to do anymore for her…or

Doctor, are you sure…Doctor, aren’t there any other medicines…

or does she need to go through another course of chemo…

 

Another shunt replacement…another tube…

is there any hope…isn’t there any hope’’

Or the words “she is gone…or

 

This is what we call SIDS”, or

“he did well with the surgery, or

most babies with this make it through…or

 

We have medicines for this…or…”

and the calls for help

and the replies for help.

 

Red brick and walls shelter and store

these calls, cries, replies, words,

moments in the lives and loves of parents

 

And children and doctors and nurses

connecting and sharing, not connecting,

responding, not responding, separated, together

 

And now the walls are gone from this place,

bricks scattered on the ground-

soon to be the place for the town houses of the north Avenues-

 

–we gather up three bricks from the site

and take them to the New Hospital and place

them in the walls where the cries and words

 

Can connect, as they are not scattered

and will not be forgotten for they are

ever present in the walls of the hearts of the parents.

 

The site is ready now,

overlooking the Valley, the view of Bonneville Lake,

ready to accept this other side

 

The town houses,

and the

rest of the city….

The Journey I Shared With My First Pediatric Patient… …Expressed in Chocolate

The Journey I Shared

  1. Cherries & Spice… she came to us in the middle of the night (dark chocolate), fussy and feisty (tart cherries), with a fever of unidentified source (spicy heat).
  2. Nutella Truffle… during her stay, she was mellow and sweet (like the soft hug of nutella chocolate), allowing us to poke and prod to figure things out.
  3. Lemondrop… finally, on a snowy day (white chocolate), I was greeted by a beautiful bright smile and an exuberant spirit (lemon drops) when she was ready to be on her way.
  4. … we have a lot to learn from our patient’s transparency, resilience, and energy. Furthermore, it goes to show that life really is better dipped in chocolate!
  5. With love,
  6. Linh Moran, MSIII

The Savior

I once saved an innocent child from drowning

He grew up to be a tyrant

In the pursuit of perfection, he drowned his entire nation

Then he drowned the whole world

In the end, he drowned himself and died anyway

 

I once saved a woman from dying

She had decided to face death with grace

Unable to let go, I brought her back to life

Months later her body was found floating in a cold river

There was evidence of great suffering before she had succumbed

 

I stopped and asked

Do we really save someone when we save their life

Do we really save them or are we saving ourselves

What drives us to save lives

Is it a mere instinct

Or just an obsession rooted deeply in our own past

Or something noble ensuring a place for us in the company of Saints

 

As I save another woman, I, silently ask for her forgiveness

Because I do not know what evil awaits her when she leaves my sanctuary

As I am declared a hero for saving another child, I quietly say a prayer

For his victims

For his nation

For the world

Alimentary

“Alimentary my dear Watson,” Sherlock stated

This was the part that Watson hated

“The duodenum could not have done it

For there was not a place for a pair to sit

But in the beta cells of the isles of Langerhans

Achalasia caught esophageal dyssynergia

Resulting in an acute dysphagia and so walks with an ileum and sweating hands

 

What’s more he worships the sphincter of Oddi”

An obvious fact thought I

“And this gives us a valuable lecithin

On the cult of the cholecystokinin

We’ll know who was right pylorus

With a simple Vermiform appendix

Performed singly by me or sprue

And Cecum justice in the pancreas.”

Production Credits, 2013 Rubor Volume 1

Editor in Chief:

Quinn Orb

Copy Editor:

Stephen Jenkins

Chief Faculty Advisors:

Gretchen Case, PhD

Faculty Advisors:

Susan Sample, MFA – Writing
Jeff Botkin, MD, MPH – Art and Photography

Fundraising:

Samuel Braden MSIII

Art and Photography:

Jennifer Yowell PhD – Chief
Reetu Malhotra
Jessica Mayer

Layout and Design:

David Nolte – Chief
Sarah Ahmad

Writing:

Kevin Garff – Chief
Noelle Teske
Robin Tillery