Harmony Magazine, Volume 8 (2006-2007)

V O L U M E
2 0 0 6- 2 0 0 7
A R I Z O N A
H E A L T H
S C I E N C E S
C E N T E R
M A G A Z I N E
O F
T H E
H U M A N I T I E S
Art Essays Ideas Photographs Poetry Prose
Purple Lily
Tessie OTalley
ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES Editor Charity Jackson Editorial Board Katherine Glaser, MFA, MPH Faculty Advisor Helle Mathiasen, Cand.mag., PhD Advisory Board J. Lyle Bootman, PhD James E. Dalen, MD, MPH Vincent A. Fulginiti, MD Marjorie A. Isenberg, DNSc, RN, FAAN Keith A. Joiner, MD, MPH T. Philip Malan, Jr., PhD, MD Kenneth J. Ryan, MD G. Marie Swanson, PhD, MPH
Harmony is a publication of the Arizona Health Sciences Center (AHSC). It is sponsored by The University of Arizona College of Medicine Medical Humanities Program, the Medical Student Government, and the Kenneth Hill Memorial Foundation as a gift for the community. All works in Harmony, both visual and literary, are the exclusive property of the artist or author and are published with her/his permission. Authors retain their copyright for all published materials. Any use or reproduction of these works requires the written consent of the author. Views expressed are solely the opinions of the individual authors and are not representative of the editors, advisory board, or the AHSC. For more information, please visit http://humanities.medicine.arizona.edu. Complete guidelines for subscriptions, donations, and submissions may be found in the back of this journal.
Front Cover: Luis Rodriguez Back Cover: Mary Foote Cover Design: Roma Krebs, Biomedical Communications, AHSC
Tessie OTalley 7 YeLLOW FLOWeR Kelly Sandberg 8 MIDNIGHT MUSINGS Armaity Austin 8 REKINDLING THE SPIRIT Peggy Gigstad 9 GOOD ENOUGH Adrienne Yarnish 10 ORCHITIS Peggy Gigstad 12 PREPARATION Matthew Bernhard 12 SeattLe PubLic LibRaRy Kelly Sandberg 13 Past HOmage tO a PediatRician 14 WRITINGS BY THE UNIVERSITY OF ARIZONA GERIATRICS RESIDENTS AND THEIR INSTRUCTOR Donna Swaim 14 UNTITLED 15 MY SONG OF DISCOVERY 15 A POEM ON DEMAND Robert Attaran 16 UNTITLED 16 THE PHYSICIAN 17 THE DEATH OF ROBERT ATTARAN Priti Sud 18 CAN THIS MIRACLE HAPPEN 18 FEAR YOU Holly Good 19 UNTITLED Kevin Akers 19 ECSTASY AND AGONY Seth Miller 20 UNTITLED 21 DEATH: Shae Vaughn 22 LIFE
HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES
Joyce Gonzales 22 WHY John Kuczynski 23 BEEP Dan Shapiro 24 THE PAINTER Christina Hayhurst 25 SeLf COmpLiance Kenneth J. Ryan 26 A MYTH FROM THE SEA: WAGNERS BREAKOUT OPERA Eskild Petersen 32 WinteR, HeLmchen FaLLs, B.C. 32 WaRming Hut, WeLLs GROg, B.C. 33 PyRamid MOuntain, B.C. Nancy Howe 34 neurotransmitter dysFunctIoN manic-DepressIoN coGnitive therapY serOqUel wellbutRin biPolAr liTHium Ronald Pust 38 EL CUAL ES NADA Yovannah Diovanti 39 La Raz Que nOs cOnecta (The Root Which Connects Us) 40 Un RezO pOR La humanidad (A Prayer for Humanity) 40 EL cicLO de La vida (The cycle of Life) Serge Hougeir 41 The Beast, SeviLLa, Spain 41 La MezQuita, CORdOba, Spain Christina Menor 42 Dusk Mary Foote 43 LittLe GiRL WaLking, IQuitOs, PeRu 43 CaRnivaL, JuLiaca, PeRu Aaron Leetch 44 La IgLesia deL PuebLO Mary Foote 44 PatagOnia Landscape, ARgentina Luis Rodriguez 45 The Patient 45 La MueRte de La POndeROsa
Linda Carr 46 PeRfect SymmetRy, Mayan VOLcanO Jennifer Nichols 47 LLuvia, LLuvia Shameema Sikder 47 NYC Carla Dormer 48 Sunset Shameema Sikder 48 JeLLyfish in MOnteRey Eskild Petersen 49 SandhiLL CRanes Brian Tsui 50 UntitLed Tessie OTalley 50 HummeR 51 Kitties 51 MeXican WOLf Christina Menor 52 Behind Yovannah Diovanti 53 HaRmOnia (Harmony) Aaron Leetch 54 Tamahu, A.V. Mary Foote 54 AmazOn Life, PeRu Kevin Yarbrough 55 MEMORIAL 55 THE HEARTS VOLERY Quinn Snyder 56 ASYMMETRY Christine Krikliwy 58 RUBBLE 59 WHO MentaL HeaLth Camp, Bagh, KashmiR 59 Tent HOspitaL in Bagh, KashmiR Robert Kravetz 60 A LOOK BACK: MILITARY SURGEONS 60 PHOTO
Janet Alessi 61 MY VISITOR 61 MY MOTHERS SONG Zoe Sorrell 62 I AM . . . Jeanette Long 64 JOURNEY TO THE PEAK 65 RETURN TO BEAUTY Anne Welch 66 PLEASURE Anne Welch 67 ARE YOU MY MENTOR? Nilay Kavathia 68 OH MAN Lisa Tarris 69 THE SECOND YEAR SPLIT Anonymous 70 PRESERVATION Josh Holexa 72 GUATEMALA Lisa Goldman 73 CHEKHOV AND HIS CASEATING GRANULOMA Doug Lindsey 74 A MESSAGE FROM THE OLD MAN Charity Jackson 76 HEARTBEATS Helle Mathiasen 78 THE ART OF MEDICINE: LOOKING FOR MEDICINE IN THE ARTS Eskild Petersen 81 Least GRebe, SWeetWateR WetLand 85 CONTRIBUTORS Kelly Sandberg 89 CuLtuRaL COmpetency TRaining 90 HaRmOny SUBSCRIPTIONS and dOnatiOns 91 haRmOny submissiOn guideLines Kelly Sandberg 92 DOstOyevsky and His FatheRs POLycLiniC
Why Harmony? There is a struggle within all of us in the medical profession, no matter our official title or functioning capacity. It is the struggle to be clinical and professional while retaining our precious individuality; to remain compassionate caretakers while learning to look at patients cases objectively and correctly. We must be able to think clearly, without our emotions guiding important decisions, and yet we cannot lose such an integral part of our beings. This becomes a delicate balance that is difficult to maintain. Harmony, and the creativity that allows for its formation, gives each of us an outlet for the conflict that lives within us. A pen to paper, a brush to canvas, an eye to the camera window each gives peace and clarity and respite from our everyday lives. Those of us who work in medicine are overwhelmingly left-brained individuals: analytical, logical, methodical. Creating something of our own, be it literature or art, allows us to exercise that neglected right brain, and to regain some measure of control over the conflicting emotions within. For were drowning, all of us, gasping for breath beneath mountains of information and the pressures to succeed. We suffocate under the weight of achieving our dreams. We fight desperately for air, for balance, for life life beyond libraries and books, life with laughter and friendship and love; life with meaning beyond passing the next exam or moving to the next level. After eighteen months of education, this winter I found the idea of entering the halls of the medical school unwelcome for the first time. Certainly no part of my dreams had changed I still longed to join the ranks of those called doctor and wanted
to do what I could to aid others. My reaction was more a recoil from the utter sameness that had become my education, from the long, arduous hours spent in the same uncomfortable chair in the same lecture hall, with merely a different topic taught by a different face marking the passage of time. This was a reactionary type of boredom, I suppose, and yet infinitely more. The mental exhaustion that came with each round of exams, the ever-present dread of failure, and the awareness of vast amounts of knowledge with no skill with which to apply them took their toll. Most of all, the patent fear of the next step the fear of it, but yet the eagerness with which I looked ahead to it. And yetand yet Im here, in the place Ive always wanted to be: on the brink of becoming a physician; of holding that beautiful wealth of knowledge within my hands but struggling through the process of getting there. Everyone struggles, and nearly everyone makes it through and that is what I count on. If others can make it, then so can I. I look back at words I wrote long ago, when being in medical school was a dream I longed for and yet dared not hope for. Those words speak of excitement, wonder, awe. They speak of a young woman poised at the brink of something wholly new and satisfying. They speak to the confidence and enthusiasm that are still within me emotions that often become too much and overwhelm me, leaving me in tears. And yet I do not think it is these raw and hopeful emotions alone that bring
me to tears; it is the awareness of other, more intimidating and destructive ideas that have stolen in along the way: the thoughts of failure, imperfection, and unrelenting responsibility. The warring of these two sides of my inner self causes me to sit alone and take stock. What is it, exactly, that I am afraid of? What is it that I am excited about? For undoubtedly, all will occur in time. Failures and disappointments I can hardly stand to think of will mix with successes and rewards beyond my imaginings, and I would be a fool to give up either side in the course of my life. I must learn to realize that I will not be strong without first feeling weak; that I will never be confident without first being scared. Admitting such things goes against my nature. I strive to be always assured in my actions, to be certain of my place in the world. And yet the practice of medicine, the art of healing, is not
a talent one is born with but one which must be cultivated through years of learning and making mistakes. It is unfortunate that such mistakes are made on the very people we are striving to help, but this is the way of medicine, not easily changed or avoided, something with which we all must all make peace. When conflicts and frustrations come and they do they are simply a manifestation of the trials of growth, the pains of becoming. They signify coping but not the solution, not the end. Not nearly the end. Charity Jackson Editor
Yellow Flower
Tessie OTalley 7
Kelly Sandberg
MIDNIGHT MUSINGS
She sleeps soundly, unaware of my presence in her room. Just minutes ago she eagerly climbed into her new bed, eager for a first nights sleep. Piled high with stuffed animals, blankies and her comfort water bottle, her sprawled, two-footed, two-year-old self breathes in and out. Im sure the fan has purred her to sleepnothing like the din as her mother was getting her ready for bed. I stealthily examine her for abnormalities. The stethoscope rests gently on her chest as my mind begins to wander. Scarlet Fever, Wilms tumor, scoliosis, Flintstones overdoseeach as improbable as the next, but what if my child has something I should be able to detect? Do I ask Dr. R. or Dr. M. about the strange batting movement she makes while running? Do healthy kids have such distended abdomens? Do they eat as haphazardly as she does? His words come back to me. Not the exact words, rather, the spirit of his words. Why am I here? Accolades, honors, letters, committees, rotations, residencies, fellowships, matches, honor, glory, respect? These are all gold stars; they come out in the wash with my daughters pen-streaked shirt. No, all his words center around onepatient. Daily Im worn down, hewn down by my own incapacity for sucking up knowledge. Strangely, this word answers my unformed question: waitwait. And I remember that night of hushed hypochondria and can endure a little bit longer.
Armaity Austin
REKINDLING THE SPIRIT

