We hope you enjoy the sixth issue of Rubor: Reflections on Medicine from the Wasatch Front. We would like to express special thanks to the Program in Medical Ethics and Humanities at the University of Utah, Associated Students of the University of Utah, the School of Medicine Office of Admissions, as well as the University of Utah School of Medicine Alumni Association for providing financial support for this publication.
Rubor was started by medical students in 2013 to provide an outlet for students to publish artistic works, and has expanded to include student pieces from all University of Utah health professional schools as well as pieces from Utah physicians, nurses, and community members. Our goal since inception has been to document the highs and lows of health and medicine from multiple perspectives. We are thrilled to receive some incredible pieces this year, twenty of which are published here. Many other submissions were first-rate but could not be included due to space. In this issue, artists and writers tackle the issues we face every day as both providers and users of our health care system: the patients who leave their mark on us, the crisis of mental healthcare in our nation, and the need for doctors who truly listen to their patients. We hope you will find these works as thought-provoking and insightful as we did.
Rubor greatly appreciates and depends on contributions from our community. To view additional submissions that were published online, please visit rubor.med.utah.edu.
– Rubor Staff
Guest Faculty Advisor
Melissa J. Bentley, M.D.
Susan Sample, PhD, MFA
I remember you had so much cancer eroding your mouth that you sneezed and it broke your jaw. So we cut your face in half and scraped everything out and chopped out one of the bones in your shin and sewed it back into your jaw to reconstruct the mess we made and I remember when they said we do this all the time you both laughed and when we wheeled you back to the blue sheets and steel you were still laughing. And the days passed and your mouth kept healing but you had something else brewing inside of you, rotting and swelling in your belly like a balloon and it filled you with sickness so we hooked you to machines and we breathed for you, squeezed every vessel and poured fluids and drugs into you, but you were so sick and you kept raising your thumb high and you said you wanted to do it you said you could do it you said. And each day the white coats would sweep in, nodding, adjusting, and you would smile but you kept getting weaker and weaker and your body kept sinking deeper but your spirit never did, I remember that. And when she asked to leave your bedside to tend to your livestock we said we’d be there for you but when she left, so did you and you had a tattoo on your wrist and calluses on your hands and that night I cried in my car and pounded on the steering wheel and demanded the moon for answers because I didn’t know if we couldn’t help you or just didn’t help you but I don’t know if I’ll ever know the difference.
And then you, I knew nothing about you except for the video you showed me from when you were famous and you told me you were so happy before you fell into your dark place with the needles and bath salts and I remember how my breath stuck in my throat the first time I saw what happened to you after they removed the dressings so every day I would sneak into your room before the white coats to drip water on the edges of your bandages so you wouldn’t scream when they ripped them off and you told me that the drugs made you hear snakes hissing and women screaming being raped and you hated it but you couldn’t quit because being without the drugs was even worse and I couldn’t imagine anything being worse so during those quiet morning hours in the darkness I told you that things would be different this time and that you could have a second chance this time and you could do it this time and I told you to come back to find me and prove me right this time and you told me you would so now when it’s late and the sky is falling asleep and my footsteps echo in the hallways I remember your video with your head thrown back laughing and I still look for you.
But for the life of me, I can’t forget you and the way that you smiled when you said her name and how you kept waiting for your mother to come but she never did so you’d talk to the ceiling pretending she was there until one day your lips kept muttering, chanting, and your eyes followed me but they were blank inside and that’s when we found the puddle of bacteria chewing into your brain so they wheeled you back into the operating room and bolted your skull to the table and scraped out the pus but your body couldn’t handle it and the baby cried for help on the monitor so the white coats came running and they burst into the room with soapy hands and the nurses ripped blue tissue paper gowns over them and they sliced your belly open and stretched the edges wide and dug deep inside and when their bloody gloves reappeared they were welcoming a new tiny human to the room but you weren’t there to see what you had held onto so long for.
And when the day was done I wandered endlessly through the hospital to the tiny broom closet filled with warm glass incubators and the nurse guided me over to the corner and I saw the only thing that made that day worth it and leaned over that little bundle of new life and whispered this isn’t what the world is always like but when I got home I still smelled like you I’m right here for you I knew nothing about you I still look for you I can’t forget you I still remember you.
Here, in the sea-salt prairie ocean
with mountain shores awash in sagebrush shale,
is home, where we pray for rain
and anoint our wounds with milk and honey.
Where alpine forests sprout from desert stone, the huntsman’s sanctuary,
and irradiated white-water veils
blur the line between sea and sky.
I pressed my cheek to salted earth and wept.
Arches of steel and sandstone
straddle the fault-line divide
reaching heavenward, supporting sky bound stars
in sickness and in health.
Come, lay your burden down in the copper hills.
Snow-capped refuge, land of a thousand tribes.
Speak easy my outcasts, my family,
Open your mouth and wait for rain
Wait for rain
It’s hidden in the canyon walls.
He needs antibiotics,
or he’ll never get better
are you listening?
He’s been acting strange
check for a brain tumor
are you listening?
I don’t want the vaccine
autism runs in our family
are you listening?
She had dry skin
so I put this oil on her
are you listening?
I looked on the internet
and she needs to be admitted
are you listening?
I just want what is best for my child
can you hear them?
This piece was designed using SolidWorks, a 3D computer design program, and was 3D printed. Tubes and connectors were added to bring the piece together. The piece is representative of the notion held by some medical anthropologists that surgeons dehumanize aspects of the body–such as the heart–in order to operate. However, perhaps the dichotomy is not so simple. Perhaps physicians shift their focus within a spectrum of a patient’s humanity in order to focus on the part most relevant to the patient’s survival.
|0430:||It hasn’t been enough. How did this come so early?!?|
|I’m still tired! Ugh!|
|0500:||I should exercise|
|0515:||I really should exercise|
|0525:||No time to exercise!|
|0547:||Go go go!|
|0600:||Made it! Morning sign out. That person’s still here?!?|
|What happened? Oh dear…|
|0630:||Hello Mr. Brown, I heard your son’s night didn’t go well…|
|0900:||Johnny is a 7-year-old boy admitted for RSV viral pneumonia,|
|now on 5 liters high flow nasal cannula…|
|1200:||Rounds are done! Food!|
|1300:||Why is that pager going off? Who wants me?…|
|1500:||Johnny is a 7-year-old boy admitted for RSV viral pneumonia,|
|now on 8 liters high flow nasal cannula…|
|1630:||Johnny went to the PICU. Did I prepare Mr. Brown for this possibility?…|
|1700:||Sign out! Now about those notes…|
|1900:||Oy, finally done with notes! Home time!|
|2000:||Dinner and an hour with my girlfriend! I should probably study…|
|2130:||I should go to bed, but I should also study,|
|but it’s bedtime, but I haven’t studied, but…|
|2230:||If I go to bed right now, I’ll get 6 hours of sleep…|
|How is Johnny doing, I wonder…|
|2315:||Johnny has been stable on CPAP, that’s good at least.|
|Now about sleep…|
|0430:||It hasn’t been enough…|
She reminded me of my mother – if my mother were a charming Southern Belle from Texas who believed that God dictated every move in her life. If my mother drove a motorcycle. If my mother was raised spending her weekends with family in Louisiana devouring platters of seafood. There was something striking about her mannerisms, though. The way she liked to hold my hand when we spoke. The way she listened to me – with kindness in her eyes, as if what I said actually mattered.
She was life-flighted onto the helicopter pad with concern for an acute myocardial infarction and was rushed into the Emergency Department where I met her in the trauma bay. She was in the middle of a cross-country motorcycle road trip with her husband when her chest had started to ache. The tech handed me a piece of paper that a year ago I would have struggled to decipher. Within three seconds I knew the steep elevations, the ones that looked like the plateau drop-offs of the southern Utah high desert I normally spent my time in June exploring, were demonstrations of the blocks in multiple blood lines through her heart. Her troponin was elevated.
Perhaps she reminded me of my mother because she looked nothing like the other patients on the cardiac floor. Her petite frame, 60 years young, drowned in the sheets of the hospital bed. She told me of her love for long runs and her most recent marathon endeavor. She told me how she had not eaten processed sugar in over two years. She told me of her love for her daughters. She scrolled through photos on her phone of bright-eyed young women. “C is a labor and delivery nurse. You’d love her,” she told me. “J is the best mom to her kids. She’s getting remarried in August. Let me show you her wedding dress,” she said. Perhaps she reminded me of my mother because even though my job was to care for her, she was the one who actually took care of me.
We rushed her to the catheter lab and I watched as she had three stents placed into two of her main coronary arteries. “Deploy,” I heard the interventional cardiologist say over and over again.