The moon gorges on Itself each day, And then bit by bit Puts itself together again.
Things change But start afresh each day, God likes shifting things Around and then Putting them back again.
Peggy Gigstad
GOOD ENOUGH
I dont remember it clearly the last time I said goodbye to Dad It is a blur of checking plane tickets watching how Mom was doing trying to be strong. I know I kissed him and he said, Well miss you. I told him Id be back In a few weeks But it isnt crystal clear and I strain to picture it To see if it was good enough. What I do see clearly are the afternoons he was awake We listened to old musicals and watched the October hills fade from red to gold to tan The time I knelt next to the hospital bed with my head on his chest. He whispered, You are my sweetheart. and stroked my hair like I was a child The way he pats little Emma when she crawls up next to him I remember grandkids perched around him in his big chair One on each arm, two in his lap, and two caught in the vise grip of his knees playing the escape game. These are the memories that matter All the happy goodbyes that sent us off on lifes adventures with confidence celebrations to welcome us home All the late night talks over martinis and extra-sharp cheese Old stories, big laughs and pick you up off your feet hugs. It is all those million moments packed tight and piled high that break the scale. There will never be A good enough Goodbye
Adrienne Yarnish
ORCHITIS
This account was written one day while on my third-year pediatric rotation. The event itself took only 2 minutes out of the day in real time but in my mind, I struggled with it the whole day and into the next week. Maybe you can identify with it in a way that may not be immediately apparent. The flower is what it is for me; it might be something different for you. But the orchid is what will make you the doctor youve always wanted to be, the person you should be. Hold onto it, wear it proudly. Just be yourself, and everything else will fall in where it should. Dont take this personallyIts about the flower you wear. Youre going to have to take it out- it is hospital policy. We cant have you wearing flowers in your hair in the hospital. Oh really? Yeah, sorry. OK, I think. I force a half-smile and dutifully remove my symbol. Mood changes. Tears come. They flow down my face as I sit at the computer with my back towards the residents finishing my write-up. Fuck that, I think. No one has ever had a problem with this before. All the physicians, even the bad-ass surgeons Ive met during third-year clerkships comment. They like it. Nice touch. Thats cool. That says a lot about you. I always think: yes, it does. It is my symbol of life, my reminder to keep it going. It is my Matthew by my side in death, as he was in life, near my ear whispering my praises, telling me Im beautiful. I can touch it and I am reminded of the person in my life that loved me, my favorite person, the person who died too soon and left me to do something with this fucked up space I take up on the planet. I touch it when things are bad and remember instantly that they are not that bad. It is a part of me, the one that dies everyday and is replaced fresh each morning. It is a piece of me as my ear is a piece of me. Without it I cannot hear, without it I cannot face life. Is this stupid? I ask myself. The intensity of emotion I am feeling about an orchid that is in my coat pocket now instead of in my hair. It is stupid. Taking the flower off does not mean anything. It still grows and blooms inside. No, it isnt stupid. Is this really a hospital policy? Flowers are definitely allowed in the hospital. Patients get flowers to bring a smile to their faces when lifes hand is holding them down. In fact, one good thing the hospital does is allow people to enjoy flowers in the midst of sadness and fear. Patients love my flowers, they always smile, say they like them. Sometimes I will give one up to a patient if he or she is so deserving; if the emotion the patient is experiencing comes close to touching the emotion that drives me to end a flowers life in memory of the shortened life which haunts me. I look up hospital policy. I cant find the dress code. From what I can find, professional dress is required. Definitions. Subjectivity. Is a flower unprofessional? Im sure a flower has been called many things but unprofessional is probably not one of them. I am weakened without my flower. My superpowers die when it is taken away as if it were the only weapon in my arsenal available to me to defeat death, negativity and fear. Is it his personal opinion? Who brought this up to him?
10
Its nothing personal, my ass, it is ALL personal. Do you think I wear it to look cute? Do you think I care WHAT YOU THINK? Maybe Ill take it out of my pocket where it is being smashed by my stethoscope and my reflex hammer and put it back where it belongs. It rides in my official white coat with all of my official medical instruments but it is the most powerful instrument Im carrying. Without it, I cant practice medicine. It is the only thing that I cannot take away to keep up with this life in medicine. Strip me down. Take it all. But dont take my muse. Flowers are healing. They heal me. They keep a smile and the thought of happiness from fading away. They heal my patients in ways I never will. I am frustrated with everyone around me They think they know. They DO know what protocols to follow to rule out sepsis in an infant, they DO know the biochemical pathogenesis of congenital adrenal hyperplasia but they probably have no clue how most of their patients are feeling. When they walk in the room, it is with the intent of getting a job done, but walking into that room is so much more than a job, even if you do it well. So often, they hide from the fear in their patients eyes. Perhaps its easier. Now they want to hide from my fear. I fear that the flower is wilting. I fear that I am wilting from the pressures of medicine, the ridiculousness of it all, the business of it all. MAYBE, I will walk out right now, fly to another country and be a healer where I have room to heal, where I have space to grow flowers, where the air is clean and I can breathe freely without administrative minutiae clogging everything up. MAYBE, I will fight. Maybe I will go talk to the resident and explain myself, not with an expectation of understanding, but to get him to see I am not a silly little girl picking flowers outside,
that I am present. I am HERE and this flower is what makes it so, what links me to the people I care for. Maybe he wont change his stance, hell just realize that people do crazy things for a reason. Hell realize that he may have the power to call CPS on a parent whose child broke his femur bone but he doesnt have the power to remove my symbols, no one does. FLOWER POWER! MAYBE I will be silent. I will go forward into the tangle of medicine and be a little more lost now. I will smile pretty and keep that which brought me here suppressed and crushed in my pocket. MAYBE I will take my medicine, get some sleep and cuddle with my dog and remember the important things in life. But, this IS important. It is the most important thing for a career in medicine to keep ones personality and original intentions intact, to not be molded by the demands of medicine. There is the hierarchy. There are the insurance companies. There are the pharmaceutical companies whoring themselves to us. There is society telling us to be successful, be rich, gain status, be well-respected. We need to keep a shell of purity to protect us from these influences which pervade yet have nothing to do with the heart of medicine: why most of us decided on this field, this way of life. MAYBE I will return to old habits, have a drink, smoke a cigarette and find a comfortable stupor to relax in. If I do this, I give up, I give in. If I do this every time that I am challenged to my core, I will end up dying a slow death as a good doctor. Maybe instead of this, I will choose to die having lived a meaningful life as a slow doctor: the one who takes the time to sit with her patients and give them a flower.
11
Peggy Gigstad
PREPARATION
Now that I look back I can see that Dad was preparing for years, really to leave this world and preparing us We all made the journey along behind picking up pieces holding belt loops moving boulders out of the way The journey was uphill, inch by inch sometimes but like marching with the whole platoon you are carried by the rhythm the sideways glances the leaders cadence We shared a laser focus on time and its fleeting nature the presence of an unwelcome visitor we were polite to, but not happy with That core of mortality that we all carry hidden barging in sitting at our table quiet but obnoxious naked and stark forcing us, like art students to see beyond the surface distractions to the form and substance beneath until it is something we can look at be with, and still breathe trying to be strong
Seattle Public Library
Matthew Bernhard
12
Past Homage to a Pediatrician
Kelly Sandberg
13
WRITINGS BY THE UNIVERSITY OF ARIZONA GERIATRICS RESIDENTS AND THEIR INSTRUCTOR

For Mercy has a human heart, Pity a human face, And Love, the human form divine, And Peace the human dress. William Blake (1757-1827) These short writings, pp. 14-23, were composed inside and outside the classroom by our geriatrics residents and their instructor, Donna Swaim, PhD. Their four-week course, Learning the Competencies through Literature, is based on a spiral bound reader which includes short selections from classic authors, such as, Brecht, Brooks, Bulgakov, Campo, Carver, Dickinson, Donne, Gunn, Huggins, Mates, Maupassant, McCann, Neruda, OConnor, Ofri, Sexton, Shakespeare, Wallis, Williams, and Zepeda. The course was created and originally taught by Helle Mathiasen in early 2004 with the aim of encouraging students to reflect on their professional and private lives as they read and discuss important literary works in a small group setting. From the beginning, students were also asked to write and share their writings. The six core competencies and their requirements for physicians can be accessed at www.acgme. org/outcome/comp/comFull.asp They are: patient care; interpersonal and communication skills; medical knowledge; professionalism; practice-based learning and improvement; systems-based practice.
Donna Swaim
UNTITLED
When Im cut I bleed When I cut another They bleed Two cuts Two skins Two causes One effect One link in a binding bracelet of humanity
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Donna Swaim
MY SONG OF DISCOVERY
I have discovered Pure ice is blue Pain In retrospect Heightens awareness Wind is tiring Things depreciate in value Experiences increase in value Being recognized validates. Curiosity motivates and stimulates Human touch is healing Dog sleds are bumpy Open hearth fires draw people and pets People In life In stories In memory Are the only treasure Reality is perception Memory is selective Enlightenment is now and here This moment, this place Never ending Whats love got to do with it? Everything
A POEM ON DEMAND
How different? If I speak my thoughts Or write an extended essay A short story, a novella, Perhaps a novel novel It is different! How different? Poetry promotes flexible thought Perhaps with only clues for comprehension Deliberate focus on fine phrases Clever words may Permit avoidance of clarity No need for perhaps better if not Punctuated properly or painstakingly No critique of ambiguity No closed door to multiple meanings Instead Stimulus to further thinking by both poet and reader Wonderfully different!
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Robert Attaran
UNTITLED
It was that summer that Joe and I decided to take up a hobby. I was a medicine resident. Joe was an obstetrician. We contemplated our new hobby with great enthusiasm. Finally, we agreed to take motor mechanics classes. They were held every Tuesday and Thursday at a community college. Soon, the classes became the high point of our week. We learned about cars, engines, oil changes, and all those other things that most men knew nothing about. The final exam was a tedious affair, but Joe, the obstetrician, and I were keen students. The lead instructor, a local, announced that for the final exam, a hundred points were up for grabs. Our task would be to disassemble, then reassemble an entire engine in an hour. Fifty points would be awarded for each section of the exam, totaling a maximum of a hundred. We each had an engine to work on. As the exam started, I got stuck in. After a few hitches I managed to successfully take my entire engine apart and then put it together again. The instructors awarded me a full 100 points. I was very proud of myself. Joe, on the other hand, got a score of a hundred and fifty. Joe was a dear friend and I was happy for him, but my competitive side took over. I cornered the lead instructor and asked him how, in an exam of 100 points, a candidate could score 150. Flicking through the pages on his notepad, the instructor replied, Lets see. Fifty points for disassembly. Fifty for reassembly. And a bonus fifty for doing the whole work through the muffler.
THE PHYSICIAN
The physician seeks to be whole Seeks fulfillment This is driven by a common desire The desire to be significant, to contribute To feel loved and valued This is why I do what I do.
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Robert Attaran
THE DEATH OF ROBERT ATTARAN

Helen, Im home! She was in the shower, out of earshot. Michael threw his keys on the kitchen counter, and walked in. He rummaged the fridge for a snack. He hadnt eaten all day. The kitchen table was cluttered. The days unopened mail, a few bills, and a small wooden box. He recognized it immediately. He ripped off his tie and sat down reluctantly. He started going through his mail. Most were letters of sympathy. Brief, cordial and kind. It had been over a week since his fathers passing. There had been an outpouring of sympathy from friends and family, even distant ones. Although he tried his utmost to control his emotions in public, privately Michael had taken his fathers death badly. Their relationship had not always been so strong. While in college Michael was often at odds with his father. Countless arguments meant Michael rarely came to visit. But, both father and son mellowed over time. By the time Michael got married, things were much better. And, when his father was first diagnosed, Michael was the most supportive son. Michael stared into empty space. His thoughts were interrupted by the sound of Helens footsteps upstairs. He looked down at the box. It was one of his fathers belongings. It now belonged to him. He ran his fingers over the rosewood exterior. It was an antique box, one of several his father had collected over the years. Some of the edges were chipped, damage that almost certainly occurred before his father owned it. He was far too careful with his antiques. The phone rang but Michael ignored it. Fighting back tears, he opened the box. Inside was the reason Michael had hesitated till now. A note from his father, dated days before his death. It was a poem. So death, at last here we are. As I lay here, my body aching, I can recall most of the names and places, the memories, etched in gold. These tired feet resting on a tired mattress, will not wear another shoe. These pale cracked lips speak no more. There is nothing left to say. My body aches. Who would have thought today would be the day. I think of the women I have loved. The embraces and goodbyes. I think of the people I hurt. Please forgive me. I think of all the time I wasted. The countless hours. There are soft voices in the room. They are dimming.
It doesnt hurt anymore.
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Priti Sud
CAN THIS MIRACLE HAPPEN

I did I did all I could To do what I wanted most Thought it would be special But the art had been lost I was asked to practice defensive medicine When did I want that Some fix computers Some fix shoes And us we fix patients But where is the bond Why is it not noble anymore Yeah, they even call it the business of medicine now Pay me for standing Pay me for sitting You can even pay me for breathing But please return me my passion.
FEAR YOU
I wash those two little feet of yours I feed those lovely lips of yours I wake up at night when you do Although I am deep in my sleep I dress that beautiful body of yours I brush your hair And still I need you More than you need me
18
Holly Good
UNTITLED
As I read The Unseemly Old Lady I was reminded of times in my own life when I had unknowingly attempted to stifle the growth of loved ones. As they aged I worried about their health, their loneliness, and their happiness, but I failed to recognize that they were changing.
My chubby cheeked grandmother lived with my family during her final years. She had always taken special care of her children and her grandchildren, but as she aged it became harder for her to maintain her independence. She couldnt drive. She couldnt walk as far as she used to. Her sight was failing her. Her finances were slim and she relied on her family to help her get by. She spent much time alone in her room watching television or doing word puzzles and we checked on her often. Every so often my grandmother would be absent at one of our random check-in times. We quickly discovered her place of refuge. She would wander down the street to visit with an elderly man (when they had met I cant quite figure out). He was the neighborhood recluse and rumor had it that he was demented and unsafe to be living alone. We would always find the two of them sitting in lawn chairs staring up at the sky. Needless to say she was quickly whisked away and returned to the safety of her home. She could never explain why she had run off, but she was always happy those afternoons. Looking back now, it really makes me wonder.
Kevin Akers
ECSTASY AND AGONY