I was six days into my third year of medical school, it was my first week of internal medicine, and all of my other patients had made life choices that placed them with us. “I smoked for forty-five years,” one man told me.”I just can’t give up my love for churros,” a sweet Hispanic grandma said the day before. Another young man confided in me his love for cocaine. But with her, it just didn’t add up.
The next morning we reviewed her lab results and her total cholesterol levels were higher than any my attending had ever seen. “700?” I repeated, as we stood as a team in the hallway, dumbfounded at the numbers on the screen.
We talked about her possible history of familial dyslipidemia and slowly connected the dots in her family tree that had never been pieced together before. Instead of panicking upon hearing the news, she thanked us for helping her understand that the episode wasn’t her fault.
On her last morning I made sure to make it to the hospital with an additional thirty minutes to spare. It had become routine that I’d spend extra time with her after asking all the necessary medical questions I would later report back to my team when we rounded the floor. I would sit on the end of her bed and we’d chat while she ate her heart-healthy breakfast. This time she wished me well, asked her husband to take a photo of us together – but only once she did her hair, finished her make-up, and changed out of her hospital gown – and I knew that I’d miss her and her southern drawl after our week together on the floor. She had shared with me her love for God and I shared with her my love for science and literature. As I now think about it, months later, I realize her maternal presence was the most warm welcome to clinical medicine I could have asked for.
“Good luck,” she said with her delicate smile as I walked out of her room for the last time.”Come visit us in Lubbock, if you’re ever passing through.”
As I did my first newborn exam today, it hit me–how you were supposed to be. A healthy baby, likely colicky, but nevertheless loved by your family. You should have been interactive with your primitive reflexes still intact, maybe even making a student chuckle with your Moro reflex just like this little one did for me today.Your clavicles and ribs should have been growing, not healing multiple fractures. Your skin should have only displayed the benign lesions we expect, not the numerous ecchymoses we only discovered well into your hospital stay because you came to us in a medical papoose instead of swaddled like your successor.
You haunt me. You’ve been following me, largely without notice, around the halls of Primary’s and even venture home with me. Yet you must always be in my periphery, for you slip into my thoughts frequently now, always leaving melancholy in your wake. I know how much skill this takes, because I, too, do my own slipping in.
I slipped into the trauma bay for the first time that day and shadowed the hoard of doctors into the CT reading room to watch Neurosurgery quickly scroll through your scans whispering phrases like globally hypoxic, diastatic fractures, and finally non-operable before brusquely leaving. I slipped behind my fellow as he was leaving the ED and listened as his only reply to police questioning was “his [your] injuries are not consistent with the mechanism from the history.” Joining you in the elevator was too obvious, so I slipped through the back stairwells and hallways into your PICU room behind the procession of intensivists, surgeons, and support staff.
I was the silent sentinel to everything that happened to you that day. I watched them take blood and transfuse blood. I witnessed a fellow futilely try to place a central line for two hours before the attending took over, only to take another. I listened as your mother told the police that it was her first day back to work from maternity leave and she had called your father to ensure he was up to drive your brother to school but discovered he had overslept. Everything was running late. It wasn’t your fault. I do not know what triggered your father’s final episode of abuse, but I hope it was mercifully fast. You did not deserve this.
You became my own private sadness when you slipped in, because the rest of the team quietly continued on, expressing anger with words, but not tone, for those that commit these atrocities against children. But I obsessed about you. I read your chart innumerable times, hitting refresh hoping to see new updates.
I eavesdropped on conversations with specialists hoping for mention of you. I compulsively scrolled through your imaging and retinal scans for hours, mentally cataloging every abnormality. Primary’s is supposed to serve as a presidio, protecting children like you from disease and death. Our system failed you; someone here had to bear witness to your life.
The closest to true enrage I saw on our service was your attending aggressively lecturing me a few days later on another suspected non-accidental trauma case, “Don’t belittle it into something more palatable. It’s like calling rape ‘non-consensual sex.’ It’s absurd. Call it what it is–child abuse.” I wonder, will all your future unfortunate comrades join you until I have a small phalanx as my shadow urging me to call it by its true name?
Maybe you’re not always in my periphery, little one; perhaps you’re a part of a brigade that follows him, slipping occasionally into his thoughts as well.
Empathy is essential to humane health care practice, yet it can be difficult to teach. While there are many strategies for teaching empathy to medical students and practitioners, most of these methods are thinly veiled attempts at instilling sympathy in the listener. Sympathy doesn’t suffice because it’s often feigned pity; true empathy requires a touch of experience to inform the sympathy.