For amber pastures and golden sun, In verdant gardens upon the run. On softening seas, twilight reflected A shallow trajectory to death expected. But. Cash in your poker chips for a halter monitor. Trade your life of toil and trade for techno-babble and pills. Not glorious ascension, but putrid declination, To rats, squalor, cat piss, incontinence. Death, be not proud, Your retirement yacht sails the river Styx.
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Seth Miller
UNTITLED
Here I lie in this decrepit, worn out shell of a body My eyes are crusted shut with the decay of my flesh I feel so trapped. Those people surround me Poking, prodding, inserting needles and prayers that are all too uninvited I dont want any of this WHY WONT ANYONE LISTEN TO ME! My denial is my comfort. Or maybe I just cant find anyone to blame for this injustice. Death will soon take control of my life, for it has already placed its menacing scythe into my heart. But it wont take hold of my fearI wont allow it. You demon of death, you may take my lifemy body But this pride is mine forever. You say that you cant take anything with you to the other side; I beg to differ. I can take this with me and I will. This is so unfair! What is fair, though? I know that I am not alone in this, it happens to everyone But why do I feel so alone? I am lying naked in the dark. So I will rebel I will build myself a fortress of isolation, Brick by brick with the stones of pride and envy. My moat will be filled with the cold distance that I place between myself and the warm hand that reaches out with love to moisten my dry, sticky tongue. Why do I choose to hurt the ones that love me. The pain that I endure I project on those that love me. It hurts, but my love, my friend, my pride tells me that they should suffer as I do. I cannot let them into my fortress, my comfort.
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Seth Miller
DEATH:
Not fear, but wonder I am not here to conquer you Someone else has already done that for me. No, I cannot even save myself. I only come with questions Like why?... Not why with an accusing tone For all men must die For no man knows whether love or hate awaits him, But we all share one common destiny It is said: The race is not to the swift Nor the battle to the strong, Nor does food come to the wise Or wealth to the brilliant Or favor to the learned; But time and chance happen to them all. For the living know that they will die, But the dead know nothing; They have no further reward, And even the memory of them is forgotten. Their love, their hate And their jealousies have long since vanished; Never again will they have a part In anything under the sun. No, this why is one of wonder For I have accepted your fate for me, for us This helps me truly live So then why?... Why do those that should be dead drink deep the breath of life? Yet those who should live sink deep into the grave? Who decides what days are numbered for each who passes into life? I know I have not the hands of my maker Nor can I choose what days and times are to be given So I simply wonder with peace and awe. And what am I to do with the time that is given to me? My purpose is simple I am to live I am to love I am to care I am to comfort. For each day is a wonderful gift that has been givennot that I deserve. So often one may find life in the shadow of death.
21
Shae Vaughn
LIFE
What is life? Life is unpredictable like a crap table Life is fun like a roller coaster going up & down & around Life is sad like a child who just dropped her ice cream cone on the ground Life is scary like the boogey man in the closet Life is empty like a vacant lot at the end of the street Life is full like your belly after a Thanksgiving meal But most of all life is life make the most out of it while youre here!
Joyce Gonzales
WHY
To care for another We go day by day We take the path to others To reach To cross the chasm of Illness Indifference Sometimes I wonder why it is my path But there is a desire to continue So I will Others may reach back Some may not Onward
22
John Kuczynski
BEEP
Beep Beep Beep Critical potassium level Beep Beep Beep Please assess this patient Beep Beep Beep Family is here to talk Beep Beep Beep New admission in the ER Beep Beep Beep Patient admitted from clinic Beep Beep Beep Eyes getting tired Beep Beep Beep Must stay awake Beep Beep Beep Call almost over Beep Beep Beep Finally left the hospital.
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Dan Shapiro
THE PAINTER
Rogers thin. 140 pounds and 63. He sits in the chair in my office, all elbow and chin, his jaw muscles and the veins in his forehead are visible beneath taut yellow skin. The wasting from AIDS can be as vicious and unrelenting as a junkyard dog and Roger is a living example. He laughs and tells me hes in the painting phase. The walls were barren white when they bought the house four years ago, three bedrooms, enough for everyone. But they decided they wanted a light blue but never got around to it. So now he paints. Im gonna put those citrus trees in front like I said, too. Hes been spending time with the yellowpages, as dogeared as my mothers bible, he laughs, the hint of his Alabama heritage in his leisurely vowels. Today he learned about the cost of gravel. Yesterday about putting a light on his mailbox like the other houses in the neighborhood. Hes already dug the new flowerbox in back, behind the rhododendron, and put new hinges on the cabinets. Im pretty proud, I gotta say. I used to be what youd call an avoider. Anyhow, thats what my wife says. But not no more. Now Im getting it all done. Yes sir. He smiles. I remember before we had Abby. Eight weeks before the due date Terry decided it was time to paint Abbys room and move everything in the closets around. We still have time, I stalled. But Terry knew different. I found her in front of the guest closet when the phone was for her. Cant take it now, Ill call em back. She said. Only her rump was visible, the rest of her buried inside the darkness. This stuff is going in the hall closet and this stuff out in the garage and this stuff...., she said, her voice muffled. Then shoes and photo albums and even a suitcase or two slowly moved out of the closet and gathered around her until I couldnt see her at all. Sure enough, when Abby came early her room could have been featured in one of those baby catalogues. Just add the baby, some assembly required, the ad might read. I remember when Dad retired. He organized all of the books in his study, put the physics and chemistry books together, and the history and political theory. The pile of yellow pad papers and utility bills and lesson plans finally gone. Suddenly you could see his desktop calendar, still showing March 2005, only the green glazed coffee mug my brother made him when we were little still left where its always sat. He finished the job just before the last day of school. Roger has it bad. Two days ago his wife had to tell him to stop painting at 10 PM, his cough was keeping the kids awake, You gotta get some rest. She told him. He climbed off the ladder and hung his head, exhausted. Its not that important, come be with me, His wife implored, holding out her hand. Just another half hour, he said, and climbed back up. She crossed her arms and watched, and eventually withdrew, alone to bed. He confuses me. On one hand, I admire the gifts hes giving to his wife and children; his labor will give them a more pleasant house for years after hes gone. But perhaps its one thing to move furniture around for the coming of a baby, or even retirement, quite another to rearrange in the face of the final curtain, when we should be throwing ourselves into the warmest embrace we can find, objects be damned.
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He shifts in his chair and looks down at his brown loafers. My wife wants to go on a family vacation, but I dont want to yet, Im gonna gain some weight, first, He says, Whatdya think? You should go. I suggest. Nah, not yet. He smiles. I still got too much to do. And it strikes me that we often die like weve lived. That last minute conversions are rare. No more avoiding for me. He says. I hope he doesnt wait too long.
Self Compliance
Christina Hayhurst
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Kenneth J. Ryan
A MYTH FROM THE SEA: WAGNERS BREAKOUT OPERA

A lecture presented prior to 2006 Tucson performances of The Flying Dutchman at the Arizona Opera Company. The name of Richard Wagner on the opera marquee is less common than for other great composers, particularly for regional opera companies. There are many reasons for this not the least of which are the considerable resources required to mount productions of Wagners works. Thus, its appearance is cause for many to rush to take advantage of the rare opportunity, but for others it produces an urge to flee. The former group includes passionate Wagnerites who never miss a chance to see one of his operas but dont care much for the rest of the operatic repertory. This is particularly true for devotes of Wagners Ring of the Nibelung. Like the deadhead followers of The Grateful Dead they will travel halfway around the world to see another Ring Cycle but would not go across the street for a performance of La Boheme. Glynn Ross told me a significant portion of these Ringheads do not go to other operas at all. At the other end of the spectrum are dedicated opera goers who systematically avoid Wagnerian opera because they either find or have been told they are ponderous, overwhelming, or just too long. There is respectable company here. Rossini said, Wagners operas are filled with lovely moments separated by quarter hours of complete boredom. Whether you are a Wagner addict in denial, or someone who has only barely overcome the urge to give your tickets away, I have good news for you. The Flying Dutchman is the perfect opera for you. For the skeptical ones I will argue that this is Wagner before he became Wagner and that Dutchman is almost an Italian opera in the style of Bellini (who Wagner greatly admired). To the Wagnerites I say, this is Wagner when he became Wagner. I know I am being a bit duplicitous here, but bear with me. All those things Wagnerites love, the orchestral brilliance, the Leitmotifs, the supernatural, are for the first time brought together here, albeit in a less developed form than his more mature operas. You can enjoy Dutchman as the dawn of genius, the first in a string consecutive masterpieces that includes Tannhauser, Lohengrin, Tristan and Isolde, The Mastersingers of Nurnberg, Parsifal, and the most monumental work in opera, some would say all of art, the four opera cycle The Ring of the Nibelung which includes Das Rheingold, Die Walkurie, Siegfried, and Gotterdammerung. Thats a total of ten, all of which are in regular performance around the world more that a hundred years later.
Synopsis
The Flying Dutchman is based on a seafarers legend of a Dutch ship captain who on fighting the wind and sea to round the Cape of Good Hope uttered a curse that he would persist though I should beat about here until the day of judgment. The Devil took him at his word and condemned the captain and his crew to sail the seas for all eternity but here was an out clause. The Dutchman could go ashore once every seven years, and if during that time he found a woman who would be constant to him unto death, the curse would be lifted. In the opera, the Dutchman at the end of one of these septennial voyages has pulled into a Norwegian fiord. There he meets Daland, another captain blown off course on his way home. The Dutchman quickly asks for the hand of Dalands daughter and Daland, observing the Dutchmans
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wealth, quickly agrees. He does not know who this stranger is, but the fact he is loaded is enough for Daland. We then meet the daughter, Senta, and discover she has an obsession with the Dutchman based on the legend and a portrait alone. When they finally meet she casts aside Erick, her betrothed, and eagerly agrees to marry this ghost. In the last act the Dutchman misinterprets Ericks pleading with Senta as a reversal of her commitment and proceeds to leave without her. To prove her constancy Senta hurls herself from a cliff into the sea and she and the Dutchman are united in death.
with the composer. Think of Lerner and Lowe and Rogers and Hammerstein. Cole Porter, Frank Loesser, and Steven Sondheim did both but are in the distinct and diminishing minority. From college days I remember an All American quarterback for the Washington Huskies named Bob Schlorett. Schlorett only had one eye (like Wotan) but it did not keep him from running, passing, and directing the offense. He played safety on defense and was also the kicker. As one sports announcer said, he did everything but blow up the ball. Well, Wagner was blowing up the ball too. He conducted, directed, and controlled every detail down to the seating arrangements and the mechanisms for moving the sets. Later he would direct the construction of a theater in Bayreuth uniquely designed to present his musical dramas. One of the innovations there is an orchestra pit beneath the stage with the orchestra rotated 180 degrees from what everyone else uses. Im told it works. By the way, the word opera is the plural of opus which means work. If we take it literally that opera is the works no one can top Wagner.
Background
The Flying Dutchman, Wagners fourth opera, premiered in Dresden in 1843. His previous effort Rienzi was a 5 act grand opera with a Roman setting more like Bellinis Norma than anything we associate with Wagner today. It enjoyed a modest success but other than the overture, Rienzi has long since disappeared. The Flying Dutchman was Wagners first enduring success, his breakout opera. Here it is of interest that Verdis breakout opera, Nabucco, had its premiere in Milan only months earlier. These two titans of opera were exact 19th Century contemporaries. Both born in 1813 they produced masterpieces in parallel for over 40 years. They never met, but there is evidence that Verdi at least followed the career of Wagner. He is known to have attended the Italian premier of Lohengrin incognito, sitting behind a screen in the back of a box with the score in his lap.
Wagner and the Supernatural

In preparing for this talk I was looking forward to learning more about how Wagner researched the Flying Dutchman legend and crafted it into an opera. For The Ring I knew how he dug back to the 5th Century to fuse ancient Germanic and Icelandic sagas into a unified whole, essentially creating a new myth of his own. From his childhood Wagner was fascinated with tales of the supernatural particularly those of German writer, composer, and painter E.T.A. Hoffmann. Hoffmann wrote novels with titles like The Devils Elixir and many short stories; the most familiar to opera lovers are those used in Offenbachs Tales of Hoffmann which include a singing doll, an evil sorcerer, and a demon doctor. In any case, Wagner found his medium in the supernatural. From Dutchman forward all
Wagners Methods
It bears mentioning at this point that Wagner wrote both the libretto and the music for all his operas. This is rare in opera and unique among the great composers. It is also uncommon in other forms of musical drama such as the Broadway musical where the lyricist typically gets equal billing
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of Wagners operas except Mastersingers would deal with mythical, supernatural, and otherworldly subjects. In a sense he would spend the rest of his life answering this question posed by Hoffmann, Could it be that that which we call dream and fancy is, in fact, the symbolic recognition of the secret thread that runs through our life?
19th Century opera. Verdi would make a similar pilgrimage but not until he was established as the leading Italian composer. Wagner was nowhere near established as a composer anywhere. He was music director in Riga but deep in debt. In fact, he slipped out in the middle of the night leaving behind multiple unpaid creditors. There is little to admire in Wagners personal life. The voyage to London was hit by multiple storms one of which drove the ship into the fiord already mentioned. It is there Wagner claimed to have heard the Dutchman legend as he said from the seamens mouths. This makes a good story, but there is evidence from his letters that Wagner had already read the Heine version of the legend and liked it. Wagner may have picked up some of the spirit of the Norwegian sailors from this adventure but the evidence indicates he had already settled on his operatic subject for Paris. Wagner did not find success in Paris. He met with Heine there and drafted the libretto but the Paris Opera was not interested, at least not with him as the composer. By this time he was nearly starving and just out of debtors prison. He finally sold the libretto alone to the Opera where it was turned over to a third-rate house composer who did nothing of note with it. Then, in desperation Wagner used his last 500 francs to rent a piano and wrote his own music in only seven weeks. The Paris Opera was still not interested but Dresden was. They wanted a more traditional 3-act presentation rather than the seamless one-act version Wagner preferred. Wagner conceded, although some still feel the oneact version is superior. Hey, the man was starving. Of course, Wagner did much more than set a legend to music. For the first time, he used the full power of musical drama to create characters that transcend time. While some of the characters in Dutchman could be considered stock creations of the time, the Dutchman himself and Senta are entirely new. They represent elemental human needs and fears, in general, and those of Wagner himself in particular.
The Legend
With the Dutchman legend when I dug in I found surprisingly little. It is frequently stated that the tale is as old as seafaring and some mention a similar curse made by the Portuguese explorer Vasco da Gama when he rounded the Cape in 1498. These are all sheer speculation. No one can find a written reference to the Dutchman legend earlier than 1821. These accounts include the Devils curse and a few other additions such as encounters between mariners and the phantom ship at sea where the Dutchman was said to relate his plight and ask for delivery of a bundle of letters from his crew to their families. The letters when examined were found to be addressed to persons long since dead. None of these versions, however, include the seven-year cycle or the prospect of redemption by a womans love. That appears to have been added by the poet Heinrich Heine as late as 1834. One of a series of papers he published in that year includes a character who has attended a play about the Flying Dutchman in Amsterdam. This character relates the plot of the play which includes the seven year cycle and the daughter of a Scottish skipper who saves the Dutchman by promising to be true unto death. No one can find evidence of the Amsterdam play itself, so it seems Heine simply made it up. Wagner himself claimed to have heard it from sailors while stalled aboard ship in a Norwegian fiord. He was on his way from Riga in what is now Latvia to Paris via London. Like New York today Paris was where you had to make it in
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The Mysterious Stranger

Some see the Dutchman as a modern version of the Wandering Jew and connect it to Wagners own financially desperate state and nomadic search for the acceptance of his art. I prefer Father Owen Lees concept of the Dutchman as the mythic phantom lover or mysterious stranger who is seeking something to make himself whole. This lure of the mysterious stranger for women is a staple of gothic literature as in Brontes Jane Eyre and is particularly developed in Ibsens play The Lady from the Sea. In the play a woman is unable to give herself completely to her husband due to a previous brief but passionate encounter with a man referred to only as A Stranger. She and the audience wait to see if he will keep his promise to return. The mysterious stranger is also the worst nightmare of us regular guys who deep down worry that our woman could bolt with some exotic stranger. Thats what happens to Erick in this opera. Poor Erick. He has loved Senta all his life and just when they are ready to be married she gives herself to a man even before she has seen him in person This sense of mystery and otherworldliness is essential to the character of the Dutchman. A local reviewer of this production expressed disappointment that in this staging the Dutchman gives little physical evidence of emotion even when promised redemption. A smiling Dutchman may have its advantages but it is clearly not what Wagner intended. Ten years after the premier Wagner published an essay titled Remarks on Performing the Opera, The Flying Dutchman. Most of the essay is devoted to the Dutchman himself who Wagner says should deliver his lines with bitter restraint and sing without a trace of passion as though he were completely exhausted. This extends even to the duet with Senta where Wagner insists the couple stand perfectly still in contemplation of one another. To Wagner this
enhanced the dawning wonder of love and he would continue this style with later lovers like Siegmund and Sieglinde and most famously Tristan and Isolde.
The Eternal Feminine

Senta on the other hand represents the feminine side in a special way that 19th Century romantic writers called the eternal feminine. That is, that feminine aspect within a man that he must acknowledge if he is to be a complete human being. This is particularly important for artists like Wagner for the feminine side is considered the creative side. Sentas acceptance of the Dutchman not only breaks the curse but makes him whole, a complete man. To some extent all of Wagners future heroines from Elisabeth to Kundry will have this quality. Leonore in Beethovens Fidelio is another ideal woman in this sense. In Dutchman for the first time Wagner fuses this idea of the eternal feminine with that of Liebestod or a culmination of love in death. That is, the love is too great to be fully expressed in this world and can only be consummated in another world through death. This is what appealed to Wagner about the Heine version of the Dutchman legend. Wagner went on to repeat this Liebestod theme in later operas. It is erotic love in Tristan and Isolde and heroic love with Siegfried and Brunhilde in The Ring. In fact, when Brunhilde rides into Siegfrieds funeral pyre at the conclusion of The Ring she is not only reuniting with him but transforming the entire universe through an act of love.
Things to Look for in the Music

Musically, The Flying Dutchman is a hybrid opera. That is, it has arias, ensembles, and choruses which are set pieces in the style of the time, but it also includes dramatic new approaches to musical drama. Some Wagnerites lament, even ridicule, the set pieces, but Wagner appears to have
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a plan here. The conventional music is sung by conventional people, the helmsman, Daland, Erick, the townspeople, and the sailors. Wagner saves the new approaches which would become part of his seamless musical drama for the characters that transcend time, the Dutchman and Senta. It makes a very effective contrast.
Wandering, and Longing for Death motives. This blending of psychological and musical content is what would distinguish Wagner from other composers for the rest of his career.
The Choruses
The choruses are the most accessible part of The Flying Dutchman and there are plenty of them. Those sung by the sailors are exuberant and I guarantee you will walk out tonight humming the melody of the Act III Norwegian Sailors Chorus. It is as lusty a drinking song as you will ever hear. The Act II Spinning chorus evokes an atmosphere of peaceful domesticity. Listen for the magical way Wagner sequentially combines strings, winds, and womens voices in a swaying melody which evokes the whirling of the spinning wheels. The melody here became popular on its own in Germany and Franz Liszt made a brilliant piano transcription of it in 1860.
The Overture
The overture to The Flying Dutchman stands on its own as a popular orchestral piece, and with good reason. Get settled in your seats because the instant the baton goes down you will hear a high tremolo in the violins which suggests the shimmer of the sea. It is followed immediately with a [tada, ta-dum-ta-ta] on the French horns. That is the Dutchman motive. Then below the Dutchman theme comes a surging, undulating theme which evokes the churning of the sea, both wind and water. And there you have it; the light above; the surging sea below and the Dutchman in the middle; all in 15 seconds. No other piece of music evokes the sea the way this one does. As one conductor put it, You open the score and the sea blows out at you.
Sentas Ballad
Sentas Act II ballad is the centerpiece of the opera. It is the first music Wagner wrote for Dutchman and is also haunting if not quite as hummable as the Sailors chorus. Before beginning the story of the Dutchman Senta emits a series of Yohoe, Yohoes which will immediately remind Ring fans of the hi yoto hos of the Walkuries. But dont miss the musical clue here that although Sentas soprano voice is very different from the French horns these yohoes are the Dutchman theme. This is highly creative use of the emerging Wagnerian Leitmotif technique. At this point in the opera we have met the Dutchman but Senta has not. She does not even know he is on his way. This suggests that all of this really is predestined and perhaps Senta is calling the Dutchman from the sea rather than the reverse. The verses of ballad itself each have musically contrasting sections. When Senta is describing the circumstances of the curse she does so in harsh descending phrases in what sounds more like an incantation than a ballad. When she comes
The Dutchmans Monologue

The Dutchmans opening monologue marks the emergence of the new Wagner. It is a piece of musico-dramatic writing without precedent. The Dutchmans first words Die Frist ist um (The time has come) are repetitions of a single note without orchestral accompaniment. Then the orchestra introduces a series of motives beginning with the violas and cellos. As the monologue continues the Dutchman cries out to the ocean where he expects to return, and then moves into broad phrases which describe futile experiences at sea. The music slows as he expresses grief, longing for an angel of redemption and finally despairs that he will be released only when the world itself ends. All of this is sung over a tapestry of themes in the orchestra identified by musicologists as the Fate,
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to the parts about prospects for the Dutchmans release by the love of a woman, her voice softens and a second melody with ascending phrases emerges. This is the Redemption Theme which was previewed in the overture but gets its full exposition here. It will appear again at the very end when Senta and the Dutchman are united in death. The aria concludes with a dramatic passage which leaves us with no doubt of Sentas intentions.
Conclusion
Wagner concludes The Flying Dutchman with an impossible set of stage directions: She throws herself into the sea. Immediately the Dutchmans ship sinks with all hands into the waves. The sea heaves and falls in a whirlpool. In the red glow of the rising sun, Senta and the Dutchman, transfigured, are seen, in a close embrace, rising from the wreck of the vessel and soaring upwards. Well, where else would Senta and the Dutchman go, and what is going to happen to the Dutchman when the curse is lifted? Will the Dutchman age as in Oscar Wildes The Picture of Dorian Gray? In the monologue he is longing for death. Is Senta going aboard the phantom ship or will the Dutchman enter Sentas world on land? No, none of the above. This couple can only exist in another world where only their mutual love matters. Here they will join not only the Wagnerian couples already mentioned but others tormented on this earth like Lucia and Edgardo, Aida and Radames, Romeo and Juliet. In this tale of mystery, love, and redemption Richard Wagner has opened the door to inexhaustible treasures of musical drama. Whether you are a Wagnerite or neophyte you gotta love it.
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Winter, Helmchen Falls, B.C.
Eskild Petersen
Warming Hut, Wells Grog, B.C 32
Eskild Petersen
Pyramid Mountain, B.C.
Eskild Petersen 33
Nancy Howe neurotransmitter dysFunctIoN manic-DepressIoN coGnitive therapY serOqUel wellbutRin biPolAr liTHium
Patient stabilized on Seroquel (100mg/2xd), Celexa (20mg), and Wellbutrin (150mg) since July 2005. Female, 51, employed. Completed MS at ASU, Dec. 2005. Experienced mania periodically since 1979. Hospitalized 13 times (1979 2004), 11 admissions for mania, 2 for depression. I am that patient, sitting in a Judaism 101 class in January 2006, preparing for Bnai Mitzvah. The rabbi is teaching the proper way to read Torah. One shouldnt read alone, he says. Torah is meant to be read aloud to another person; discussion of differing opinions is sacred. The rabbi reads two verses. The first tells of Abraham and Isaac seeing a pillar of fire on the mountain and the countenance of god in a cloud. The second is Abrahams brutal dismissal of the manservants who fail to see these glories. Abraham belittles them, compares them to donkeys, incapable of perceiving God. The rabbi asks, Did Abraham see an actual pillar of fire? One student offers, Perhaps it was a sharp ray of sunlight, perceived with the intensity of Gods presence. The rabbi continues, And what would it be like, to see God in every sunset, in every cloud, in every moment? Everyone proclaims it would be wonderful, glorious to live in this heightened state of awareness. Shouldnt we strive for that? the rabbi asks. Can you see how I get tangled up? I ask the psychiatrist. I have lived like that, experiencing deeper meanings and seeing evidence of divine revelation in everyday phenomena. When I do, I have learned to recognize that I am ill. When I see God in the sunset, or find physical confirmation that I am following Gods will, I call my doctor. I fiercely hold fast to a belief in coincidence in a culture where, increasingly, many profess they do not. I work with scientists who value systematic rationality in the office, but at the restaurant after work, assert that people enter our lives for a reason. I know highly educated people who yearn for mystical experiences that will unveil to them the pre-destined purpose of their lives. In moments like the classroom discussion, I keep quiet about my manic experiences, those days when it seemed that all of reality was unfolding with me at the center. I take my questions to the psychiatrist: When so many say that they seek to hear the voice of god, what would they do, if, like me, they actually heard a voice in their minds ear? Would they think that their spiritual search was being fulfilled or would they assume that they were mentally ill? The question is not rhetorical if you have periods of mental illness and you want to cease living that way. I pay close attention to books written by those who study bi-polar disorder. Since 2000, there has been a new crop with titles like A Bipolar Survival Manual. They recommend that I live with a self-watchfulness that borders on paranoia. The essential message is embodied by one books suggestion that couples declare a Bipolar-Free Zone, in which for an hour a day or one evening a week you and your bipolar partner do the things that couples do. The implication, reinforced throughout the book, is that aside from this bit of time, you and your bipolar partner live defined by the disease. Living a life identified with disease is not a life easily embraced. It seems that many miss this point. Who among us hasnt seen hospital-ward posters that suggest history and scholars have redeemed the struggles of epically unhappy manicdepressives such as Vincent van Gogh, Virginia Woolf, and Sylvia Plath? For most of my life, Ive
For example, Miklowitz, D.J. 2002. The bipolar disorder survival guide. New York, NY: Guilford Press; Torrey, E.F. and Knable, M.B. Surviving manic depression. 2002. New York, NY: Basic Books.