We have a suggestion. Imagine walking into a lecture hall for first year medical students about to start their cancer unit.The desks each have a pill cup with a powerful emetic and a barf bag. Students file in and find seats in the room. As the lecturer stands up to begin teaching the pharmacodynamics and kinetics of chemotherapy they begin with these simple instructions: “Take the pill. Keep the barf bag close. Let’s get started with alkylating agents.”
Now a room filled with vomiting medical students may not provide the best pharmacology learning environment, but would even this short-lived experience not instill a touch of empathy in the retching student? Imagine working through all the side effects of chemo in the same resolute way.
Our suggestions for developing empathy for one’s patients, however tongue- in-cheek, are inspired by a teaching moment of the late 19th century’s great physician and teacher William Osler who, according to legend, taught empathy to his medical students one day while rounding. In teaching about patients’ experiences with bedrest (which was commonly prescribed in those days and which he strongly supported), Osler pointed at random to one of his medical students and said “You. Bedrest. 2 weeks.” In the spirit of Osler and to remedy the dearth of empathy in aspiring medical providers we recommend the following treatments:
For your cancer patient undergoing chemotherapy we recommend not only taking the emetic you first had in the lecture room at least 3 times per day for the following week, but also to be sure to shave your head.
For the COPD patient, we recommend breathing only through a straw or oxygen-depleting mask for a minimum of 12 hours per day.
For your dermatology patient with intractable skin rash we recommend an itch-producing ointment applied liberally to your own skin.
For your wheelchair-bound patient, we recommend spending a week in a wheelchair, 24/7, no This won’t tell you what it’s like to spend ten or twenty years in a wheelchair, but you will discover lots of obstacles to getting around.
Do you have a patient with a high spinal cord injury? Spend a week motionless in bed, with all your bodily functions attended to by others.
How about a patient with a feeding tube? You can see the presentation of what you plan to eat, smell the aroma and even put it in your mouth, but you must spit it Your entire nourishment must come only from bland, tasteless gruel that you must eat exclusively for a week.
For diabetic neuropathy, consult a neurologist and try to replicate numbness, tingling or serious nerve pain.
You may have patients addicted to It may be difficult to simulate the craving – although you should give up whatever brings you the most intense pleasure — but you can certainly simulate the intense constipation caused by opioids by taking Imodium continuously at the maximum dose.
For your schizophrenic patient, you must use your earphones to project voices into your head for 24 hours per day, for one nonstop week.
To truly understand the dementias, especially later stages, you could begin with going without sleep for 48 hours and trying to function in your normal Of course, that’s only the beginning.
These suggestions are merely a start and we encourage the reader to consider further strategies for enhancing empathy in the situations of more complex patients. Keep in mind the great William Osler and that hapless medical student consigned to bed rest as you develop the trait of empathy. And if you’re really serious about becoming a great physician who truly understands what your patients are going through, try all of these exercises, one after another, for the entire time you’re in med school. Of course you’ll never really know what it’s like to be the patient in these difficult situations, but at least you’ll be a lot closer than many physicians ever get.
my mother has an invisible son
he protects her, loves her, is hers and will never leave her
he is free
he lifts my mother and saves her from being the woman she is
my mom felt him in her womb not once, not twice but three times
when i was born my mother cried
she searched for her son on (not in) my body
i see my mother’s invisible son sometimes
he is not real but i can feel him
he is everything my mother could never be
bright as the sun, loud as thunder
carefree like the rain and limitless with dreams
she wants the world and he is her key
my mother wants me to pray for him and i want to contribute to her dream
taking four years of my life, i kneel and ask Waheguru (god) “please give me a brother”
she smiles, i can make her happy now that it is not invisible it is real
my mom messed up the arrangement
the arrangement my grandparents made
the arrangement of her marriage, duty and feminine
my mom catches his glimpse in my sisters and i
i think it scares her a lot and it scares me too
it confuses the lines she has created
she (re) arranges the arrangement
she is a fighter and we are the world
her son is not invisible
he is real and
he lives in my soul
The pit in your stomach, the feeling that you are about to throw up. You can’t move.
You feel like the whole world is moving and you are frozen.
The feeling of emptiness inside you. Your hands shaking, it’s sickening to move. Your whole body sweats, and you are pale. That’s what I feel like.