Fast, J.A. and Preston, J.D. 2004. Loving someone with bipolar disorder. Oakland, CA: New Harbinger Publications, Inc., p. 205. For example, chapter 8, The bipolar conversation, in Fast, J.A. and Preston, J.D. 2004. Loving someone with bipolar disorder. Oakland, CA: New Harbinger Publications, Inc.
Jamison, K.R., 1993. Touched with fire, manic-depressive illness and the artistic temperament. New York, NY: Simon & Schuster.
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believed that my creative successes, of which Ive had many, were flowers of my disease. Thanks largely to artistic, suicidal role-models, I thought that my lifes task was to learn how to be bipolar and stay alive. Today, I understand my task is the same as everyone elses: to learn how to live a good life. When I was first diagnosed in 1979, tricyclics were new and younger psychiatrists held that medication could normalize bipolar disorder. More recently, the role for cognitive therapy alongside pharmaceutical treatment has regained favor. Even so, the cognitive therapy oriented books that Ive found encourage bipolar individuals to elevate their disease to the center of their lives, advocating daily or twice daily selfassessment of moods, sleep patterns, medications, and environmental triggers. Homework is assigned to ensure that any changes can be reported to physicians for a reassessment of prescribed medication. I experience this wellmeaning advice as a recommendation that I live like an ever-watchful keeper of the wild beast within. Are healthcare workers open to another approach? What if the helping professions asked the question, What does a person who has lived a bipolar life need to know to transform his experience of the disease from fear to respect? What if instead of teaching people to be hypervigilant, healthcare providers assisted a person to live normally in a post-bipolar world? I have anecdotal evidence of success with this approach, which means that it worked for me. I dont know if it will work for others. However, I see many like me who suffer from bipolar disorder and who remain lost, drunk, or high living in fear of themselves.
I learned a different approach from the community of cancer survivors, to which I also belong. My cancer appeared at 42, virulent and visible, a golf-ball-sized tumor on my tonsil. From the very beginning, I was startled by the parallels between life after cancer diagnosis and life after bipolar diagnosis. Cancer, like bipolar disorder, frequently leaves a person feeling vulnerable to a deadly, hidden beast within. The body has betrayed itself; one will never be truly healthy again. The consequences of cancer diagnosis and treatment, physically and emotionally, change a person forever, just as the consequences of bipolar disorder do. Both diseases happen to both the patient and the family; no one ever forgets, no one is untouched. With both diseases, the root cause is biology. Nobody earns bipolar disorder, just as nobody earns cancer. Neither is deserved. For both, the possibility of recurrence looms always. For both, health must be monitored for the rest of ones life. But the tone of the coping literature written for the two diseases differs significantly. If you have had a cancerous tumor, you are a survivor. If you have had a bipolar episode, you are bipolar. Most of the cancer literature is written by cancer survivors, one survivor talking to another, preparing the way for those who come after, offering stories of strength and hope. Nearly every author suggests that difficulties lie ahead for the survivor who identifies with the disease. In the world of cancer survivorship, one rarely seeks a cure, one seeks healing. Survivors are encouraged to focus on the bodys innate ability to heal, and to see themselves actively assisting the healing process by eliminating obstacles on all planes: physical, emotional, and spiritual. I cant remember ever finding the survivors concept of healing mentioned in bipolar survival guides. Usually the phrase is closer to guarding
Newman, CF., Leahy, R.L, Beck, A.T., Reilly-Harrington, N.A. & Gyulai, L. 2002. Bipolar disorder, a cognitive therapy approach. Washington, D.C. American Psychological Association.
Newman, CF., Leahy, R.L, Beck, A.T., Reilly-Harrington, N.A. & Gyulai, L. 2002. Bipolar disorder, a cognitive therapy approach. Washington, D.C. American Psychological Association. p. 29-30.
Howe, N.L. 2000. Canswer. Palo Alto: CA. Varian Medical Systems.
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against risk of relapse. The cancer community encourages newcomers to find supportive companions for the journey, calling medical treatment only half of the recovery process. After cancer, we learn to prepare ourselves for a new normal, using the phrase profoundly explored by Dr. Wendy Harpham. The cancer community culture acknowledges the risk of recurrence, but instead of hyper-vigilance, survivors focus on making healthy choices to lower the odds. Cancer survivors learn, often painfully, that ones attitude and choices can affect health, but neither can control it. Taken as a whole, the culture of the cancer community stresses personal choice, positive actions, and reality-based hope.10 During my quarter-century in the bipolar culture, the standard medical encounter has evolved into a 15-minute, medication-monitoring session with a psychiatrist once every six weeks. The books suggest that the great challenge for physicians is to keep patients on medication. Physicians acknowledge that the risk of relapse is high because often the medications work slowly, imprecisely, and frequently with deleterious sideeffects. The mixed bag that results leaves some patients convinced they are better off on their own. It is in the spirit of sharing the wisdom of one community of healers with another that I offer my experience as a person who enjoys living a normal life, despite bipolar disorder. 1. A pragmatic definition of bipolar disorder is useful. Here is mine: Sometimes when I wake I am not the same person who fell asleep.
This has been my primary experience of bipolar disorder and yet I didnt find the words to describe it until I was 50. I didnt realize that this unreliable self was the problem. For the 25 years that I lived with unmedicated bipolar disorder, I thought that my ever-changing self, the manic creative wunderkind, would somehow discover a solution on its own. I credited this cyclic, energetic self with originating the breakthrough ideas that had earned me awards and promotions. My first step toward health was abandoning the false hope that there was an intellectual solution to the biologybased cycle of mania and depression, either through cleverness or through creativity. 2. An experiential definition of a productive patient/physician relationship is also useful. Here is mine: We are good-faith collaborators, each with our own responsibilities. A partnership exists. The physician works to find a medication combination that restores equilibrium to a brain beset with neurotransmitter dysfunction. The patient works to gain the knowledge needed to identify disequilibrium, to identify equilibrium, and once achieved, to maintain equilibrium going forward. As recently as spring, 2005, I asked for admittance to an out-patient mental health program following a devastating manic episode. Post-mania is terrifying, even with medication. The department head saw me for 10 minutes (he was 20 minutes late to the admittance interview), during which time he inventoried my medications and diagnosed me with narcissistic personality disorder. I was placed into the daily, 2-hour therapy group ($180/ day). In the second week, the group leader stood in front of me and demanded loudly, When is enough enough for you? When are you going to take responsibility to get better? She said that as if there were some part of my healthy thinking
Newman, CF., Leahy, R.L, Beck, A.T., Reilly-Harrington, N.A. & Gyulai, L. 2002. Bipolar disorder, a cognitive therapy approach. Washington, D.C. American Psychological Association. 218-221.
Harpham, W. S., 1994. After cancer, a guide to your new life. New York, NY: W.W. Norton & Company, Inc.
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Harpham, W.S. 2006. Happiness in a storm, facing illness and embracing life as a healthy survivor. New York, NY: W.W. Norton & Company.
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processes that could fix the dysfunctional ones.11 I left the program, bewildered and despairing. Three weeks later I initiated a partnership with a physician who trusted that I was taking my medication as prescribed, and that the medication wasnt working. In turn, I trusted him when he told me that he would work with me until an effective medication was found. My responsibility, he said, was to do whatever I could to occupy myself while we waited. He took my thinking mind off the hook and encouraged me to exercise, play with my dog, and keep busy by doing simple things. He gave me his telephone number. For the first time in 25 years, I could do something to help myself, and I could call someone when I became frightened or despondent. 3. Healing happens when it is sustained by hope. Ive been told, No one ever died from a feeling, but I believe that many people with bipolar disorder have died from a feeling of hopelessness, or more precisely from the apathy toward treatment that hopelessness engenders. Within the cancer community, experienced survivors warn newer ones that life after diagnosis and treatment is at least as challenging as life during treatment. Bipolar patients walk a similar path but rarely do we have a guide. While my physician experimented with different medications, I experienced my emotional life differently, my energy levels varied dramatically, my sleep requirements were inconsistent, and my weight increased. My thinking was occasionally clouded, my concentration flagged. When medication restored my equilibrium, I found myself living in a new world, one which was initially distressing. I had to reorganize my schedule to allow for more sleep, and revise my eating and exercise routines to regain control
11
of my weight. I wanted a collaborators help to untangle the rabbis question and to evaluate the risk of signing my name to an essay about my experience. Healing doesnt require that I find perfect solutions for every situation. Healing occurs when I feel confident enough to make choices that define my new life. The cancer community is largely volunteerdriven, but it benefits greatly from the respect and cooperation of oncologists who have learned from research and experience that patients benefit when physicians help them move from victim to victor.12 Mastering medical knowledge and choosing among all possible treatments are tactics of the cancer community culture13 that cannot apply to a patient in the throes of bipolar disorder. The dependence that those with bipolar disorder have on physicians makes it even more important that those of us who have successfully navigated the rapids speak up and offer our testimony. It is not uncommon for cancer survivors to voice the conviction that while a diagnosis of cancer is devastating, it can also offer opportunities to refocus ones goals and find new meaning in daily life. We who live in the bipolar world could use more of that.
12
Del E Webb Memorial Hospital, 14502 West Meeker Blvd., Sun City West.
Harold Benjamin, founder of The Wellness Community, an international, non-profit organization dedicated to providing free support and education as well as hope to people affected by cancer. The Wellness Community operates centers in 22 states, Tokyo, and Tel Aviv. 13 Harpham, W.S. 2006. Happiness in a storm, facing illness and embracing life as a healthy survivor. New York, NY: W.W. Norton & Company.
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Ronald Pust
EL CUAL ES NADA
Air up here is everything yet nothing for a moment Im warm, I glow but thats the sun the next Im in a cave, darkened and damp still thats the cloud now Im driven and shorn, bleating and cold yet thats the wind. Enlisted in turn, commanded at random by sun, cloud, wind, with no will, no worth of its own, the air is a buck private, but privately, Im alive in it, because of it which is nothing.
38
La raz que nos conecta (The Root which Connects Us)
Yovannah Diovanti
39
Un rezo por la humanidad (A Prayer for Humanity)
Yovannah Diovanti
El ciclo de la vida (The Cycle of Life) 40
Yovanna Diovanti
The Beast, Sevilla, Spain
Serge Hougeir
La Mezquita, Cordoba, Spain
Serge Hougeir 41
Dusk
Christina Menor
42
Little Girl Walking, Iquitos, Peru
Mary Foote
Carnival, Juliaca, Peru
Mary Foote 43
La Iglesia del Pueblo
Aaron Leetch
Patagonia Landscape, Argentina 44
Mary Foote
The Patient
Luis Rodriguez
La Muerte de la Ponderosa Luis Rodriguez
45
Perfect Symmetry, Mayan Volcano
Linda Carr
46
Lluvia, Lluvia
Jennifer Nichols
NYC
Shameema Sikder 47
Sunset
Carla Dormer
Jellysh in Monterey 48
Shameema Sikder
Sandhill Cranes
Eskild Petersen
49
Hummer
Tessie OTalley
Untitled 50
Brian Tsui
Kitties
Tessie OTalley
Mexican Wolf
Tessie OTalley
51
Behind
Christina Menor
52
Harmonia (Harmony)
Yovannah Diovanti
53
Tamahu, A.V.
Aaron Leetch
Amazon Life, Peru
Mary Foote
54
Kevin Yarbrough
MEMORIAL
The despot of my childhood was a statue erected to oversee my growing as pigeons hopped around his tiny head making a diadem of their droppings. Sitting at his feet I learned that patience is just stoicism and love, a distant gaze. Oh that wonderful smell of tarnish and wet granite that covered my hands when I climbed into his arms One was fixed holding his side and the other pointed straight ahead at my future
THE HEARTS VOLERY

Give me lucre Give me love Watch the eagle crush the dove Talons tear soft feathery flesh Charity falls to selfishness
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Quinn Snyder
ASYMMETRY
My obsession with the idea of symmetry dates back to early childhood. Compulsions from the early days included tapping on a table a specific number of times with my right hand, then repeating it the same number of times with my left hand. 8 left, 8 right. 3 right, 3 left. The tapping was enjoyable and relaxing for me, annoying for others. One time at a UCLA football game I unknowingly began my tapping routine on the back of a bench full of elderly LA football fans. I was young at the time, maybe 8. One woman turned around and peeled her radio headset off her salt-and-pepper haired head to say: Hey kid, go get a drum set. I stopped abruptly as her brief and well-practiced maternal stare struck fear into my young heart, but it was at that moment that my want became a need. I waited until she averted her gaze before I stealthily completed the remainder of my symmetric routine and withdrew my hands. When I was 11 I began to flip already turned off light switches on and off when I left a room, the same number of times with each hand. On-off left, on-off right, on-off right, on-off left. It all seemed so perfect. I would sit alone, saying the alphabet forwards and backwards until I reached some sort of predetermined symmetry that I deemed an appropriate stopping point. I knew my behaviors were unhealthy but I could not stop myself. My actions were always performed in secret. Perhaps my brother was the only person who might have noticed but I still have never asked him. All of my artwork from youth carries a symmetry along a vertical, horizontal, and/or radial axis. In 10th grade my picture of a carnivorous PacMan being pushed in a circle by a man with the hopeless intent of devouring the next man pushing a carnivorous Pac-Man won a local art contest. I clung to mathematics as a means of sublimation of my problems, just as many members of my family had done before me. Somehow mathematics has a protective effect against psychopathology, or perhaps psychopathology has a protective effect against mathematics. In high school my cousin was a seemingly well-adjusted young man as he scored an 1130 on the SATs with a 330 on English. Later he drifted in and out of jobs and school, eventually succumbing to Bipolar Disorder. Diagnoses of additional family members on my mothers side include Tourettes, Depression, and Schizoaffective Disorder. And yet others have gone on to become a well-renowned engineer, a high school math teacher, a future astronomer, and me, an MS3 who spent college getting a degree in theoretical mathematics. Sometimes I wonder if my cousin just didnt take his math far enough. As math was my crutch preventing me from being swallowed up by the monster that is OCD, it also became my way out. I broke during my Sophomore year of college while attending a lecture on differential equations. Although I had seen many a nonlinear equation before then, I will never forget laying eyes on a Lorenz system for the first time. There is an infinite lack of unending asymmetry. I unraveled in its curves, and for the first time it was OK. It didnt hurt. From there my obsessions and compulsions quickly dissipated. I never told anyone of my problems until I mentioned some of my long-dead habits this year. During my psychiatry rotation my peers and I had the obligatory conversation that takes place on all third-year psych rotations the one about how psychiatrists believe that all medical students have some inherent degree of OCPD. A friend then jokingly accused me of exhibiting habits that lay somewhere between OCD and OCPD. People in the room laughed and then revealed some of their own minor control issues. When it was my turn I proceeded to mention what I used to do with the light switch. It was a show stopper. For a brief moment I read on the faces of my peers the same disdain my relatives and patients must have felt when they allowed themselves to publicly manifest their psychopathologies for the first time. Fleetingly
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I felt ashamed, but quickly the revelation of my secret became just as cathartic as flipping those light switches once were. The last straw came one week ago today when I started my family medicine rotation. We began the first day with a module on back pain lead by a doctor and a PT. Does anyone in here have back pain? asked the doc. I have had back pain for many years so I quickly raised my hand. Good then, take off your shirt and shoes. I stripped to the waist in front of my peers and jumped on the makeshift examination table for the sake of the most thorough back examination of my life. The exam was entirely normal except that my left leg was found to be a full 2 cm shorter than my right leg. This really could be the cause of your back pain, said the PT. You should try getting an orthotic for your left foot. That night I went out to purchase a lift solely for my left foot. I opened the package and stared at the two perfectly symmetrical pieces crafted by Dr. Scholls. At first the orthotic was a crushing blow to my ego as I placed one into my left shoe and tossed its brother into the trash, but the truth is that I have had no back pain since. I feel different. I feel OK. I feel OK.
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Christine Krikliwy
RUBBLE
A bomb explodes Body parts, brick and mortar decorate the mountainside Intelligence at work Mountains move, land slides Houses fall, humans buried alive A new geography The ocean swells A wall of water greets and leaves as though nothing happened Claiming lives, destroying families Cars, boats and debris everywhere Nature at work High blood pressure, post traumatic stress, depression Broken hearts and broken lives Fight for survival or succumb to the ultimate Bombs, earthquakes and Tsunamis invade Whose intelligence? Yours, mine, CIA, M15, ISA, ISI, FSB My mothers, your mothers or nature? Will we ever find our way back after the intelligent and nature are done with us Or will we be divided forever?
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WHO Mental Health Camp, Bagh, Kashmir
Christine Krikliwy
Tent Hospital in Bagh, Kashmir
Christine Krikliwy 59
Robert Kravetz
A LOOK BACK: MILITARY SURGEONS

Despite sophisticated advances in medical care and technology, the consequences of wars: death and permanent injury cannot be prevented. From the blood-soaked fields of the Civil War to the hazardous roads of Iraq and Afghanistan that soldiers travel, life and death still depends upon military surgeons. Military surgeons provided medical care to the soldiers who manned the military forts scattered throughout the country during the period of Westward expansion (18301880). They also provided medical care to the settlers in the newly inhabited territories because civilian medical care was lacking. The Civil War was truly the testing ground for military surgeons and they played a pivotal and vital role in every conflict that the United States has engaged in up to the present. Battlefield medicine and surgical treatment were initially performed on site. It became apparent that rapid removal of the wounded to back hospitals and in recent times to military medical centers was essential for improved survival. Today med-evac helicopters serve the same function as horse-drawn ambulances did during the Civil War. The principle of triage, prioritizing care according to severity of injury, was first utilized during WWI. That principle is now utilized as well in all hospital emergency rooms. In critically ill patients, we talk about the golden hour as the window of opportunity for saving lives. Military surgeons talk about a golden five minutes for initiating treatment. Although most battlefield deaths occur in the first hour of injury, 20% take place during the first five minutes. Since Korea, 98% of the wounded that reach a hospital within the first hour survive. Civilian trauma care owes much to what has been learned from military surgeons. There has been a significant evolution of military surgical activities during the past century and a half. Advances in technology have significantly decreased mortality and enabled the wounded to return to more meaningful lives. Although much has changed in battlefield surgery over the years a great deal has not. The principles of immediate care and battlefield evacuation are the same. Illustrated here is the cap of a military surgeon from the Civil War era that was worn until the beginning of the 20th century. The excavated bottles are embossed with the logo of The Hospital Department and were used by the military during the nineteenth century. They possess an attractive iridescence due to manganese contained in the antique glass. It is difficult to believe that these dug bottles fetch $400-$600 each from collectors.
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Janet Alessi
MY VISITOR
Tensile strength of ligaments hold together bones of little birds, and other things she has found while she is with us. They hang drying off my eaves oozing slightly. My postman probably spotted them when he dropped my mail or more likely smelled them. I have a visitor you see. The she I spoke of is my paleontologist cousin. My daughter speaks of new things since shes come. Roadkills. Things found dead along roads Are roadkills. My cousin collects them. And skins them. And dries them. Sometimes she freezes them my aunt tells me with a shudder in her voice as it is her freezer my cousin uses. Her collection of bones is large. I understand she even has a horse in it now. When I called last Fourth of July she was skinning an alligator. She said she couldnt eat the meat; it had been out in the sun too long. I couldnt imagine doing that with my Fourth of July. Ever. But then I remember when we were little kids she ate snails. I never did.
MY MOTHERS SONG
My mothers song flows through my mind, Stirring memories of almond trees in bloom, And mustard taller than my curls. My mother was a white angel whose dark curls Like mine, were beautiful. Mornings when she left me, the child crying For her to stay, remain, tempered now by The knowledge that she had to go. The scents and smells of medicines and illness That she tended then come to me now from Long ago visits and more recent ones to tend her, My dark haired angel who has gone I know Because she had to.
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Zoe Sorrell
I AM . . .
I am the stop sign Where catchy slogans Have been inscribed You, the confused driver. You are the mirror Perfect, unshaken I am the crack That skews all that is reflected. I am a kaleidoscope That shifts in character, Shape, and size You watch, bemused. I am the thread In your favorite shirt That you are afraid To pull. You are the telephone wire I am the shoes That someone threw up there When done with me. I am the yellow car Driving backwards You are the green town I, your biggest pain. You are the latest computer Perfect and prim I am an adding machine Thats missing a nine. You are the number 2 2 eyes, 2 ears I am an irrational number That no one knows the end to. I am the time at night Just before you sleep My secrets creep across your roof My smile watches from your windowsill. Now you know who I am So I have covered who. You may wonder where Im from So thats what Ill tell you. I come from friendly chats With other bairns my age Im from the strangest hats And pants that are striped and beige. I am from dont push your luck. But I do it anyway People say Im as lazy as a rubber duck But I dont care what they say.
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I am from an optical illusion Confusing those surrounding me I always leave others hanging in confusion Unlike the pictures, I have no answer key. I am from always a yes or no. Coming from permanent, definite phrases Ill never just say maybe so I refuse to believe in the moons changing phases. I come from a flautist that everyones heard I make the solid tree trunks sound again I come from the call of a woodpecker bird. I peck while I pray to the world: Amen. I come from the smell of chai Singing a calm and soothing voice Asking not who, not where, but why Reminding the world that it still has a choice. Im from that choice, possibility A Im also from B, but Ill never know why. Sometimes Ill always have something to say Yet my origin says that Im also dead shy.
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Jeanette Long
JOURNEY TO THE PEAK

San Francisco Peak solidified in Sacredness, so beautiful, so majestic. As I explore the depths of your soul I am caressed by the wind, the sacred wind. Oh yes, it brings harmony to my ears. As I stand atop of your very soul, I am grounded in Sacredness. I look over the horizon and take in the beauty of Mother Earth. The beauty, forever infinite, depicted in array of colors. Yes, you have shown the true Nature of Beauty. San Francisco Peak, you lie west of us, bordering the boundary of our existence. It is here that our ancestors have roamed, it is this place that brings harmony. As I sprinkle corn pollen into the wind, I give thanks to the Holy Ones for providing such Sacredness and Beauty which restores harmony within ourselves. In beauty it is given, In beauty it is taken, In beauty it will end, In beauty it is finished.
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Jeanette Long
RETURN TO BEAUTY
Come home my brothers and sisters, come home to the sacred mountains, come home to the sweat lodges, come home to the ceremonies, come home to your moccasins. Let the guidance of the creator bring you along the path of the rainbow, through the echoes of sacred songs where beauty will encircle your soul with comfort. The feathers that protected you, the tobacco offered, the prayers sought, the sage drifting in mid air, purify your senses, purify your soul, purify your body. Renew your spirit for you are the child of the creator, follow the sacred path, the corn pollen path, where beauty and harmony will nourish your tattered soul. You are my honored guest, you hold my pride, you have done well to protect our rights, to protect our homeland we hold so dear. The legacy of our ancestors, who fought for our rights, who fought for our land, is innate in your soul. You pave the path for the noble spirit of our patriotic ancestors who have gone before you, who gave unselfishly. You will never be forgotten, our MIAs, our Code Talkers, Ira Hayes, our Chiefs of distant past, our Women Warriors, Lori Piestewa, our fallen hero of a new beginning, and our Vietnam Warriors. We praised you long before the country stigmatized your efforts in Vietnam. Your duty and sacrifice will never be forgotten. We honor you at Pow Wows, we honor you as the drums beat, to the prayers spoken, to the Gourd Dance. You will always be my honored guest. Return to beauty my Native Veteran Warriors, return to the path of the creator, return to harmony. In beauty it is so... Welcome Home.
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Anne Welch
PLEASURE
After a week away from medical school, I start to wonder whether or not the moments of pure pleasure that I experience outside of class will exist in my working life as well. Outside of school the moments seem to abound. I step outside on a sunny afternoon to straighten up the backyard and am treated to the sight of my dog joyously rolling on his back in the grass. I cannot watch the performance without smiling myself, and Im often tempted to slip off my shoes and chase him around in my bare feet. If I am especially lucky, he will be in the mood to go swimming, which involves a zealous leap from the top step of the pool into the water, with great splashing and tail wagging throughout. Holding my cousins three-month-old son provided another moment. His soft, small form relaxing into sleep in my arms similarly relaxed me into a state of pure pleasure. I could slow down enough to notice and appreciate how the tiny fingers of one hand lightly cupped my arm, while the fingers of the other hand gently rested on the edge of the table by which we sat. What would normally be insignificant details are events filled with wonder for me as I marvel at life. Even at a busy airport, a half hour spent tucked away in a dark booth sharing a glass of wine and open conversation with my mother is an opportunity for pleasure. Forced to stop and wait for our planes, we can simply enjoy each others company while reflecting on recent and distant experiences. Just as I begin to worry that it is only in my free time that I find pleasure, I remember the deliveries I witnessed with my father, and the feeling of pleasure that was shared by all in the room as the new baby emerged and took its first breath. Further searching reminds me of the pleasure I took in the relationships developed with the parents of young patients at the neurology office. Though most of our exchanges took place over the phone, I felt great satisfaction in listening to their concerns, counseling them as best I could, and even in facilitating something so simple as a medication change. As I get closer to being in the role of caregiver, these assisting experiences will diminish, but I know there will still be pleasure to be found. The patient trust of the two-year-old that holds her head still while I look in her ears is a source of pleasure to me. When I can actually consistently recognize pathology from normal and then take steps to remedy it, I can only imagine that the pleasure will increase. For now, I resume school with more optimism and keep myself open to finding pleasure and happiness in all aspects of my life.
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Anne Welch
ARE YOU MY MENTOR?

(Inspired by the childrens book, Are You My Mother?) One day a college student decided that she wanted to be a doctor. She soon realized that to become the best doctor she could be, she would need a mentor. She went to her advisor for her major, English, and learned that the advisor had been a chemistry major in college, but now had her PhD in English. The student thought to herself are you my mentor? But she soon realized that a literature professor could tell her little about getting into medical school or practicing as a physician. The student graduated from college and went on in search of her mentor. While applying to medical school, she got a job working for a respected neurologist. She thought to herself are you my mentor? But the neurologist spent his time conducting research, publishing papers and chapters, and serving on boards of several academic associations. When he did see patients he talked at them, not to them, and they often left his office in awe but confused. The student soon realized that the neurologist could not teach her the skill of diagnosis or model successful patient communication. The student continued the application process and went on in search of her mentor. Her community interview for medical school was with a family practice physician who was an alumnus of the school. The doctor was friendly and encouraging, and the student thought to herself are you my mentor? As the interview went on, the student learned more about the doctor. She learned that the doctor viewed her profession as nothing more than a job, and that she got irritated when a patient would approach her outside of the office. The student soon realized that this doctor would not show her how to become the special part of the patients family and community that she wanted to be. So the student enrolled in medical school and went on in search of her mentor. During her second year she was assigned to work with a pediatrician, and quickly thought to herself are you my mentor? As time went on, the student learned much about pediatric diagnosis and treatment, but only rarely saw the moments of warmth and connection between the pediatrician and her patients that the student thought important. The pediatrician was often frustrated by administrative and technological difficulties in her practice, and the student, already familiar with that aspect of medicine, realized that she too was not her mentor. Worried that she would never find a mentor, the student turned to the people she always turned to her parents and friends already in medicine and realized that they had been her mentors all along. These mentors also pointed out that she had learned so much from all of these other doctors, both of what she should and should not do in her own practice, that in a way they were all her mentors, too.
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Nilay Kavathia
OH MAN
Tin Can Frying Pan Japan Oh Man Fat Man Ray Ban Pakistan Oh Man Catamaran What in my han I think I can Oh man Flight Plan Ceiling Fan Steely Dan Oh Man Solo, Han Sam I Am Taliban Oh Man Brady, Jan Grill Foreman Mutilans Oh Man Mammalian Light tan Spick n Span Oh Man Moon Man Muffin Bran Moving Van Oh Man Peter Pan KluKlux Klan Attention Span Oh Man Sudan Raisin Bran Harmattan Oh Man Duran Duran Cheyenne Irinotecan Oh Man Cat scan Diane Cayman Oh Man Caveman Spokane Trash Can Oh Man Muffin Man Buslafan Michigan Oh Man Afghan Carl Sagan Jordan Oh Man Oh Man Oh Man Oh Man Terminan
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Lisa Tarris
THE SECOND YEAR SPLIT

A fourth-year once said to me, Youll have completely different friends by the time you graduate. I didnt put much stock in it then. The friends I had made that first year seemed hard and fast; I didnt see any reason to doubt that wed still be friends 3 years down the road. Lately, however, as our class approaches this major transition through boards and into clerkships, Ive been reflecting a bit more on what she said. This is the first time in medical school that our plans for our future careers have come into play so directly. Although far from an exact science, I feel as though weve been roughly sorted. Pediatricians over here, surgeons in that line, family practice this way pleasenot to mention Tucson vs. Phoenix. I feel like were standing en masse at the crossroads. Very shortly it will be time to wave goodbye and start down our separate paths in much smaller groups. Im sure everyone is traveling on with a few close friends, and perhaps some people theyd rather not be going with. Undoubtedly friends will try to stay in touch. Surely theyll tell each other how their rotations are going, perhaps try to talk of what little life is left for us outside of school, and hopefully even have time to get together now and then. I wonder how many friendships will be lost? Will relationships built on the daily grind of these past two years slowly dwindle into nonexistence? Will buried personality traits emerge in those you will be working with? Will the stress of doing well on key rotations bring out the hidden suck-up, or the propensity to try and show others up? On the flip side, how many new friendships will be forged? Are there people you barely know, or perhaps even think you dont like, who will become close friends with the joy and miseries shared in rotations? Will there be those that manage to band together and share the burdens, rather than compete? The specific group we will continue our journey with was for the most part beyond our control. Im sure the dynamics are never the same from year to year. Our final year we will venture down even smaller trails, sometimes completely on our own. When we stand together again at graduation, I know we will have changed in more ways than one. Beyond our educational transition into doctors, we will be different not only for the friends weve made, but also for those we may have lost.
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Anonymous
PRESERVATION
The ceiling was white and bare. No pictures, no distractions to take my mind off what I was doing and why I was lying on this cold, hard table. I looked off to my left and saw her standing above me. She held my hand and caressed it softly, as a mother often does when her child is suffering. She looked me deep into the eyes, as if she could feel the pain I was going through. There, there. Just a few more minutes. I couldnt stand that look in her eyes, that look of pity and sadness, so I turned my eyes back to the ceiling. I blinked and then closed my eyes tightly. Please, please hurry up. I opened them again and waited, staring at that blank ceiling above me. I couldnt look at the doctor at the foot of the table. I couldnt make eye contact with him. I couldnt let him see me and my shame and my pain. So I stared at the ceiling. A single tear ran down my right cheek. Youre doing great honey. Just hang in there. I looked to her for reassurance. I looked to her for some sort of acceptance that I wasnt a horrible, terrible person. She looked away. Why are you crying??? Youre doing the right thing. Youre doing the responsible thing. You cant possibly have a kid now. You cant even take care of yourself. I closed my eyes so I wouldnt have to see the reality of my situation, but I could still hear the noises. Suction. More suction. Like a vacuum cleaner but different. Just keep your eyes closed. Itll all be over soon. *** Sometimes months go by without reliving that day, that time of my life. What a heartless bitch, youre thinking, right? Its okay. Id be lying if I said that I hadnt thought that myself at times. But the difference is that I now know better. I had turned eighteen only months prior. His name was Ben. At the time, I thought he was an amazing guy, someone who cared about the girl that I was to become. Of course, at eighteen, I didnt know any better. My notion of what that meant consisted of someone who would allow me to do the things I wanted to do without worry for the consequences. I didnt want someone nagging me and pointing fingers at all the wrong I knew I was doing. The times we had were great, clouded by the intoxication that we harbored on a daily basis. Ben was fun. He also stood by my side, smiling over me, encouraging the slow poisoning of my body and soul. Ben and I experienced a lot together, including nearly being thrown in jail not once, but twice for our habits and the careless behavior that accompanied them. Luckily, I managed to escape that fate. Perhaps luckily isnt the right word; had my recklessness been restrained earlier, I may not have had to live through this experience. Ill never know. I remember the day I found out I was pregnant. Its a day Ill never forgetI remember the exact moment: the lighting in the room, the feeling in my stomach, the smell of the air, the tears pouring from my eyes. I remember calling Ben to tell him the news; I remember the harsh words he threw at me as if this was entirely my fault. Whore. Slut. How could I possibly do this to him? I remember calling my best friend and begging him to help me figure it all out. I remember him holding me, rocking me while I sobbed through the night, telling me that he would take care of me.
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While I never anticipated being so stupid as to get pregnant before I planned to, I always told myself that I would terminate the pregnancy if ever in that situation, with no second thoughts. The reality of it, not surprisingly, was far from this nave, hypothetical, never going to happen to me conclusion. Of course I had second thoughts. But I knew that, given the circumstances of my life at the time, I made the best decision. Had the fetus managed to survive the poisons that coursed through my body and all the damage I had already inflicted upon it, it would have been born to a girl incapable of becoming a mother emotionally, mentally, physically, or financially. Ive now learned that the most consistent feeling that women have after terminating a pregnancy is relief, and, in my case, this was the absolute truth. Like I said, there are months that go by without these images coming to life in my head. Sometimes, all it takes is a smile from my godchild, and I think about what my life would have been like had I made a different decision. I wonder if I would have been able to pursue my dream of becoming of a physician. The truth is that I probably would not have had the opportunities that got me here. There isnt a day that goes by that I dont consider myself lucky to be here, to be given this chance to use my experiences, good and bad, to help others. And it gives me some comfort to know that I lived through this so I can look at my patients, without judgment or condemnation, and accept their decisions as their own.
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Josh Holexa
GUATEMALA
Things I have learned to love: dogs running in packs beans at e,v,e,r,y meal women clad in VIBRANT attire with babies strapped to their backs different c/u/t/s of meat insects in my bed mangoes-mangoes-mangoes afternoon rains diesel exhaust chicken buses as my primary mode of transportation using 1 square of toilet paper the incredible frustration at the inability to communicate the subtle euphoria at getting my point across the lines etched in the faces of the people that tell stories I cannot even begin to imagine the eyes that burn with hope and desperation the feeling of humility the feeling of humanity
amoebas in my colon
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Lisa Goldman
CHEKHOV AND HIS CASEATING GRANULOMA