I just sit in the shower because I am too weak to stand. I am always wondering,”Is all my homework finished? Is the door locked?” *check,check,check,check,check,- check* I always check 6 times.
My hands are dirty, I need to go wash them.
My hands are so dry from always washing my hands, it hurts to move them.
Uh oh, I had an upsetting thought, better re-do what I was just doing. My OCD is like another person in my brain, telling me what to do.
Talking about my anxiety to counselors. One of them, Leslie, telling me my OCD is just a little glitch in my brain. That everyone has glitches and this is mine. I keep telling myself that. It’s just a glitch in my brain.
I feel like my life will never be the same again, and that I will always be like this. Always having thoughts running through my head. Doubts, questions, being unsure about everything, always asking myself “What if?” What if something bad happens to me today?
What if there is a fire tonight? Better go check the things that are plugged in. What if someone breaks in? I better go check the door again to make sure it is locked. Aghhh! My mind won’t stop! These thoughts are so upsetting! It’s just a glitch in your brain.
My mom helps me.
I feel like I am just a burden to her and my family.
My mom tells me that I am never a burden to her or my family. She takes me to Leslie. I tell her all of my upsetting thoughts and my compulsions.
She says, “It’s your OCD putting these thoughts into your head, and causing you to do this compulsions. It’s just a glitch in your brain.”
All I can think of is that this will never get better. My whole life is going to be like this.
I hear that I have an appointment with Leslie. Anxiety starts to build up.
My OCD suddenly gets worse. It’s just a glitch Addy, don’t let it control you!
Leslie keeps telling me that I am the bigger person, and that I need to take control of my OCD, not the other way around. It’s so hard though. It feels like someone is yelling at me inside my head, commanding me to do things.
I look at other people.
Look at how happy they are, they can go about their lives without having to do things a certain number of times, always checking, and doubting themselves!
I wasn’t like this when I was younger. Why is this “glitch” showing up now?
One day all of my stress and anxiety exploded like a shaken can of soda. I ran to my mom, I felt so sick, and weak. I could barely move.
Growing up, I had stress and anxiety about things. I could handle it, sometimes I would go talk to a counselor for help, but on this certain day it got really bad.
I had a hard trial ahead of me.
My counselor and parents tell me that I’m going to have OCD my whole life, and I am learning ways on how to handle it. All I can think of is that I am never going to get over this. It is too controlling.
This is a secret of mine.That no one really knows about except my parents.
Whenever I was stressed out, I would listen to Christmas music. It was one way for me to get my mind off my OCD and be happy. Now whenever i hear Christmas music, I can only think of that rough time in my life.
After the worst 3 years of my life, I finally have my OCD under control.
I never thought that I would.
After learning and starting to apply the tools that I learned, I faded from going to
Leslie. I wanted to try and figure it out, and I did.
I overcame my OCD.
I still have it today, but it isn’t in control of me so much. Sometimes it gets bad, but not often. I go and talk to my mom for help and I dig deep, and realize that it is
trying to control me again.
It’s just a glitch in my brain.
I can go throughout my days now, and get things done. I’m not having to be constantly checking, or wondering “What if?”
I have come to the realization that my OCD is a part of me and I have accepted it.
It’s just a glitch in my brain.
Can’t you stop?
Another break for a smoke,
just a few a day, every day.
Another pack-year added,
year of life subtracted
Are you finally done?
Quitting again. Trying hard.
Kicking the habit in a moment of clarity–
a firm resolution.
But it’s on your shirt. The cigarette smoke
has woven its way into your lungs
damaging and scouring the cilia,
hastening the dysplasia
wasting away the original cells
the ones that gave you filtered, beautiful clear air.
Trading one addiction for another,
this is better
this is safer
you may live longer
you can think clearly,
but can you breathe deeply?
I’m happy you’re here
alive and optimistic.
But I’m supposed to advise you
give you statistics
that will make you anxious,
make you worried,
make you smoke,
all we want is for you to quit
Am I helping or hurting?
I love you and want what is best.
cigarette in hand,
twenty-five feet away
next to a girl eating her daily donut
How is that different?
ischemic attack waiting
she goes unnoticed, even accepted.
Where is the line?
You’re better than ever.
I’m so proud of you.
I look up to you.
Your definition of life
You’re not a statistic or a label
You are my brother.
In the back of my mind
I wonder–for how much longer?
GUEST FACULTY ADVISOR
Melissa J. Bentley, M.D.
Susan Sample, PhD, MFA