Anton Chekhov (1860 1904) wrote complex, descriptive, intimate stories about complicated upperclass 19th century Russian women and men, many of whom fall from grace and some of whom are redeemed through suffering. Observing frustrated people, rotten marriages, Chekhov knew his subjects, knew suffering, and offered his characters and readers spiritual redemption through the mechanism of suffering. Mycobacterium tuberculosum, a small intracellular acid fast rod, provokes flower-like giant cells in the tissues of its host. Like ballet dancers on a stage, macrophages coalesce and form multinucleated arrays under the spell of mycobacteria. A struggle ensues between the host and the microorganism. Neither seems to win, and yet neither will give up the battle. And so progresses a series of episodic fevers, with cough, night sweats and malaise. The fight goes on for years, changing the architecture of the alveolar landscape, forming landmines of purulent exudate within the parenchyma of the lung. The caseating granuloma is composed of necrotic debris, dead and living neutrophils, macrophages and lymphocytes. Not completely human, not completely bacterial, it is cheese-like in its opacity and texture. This human tissue attempts to wall off and prevent the spread of the enemy mycobacterium. If a host is unable to fight off TB during the initial infection, the spread of TB over many years can cause abscessing and scarring not only within the lung but also in the brain. Once a granuloma ruptures into the airway, coughing spreads the mycobacterium particles to subsequent hosts, and thus the disease is passed along from one nineteenth century playwright to another. Tuberculosis didnt kill Chekhov suddenly. It made him suffer a series of agonizing episodes of reactivation and remission, giving him time to write plays. In its cheese-like opacity, the granuloma provoked not only productive coughing, but also stories. Desperately sick, hacking and coughing away his final days in Malta, he continued writing until the bitter end. Perhaps he longed for sunlit shores and open fields of sunflowers, tossing in a summer breeze, freedom from a productive cough. Like a medical student cramming before a midterm, he knew the restlessness and futility of a terminal process. Perhaps as we slave away in the library, sensing the end of time drawing near, we may pause to contemplate a utopian future of modern healthcare, a rewarding career with grateful patients, a practice unfettered by third parties, and all the right answers. We march into battle against Mycobacterium tuberculosum, a small, acid fast intracellular rod. If we cant defeat the disease enemy in reality, perhaps we can defeat him figuratively on the exam. Suffering for a purpose might not make us better people, but it makes us stronger.
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Doug Lindsey
A MESSAGE FROM THE OLD MAN

Dr. Doug Lindsey was an ER Doc here at UCHC and trained at least one generation of medical students and residents. A MASH surgeon in Korea, he was rumored to have been the model for Colonel Potter on the TV show. If he wasnt, he should have been. Kindly Old Doc Lindsey as he signed his notes, was gruff, lovable and one of the very best clinical teachers I encountered. He shoved medical students and residents into the patients room to see what they could figure out, and helped us understand we knew a lot more than we thought we did. He wrote a book of his patented five minute lectures called Simple Surgical Emergencies, which I still use as a reference from time to time. If you did something well you got a little gold star on your name tag, and we all wore those proudly. If you did really well, boy or girl, he pronounced you as a good man to run the river with, and that was something to be really proud of. One of my favorite Lindsey sayings (of many) was, there are two things every young physician needs; a few gray hairs for experience, and a few hemorrhoids for empathy! Doug passed away a few months back. I found this little gem in the 1982 Medical School yearbook; his advice to graduating students. I was amazed to find how much of what he said still resonates 23 years later. Seemed like a fitting tribute to introduce him to the next generation. Cheers! Lane Johnson. As far as I know I consumed my ration of Agent Orange, and I know that I absorbed more than the average share of ionizing radiation during three nuclear detonations on the Nevada test range. One was a medical exercise, not a weapons test; it involved a hundred dozed pigs and several dozen medical officers. Like you, we worked hard and played hard. One night a few of us had barely gotten to sleep after a poker game when a large contingent returned form Las Vegas in the wee hours and woke us all up with their laughter. Then up at dawn and over to a hearty breakfast before trucking out into the desert to prepare for the big bang. I shared a table with an infantry officer. Tell me, Colonel, are you guys typical of all physicians, or is this something special because you are out of the hospital for a change? Just routing, I replied This exercise is very important to the Medical Department; thats why we work so hard. If we were on vacation somewhere we could cut loose and relax. Unfortunately, my answer was not entirely true. Too many physicians work too much and play too little, postponing the savoring of life until they have amassed a pile and can retire to golf and shuffleboard in some luxurious Geriatric Ghetto in the sun belt. Dont do it. Mike a pile if you wish, but the first time you find yourself worrying about finding a place to shelter the pile from the erosion of taxes it is high time you thought about having more fun and making less money. On another occasion at Desert Rock one of the line officers casually queried a group of medical officers with: How come you Docs act like you are smarter than other people? He got a laughing chorus reply: Because we are! Yes, you are of a chosen few. You realized that in the moment of ecstasy at the opening of your letter of acceptance. You will be reminded again by the feeling which comes with the formal award of your MD degree: a deep, warm, suffusion of pride, of relief, of gratitude to those how have supported you. But never make an ass of yourself by flashing your self-perceived superiority. Keep the pride to yourself; let it comfort you and sustain you when the going is rough, which it often will be. And remember that you owe respect to the experts in whatever field; you owe empathy to others who have struggled and sufferedeven to those who have not succeeded as you have; you
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owe the best of care to your patients, regardless of how uncooperative they are, in spite of how much their illness is of their own doing, and without consideration of whether they have a nickel to pay you or not. These are notable exhortations, but they can be put into practice: Challenge authority. Dont goad your professors or your residents by imputation of idiocy or error, but instead weigh what you hear and read. Even if it meets with criteria of common sense, ask yourself: is it supported by fact and valid comparison? Or is it founded on opinion and anecdotal evidence and perpetuated by custom? Much of what you have been taught during the past four years will turn out no to be true. So when you challenge authority, that means dont be an authority yourself. There is no place in medicine for: Im your doctor, and I know best. Remember that medicine is not an exact science. Dont offer a warranty clause. The radiologist cannot rule out fracture, and prognosis is not a statistical phenomenon. Be honest with: We dont see any evidence of fracture on the films, or, The corneal abrasion is shallow and it ought to be 90% healed by tomorrow. Dont be afraid to ask. The experienced nurse is the interns best friend. And when you are out in practice seek the counsel of your junior colleagues as well as your seniors. Treat the rich like they were poor. Dont squander their money on superfluous tests. Treat the poor like they were rich; if they need something done, then do it. Better yet, treat them both alike and keep the billing and collecting out of the examination and treatment rooms. Tell your Vice President in charge of Finance that you expect her to keep the professional corporation profitable and earn her bonus, but that you never want to know which patients are paying their bills and which are not.
For the rest of your life, keep up with whats new in medicine. Im not talking about how to choose from the flood of brochures from the CME industry. It takes everyday work. Attend some of the staff conferences outside of your own specialty. Subscribe to the New England Journal, and read every article, not just those in your own field. Subscribe to current Contents (Clinical Practice) and scan the literature of the world by sending for reprints. The Annals, the Archives, and the American Journal are not enough. When you are staying current, then you can fan the brochures for the conference that offers the most in terms of where and when and what your spouse thinks. And you can doze through the lectures with a clear conscience if you were up too late last night. Congratulations. Good luck. And have fun. Kindly Old Dr. Lindsey
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Charity Jackson
HEARTBEATS
He lay there quietly, naked beneath the gentle warmth of the heat lamps. His skin was peeling in places and was dusted with fine hair in others, remnants of protectors in the aquatic world he was used to. Occasionally I could hear him shudder and sigh, as if still adapting to this new and strange life outside the womb. Only two hours old, he was already the focus of much attention from those of us gathered in the nursery. The nurse prodded and pulled at him, stretching his tiny arms and legs this way and that way, testing reflexes and assessing tonicity. She turned him over quickly yet gently onto his stomach. The suddenness of the act was not lost on him, however, and sharp cries soon erupted. She ran her hands along his small body and pried his buttocks apart before turning him once again to his back. Now fully awake and not altogether happy, he continued to cry. The delicate muscles of his chest and abdomen worked powerfully to push air in and out of his lungs. The nurse moved on and the pediatrician took over, placing a finger in the childs mouth and effectively quieting him. The physician then turned to us, a group of excited yet nervous medical students. He took us through the newborn exam, teaching us how to test for strength and reflexes, to look in their eyes and listen to their hearts and lungs. He let each of us practice, and for the first time I cleaned the small pediatric bell of my stethoscope with an alcohol swab and waved it dry. I placed it on the babys chest, directly over where I knew the lung would be. I listened. The air moved so fast a quick puff of air that seemed wholly inadequate to sustain life. When I listened more carefully something else resonated in the background, the echo of the heart beating strongly nearby. My own heart accelerated in response and anticipation of listening to this newborns heart. Unexpectedly, thoughts of embryology and heart development ran through my mind the knowledge of all of the adaptations this tiny heart must make in order to work independently, without the aid of mother. Holes must close, vessels must open, blood must flow quickly and efficiently through the now-working lungs and back to the heart. And then, with a slight shift of my stethoscope it was there a quiet yet powerful heartbeat. It was fast faster than anything Id heard, yet the heart sounds I had learned to identify were still distinct. Bump-bump. Bump-bump. Life pumped there beneath my stethoscope, resonating in my ears and head and soul. Life pumped beneath my stethoscope for the second tiny heart I examined as well, although it was very different, for it was a very sick heart. Months of living suspended within mothers womb had not only allowed the baby girl to grow and develop, it had also protected her from her own badly malformed heart. With her infant lungs unneeded and her mother providing the necessary oxygen for life, she had thrived and grown just like any other infant. This child, however, was not like every other. Problems with her tiny heart did not manifest themselves until birth, when it was forced to sustain life on its own merit. Holes between heart chambers and distorted great vessels hindered the work that the struggling heart needed to accomplish. It was failing, and the failure was evidenced by the bluish hue that blanketed the child. The difficulty was not only noticeable to the eye but to the ear as well, a fact evident to me as I examined her. As before, I carefully cleaned the small bell of my stethoscope and placed it gently on the chest above the lung where the breaths were quick and short. The fragile ribcage rose and fell, and here again was the treasure I searched for the heartbeat. It was quick and quiet and yet there was something wholly different about the
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sound. Between the steady beats I had come to recognize was something else, something liquid and out of place. Interspersed between the normal heart sounds was the sound of blood moving through holes that shouldnt be there a heart murmur. Rather than the continual bump-bump of a normal heart, this ailing heart filled my ears with a unique bump-bump-swish, bump-bump-swish. It was an odd sound, the swish, and to my untrained ears nearly identical to the sound made by the babys lungs. It was a terrifying sound as well, for though only a novice medical student, I was well aware of its meaning and severity. This baby girl would have a difficult time surgery and recovery and a lifetime of doctors visits were in her future. Yet as different as this heart was from the baby boys I had first listened to, life still flowed there, declaring its presence in the form of rapid heartbeats in my ear. I thought of this as I smiled down at the sleeping infant, said a prayer for her and smiled at her mother. In the time since I met these two infants I have listened to countless hearts. There have been hearts that beat strongly and hearts that beat softly; those that work in the perfect rhythm they were meant to and those that labor tremendously for each beat. Yet the remnant memory of those two infants and the awe I felt in recognizing the life their unique and distinctive heartbeats sustained remains lodged in my mind and in my own heart. The miracle of life itself compounds the miracle of birth and all of it never ceases to amaze me, or to make me feel small and inadequate. In remembering this I can hope to touch and aid the miracle myself.
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Helle Mathiasen
THE ART OF MEDICINE: LOOKING FOR MEDICINE IN THE ARTS

That is why as a writer I have never felt that medicine interfered with me but rather that it was my very food and drink, the very thing which made it possible for me to write. Was I not interested in man? There the thing was, right in front of me. I could touch it, smell it. It was myself, naked, just as it was, without a lie telling itself to me in its own terms. William Carlos Williams (1883-1963) The Autobiography Williams, or as his admirers call him, WCW, is the most important American physician to succeed also as a writer. His medical practice nourishes his writing, and he feels he needs his two careers, as stated in the quotation above. As Williams discovers, medicine and literature both pertain to the human condition and therefore feed each other. Indeed, the work done by WCW and many contemporary writers and medical practitioners can be described as diagnosing and (sometimes) curing the human condition. This human focus of both medicine and literature has inspired a relatively new interdisciplinary field of research and practice: the medical humanities. The birth of this innovative discipline occurred in the 1970s. Two faculty members in the Department of Humanities, Milton S. Hershey Medical Center, Pennsylvania State University in Hershey, Pennsylvania, Joanne Trautmann and Carol Pollard, created the first bibliography of literature and medicine in 1975. In this work, they annotate hundreds of first-rate literary works originally written in English, French, German and Russian, as well as Italian and Spanish. They also include ancient works first composed in Greek and Latin. All these illuminate medical issues intended to raise questions about the nature of objectivity in art as compared to medicine, for instance, or about the aesthetics of the body, or the nature of the dramatic role in a health care situation. The editors choose thirty-nine topics, beginning with abortion, adolescence, age, alcoholism, the body, euthanasia, medical profession, poverty and health, and ending with topics such as sexual roles, suffering, suicide, surgery, VD, women as healers, and women as patients. Works discussed are also cross referenced by author and period. As an example of the annotations we may study the one listed as : The Bible. 1 Corinthians. Topics found therein are the body, death, and sexuality. The annotation reads, In this famous discussion of sexuality and marriage (Chapter VII) Paul favors chastity, but says that it is better to marry than to burn. After a couple is married, each has power over the body of the other. In Chapter XV, these magnificent lines follow a discussion of the resurrection of the body: O death where is thy sting? O grave, where is thy victory? One of the last annotations features a story, SemiPrivate by Helen Yglesias published in The New Yorker, February 5, 1972. Its topics include death, handicaps, nurses, disease and health, medical ethics, sexual roles, doctors, medical institutions, and women as patients. (1) Reading fiction through a pair of medical glasses takes a little getting used to, but it can become a habit, and a beneficial one for caregivers. Clearly, medical issues are life issues: we all suffer, get sick, and die, and these stages and every stage in between have been written about by authors who are patients or observers, including patients family and friends, doctors, or other medical professionals. When reading attentively, one can often find in a poem, story, or play a number of topics relevant to medicine. This approach to literature is what medical humanities is all about. As the field has grown, an on-line medical humanities database has become available. This resource originates at New York University and is managed by Felice Aull, PhD, MA, and her board of distinguished editors from American universities. This expansive NYU database includes annotations on art and film as well as literature, by keyword, genre, era, author,
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physician authors, men and women authors, authors of various ethnicities, and by the title of the work discussed. Its list of keywords encompasses such medical issues as abandonment, AfricanAmerican experience, art of medicine, Asian experience, child abuse, eating disorder, genetic engineering, impaired physician, Latina/Latino experience, menstruation, and so on. The leading and most up to date database in the medical humanities can be accessed at: http://endeavor. med.nyu.edu/lit-med-med-db This excellent database was initiated in 1994 as a resource for scholars, educators, students, patients, and others interested in advancing the art of healing. The NYU annotations have been organized following the rationale that The humanities and arts provide insight into the human condition, suffering, personhood, our responsibility to each other, and offer a historical perspective on medical practice. Attention to literature and the arts helps to develop and nurture skills of observation, analysis, empathy, and self-reflection skills that are essential for humane medical care The social sciences [included in the medical humanities ] help us to understand how bioscience and medicine take place within cultural and social contexts and how culture interacts with the individual experience of illness and the way medicine is practiced. Movies being a considerable source of cultural meaning in todays world, the NYU editors review relevant contemporary movies, such as, A Beautiful Mind, The English Patient, Gross Anatomy, Iris, The Sea Inside, Super Size Me, and Y Tu Mama Tambien. (2) These films offer insight into a variety of cultural attitudes to illness, suffering, and death; they celebrate the courage of individuals facing hardship, and they communicate the life lessons we can learn from other human beings. Medical humanities is a specialty encompassing medicine and literature, the performing arts, music, bioethics, history, philosophy, psychology, theology, anthropology, theology and sociology. Currently, a significant number of this nations accredited medical schools support programs in
the humanities, including bioethics. Academic Medicine, vol. 78, no. 10 (October 2003) describes thirteen American, two Canadian, and seven international medical humanities programs. Here is a list of some of the American institutions which feature medical humanities: The University of California, Irvine, College of Medicine; Northwestern Universitys Feinberg School of Medicine; Michigan State University; University of Missouri-Kansas City School of Medicine; New York University School of Medicine; University of Rochester School of Medicine and Dentistry, Rochester, New York; Stony Brook University School of Medicine; Hiram College; Northeastern Ohio Universities College of Medicine; Pennsylvania State University College of Medicine; University of Texas Medical Branch at Galveston; and University of Texas Health Science Center at San Antonio. Our own medical humanities program at The University of Arizona started in 2003 and is still evolving. It provides a Medical Humanities Lecture Series featuring nationally known speakers, book club get togethers, Harmony, a magazine for the humanities, and educational opportunities for students. Our website http://humanities. medicine.arizona.edu contains more information. The Harmony mission statement, composed by medical student editor (Shad) Farshad Marvasti states: The goals of this new Magazine are to value the different perspectives, insights, and experiences present within the Arizona Health Sciences community through the publication of original works of personal expression. (3) The inauguration of The University of Arizona Medical Humanities Program accords with the wishes of many medical students entering The University of Arizona, as evidenced by a survey conducted in 2004. First-year students (Tucson) and thirdyear students (Phoenix) strongly support a credit based medical humanities course (82% of first-year students; 83% of third-year students). In addition, 82% of the first-year students (Tucson) and 76% of the third-year students (Phoenix) felt that a medical humanities elective should be offered during both
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the third and fourth year of medical school. With the curriculum revision being planned for The University of Arizona medical schools in Tucson and Phoenix, humanism will become embedded in all four years of study. The website http://curriculum.ahsc.arizona.edu may be consulted for further information about this new curriculum.
works.(4) Indeed, omissions and silences in the patients story may be as significant to the truth (or the case) as what is expressed. Evidently, a story, poem or painting may contain both stated and unstated messages accessible only to the trained reader. This particular literary application of the humanities to medicine is now the field of Narrative Medicine, discovered and explored by Rita Charon, MD, PhD, of Columbia University College of Physicians and Surgeons in New York. On her website, www.narrativemedicine.org, Dr. Charon lists her Narrative Medicine Rounds and other activities, and describes her innovatory concept of parallel charts, a kind of structured writing involving students writing narratives about their patients from the patients point of view and parallel to their patients charts. She claims that a study of this innovation shows that students who wrote were found by their faculty to develop better therapeutic relationships with patients and to be more effective as medical interviewers. Students who wrote evaluated themselves as more confident than those who did not in such clinical capacities as caring for dying patients and giving bad news. However, writing is hard, and medical students are pressed for time. Nevertheless, Dr. Charons efforts have resulted in structured writing becoming incorporated into the third-year medicine clerkship at Presbyterian Hospital in New York. In small groups, students write, read their writings to their peers, and engage in frank discussions. The outcome has been positive. Practicing the difficult skill of structured writing can apparently make better doctors.(5) Briefly stated, this is the goal of humanism in medical education: to make better doctors. We believe that writing and communicating about and with patients alongside your own individual experiences can promote better self understanding and better medicine. In addition, state Coulehan and Block, Good clinician communication does prevent malpractice suits, even if there is a bad medical event or outcome. In dealing with
What the Humanities Offer to Medical Education

The humanities hold a special place in medical education, as they involve the learner in an experiential, self-reflective endeavor. Ideally, students of the medical humanities will exercise and develop their emotional, intellectual, and spiritual knowledge as they read, write about, and discuss literary and other art works as these relate to the daily life and practice of each person. In writing about and reflecting on a poem, for example, an individual student, resident, or faculty member can strive to develop the vocabulary and narrative skills needed for analyzing the stories her patients tell. Good listeners will notice the point of view, word choice, and interpret the meaning of the message hidden in the patients narrative. Recently, such analytical techniques normally used to interpret literature have been shown to be valuable to medical practitioners. Here is Marcia Day Childresss description of the physician-patient relationship in literary terms: The physician is the critical reader, highly skilled both in eliciting and interpreting the patients story, which encompasses all the patient says, how he or she says it, and the myriad nonverbal cues (including body language, significant omissions, and broad lacunae of silence) that accompany this telling. The physicians responsibility is to listen to the patient in a close, careful, and nuanced way in order to elucidate and then explain the patients narrative, bring out and reflect its coherence and meaning, and finally translate what the patient has said and enacted into the formulaic tale the case presentation with which clinical medicine
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todays patients, often well informed, inquisitive, and eager to participate in their own treatment, technical mastery is not sufficient: the good doctor (ideally) must also have developed competent communication skills and a suitable bedside manner. Who gets sued and who doesnt has been shown to depend on the degree of communication skills doctors demonstrate in dealing with patients. Arguably, good communication skills can be learned through the humanities, in creative or analytical writing, and/or discussing, as well as studying representative texts.
doctors avoid it. However, Tolstoys Russian and todays American patient deserve information delivered in plain language with empathy for the patient as a person. Sometimes what is needed is just listening: being a good listener proves the physicians attention to the patients emotional needs as she follows the maxim: Dont just do something; sit there. This empathic skill is
The crucial importance of good communication skills in medicine cannot be overemphasized. In their valuable book The Medical Interview. Mastering Skills for Clinical Practice, Coulehan and Block use a famous story to illustrate the importance of communicating empathy when delivering bad news. The story The Death Least Grebe, Sweetwater Wetland Eskild Petersen of Ivan Ilych by Leo Tolstoy portrays a worried protagonists visits with critical particularly in dealing with chronically several doctors who diagnose him with various ill, seriously ill or dying patients. The use of arcane illnesses, for instance, a floating kidney. sensitive and accurate word choice and body Their incomprehensible diagnoses only increase language in such situations can be learned from Ivan Ilychs fear that he is going to die soon. stories about callous, arrogant, or kind and humble This exercise in medicalese signifies the doctors physicians. Literature offers plenty of good and avoidance of the situation. The patient wants the bad role models for physicians, demonstrating that truth; he suspects he is dying, but the doctors fail linguistic competence and clinical skills weigh to address the patients human concerns in simple, heavily in the patient encounter. clear language (6). Clearly, bringing bad news is unpleasant for the messenger, and therefore some
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The story about Ivan Ilych ( or Everyman) can be helpful on many levels, and especially relevant to todays patient-centered practice of medicine. What uninformed patients tolerated in the past, say, in nineteenth-century Russia, will not be tolerated by todays googlers. They want straight answers. Thus, Michael S. Woods, MD states, Physicians who insist on using either tech talk or baby talk with patients are, frankly, attempting to maintain a controlling position. Such behavior will not work any more, since it is public knowledge that as many as 98,000 people die in hospitals each year due to medical error. Professionalism demands that a physician realize her/his own human fallibility and the humanity of the profession as a whole. Dr. Woods argues forcefully for the power of good communication skills, especially in cases of unintended negative consequence or complications. In order to start his patient relationships on the right footing, he even encourages patients to call him by first name when introducing himself to them, and calls patients also by first name. This seems to put patients at ease. Woodss 2004 book Healing Words: The Power of Apology in Medicine, produced with Hilda J. Brucker, posits that the quality of doctor-patient communication influences not only the patients desire to initiate a malpractice suit but also the physicians own mental well being and enjoyment of her/his daily practice. His bibliography cites data indicating that the likelihood of a lawsuit falls by 50 percent when an apology is offered and the details of a medical error are disclosed immediately. This short, concise book is useful to medical educators and practitioners of the healing art, and to patients. The general reader might ask himself/herself how many times he/she has received an authentic apology from a doctor who was late for a scheduled appointment or who interrupted his patient. Woods believes that management techniques used in business can be transferred successfully to the profession of medicine. The customer or patient will be more satisfied and less inclined to sue if the provider
shows regret, responsibility, and remedy when an error has occurred. In addition, argues Dr. Woods, including the liberal arts in pre-medical and medical education may encourage openness to other perspectives and ideas. He maintains that Due to their training, many physicians have trouble assessing themselves accurately and receiving constructive feedback. Medical students are taught science nearly exclusively. This tight focus results in a kind of forced social illiteracy. Dr. Woods own traumatic experience with a malpractice suit gave him the perspective to write this book. (7) In the marketplace of medicine, the educated customer will seek the best health care for the best price. Physicians competence or incompetence will become ever better known, and some patients will demand to be compensated for medical errors. Medical malpractice suits will not go away. Commonly, doctors fear malpractice suits which can wreck their peace of mind or reputation temporarily or for good. Perfectionist doctors tend not to report mistakes, even though most medical mistakes do not result in a law suit. The cost of malpractice insurance is high; many doctors complain of its being too high. Clinical psychologist Daniel Shapiro, PhD, has offered a no-fault solution to this serious issue. At present doctors must pay damages beyond what their malpractice insurance covers. Shapiro suggests that physicians should voluntarily report mistakes to a local commission. Those who do so will not have to pay personally , but their patients would be adequately compensated from local injuredpatient compensation funds paid into by patients and doctors. Providing such a financial incentive would make more doctors come forward to admit their mistakes as they saw that disclosure of errors entailed freedom from personal payment. Dr. Shapiro believes that patients trust the system to protect them, but Most patients are unaware of how little protection they now have. Having experienced both sides of the patient/doctor perspective, Dr. Shapiro correctly states,
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patients and doctors want the same thing: a system that builds trust, helps each group learn from mistakes and compensates those who are injured. (8) In the best of systems, individuals could learn from their own honest mistakes and those of others. However, fear of malpractice suits and personal pride (perfectionism) stand in the way of total honesty in medicine. Sincere communication, empathy, apology, and honesty should be practiced by doctors, indeed all of us, every day of our lives. Do we even need to remind doctors to be kind and compassionate? All humans should know to be tolerant, respectful, and sympathetic. But since medical education focuses on science and learning about the body, medical students only secondarily learn the importance of the patients psychological, spiritual, and social needs. They may not be taught to consider even their own wants. The tradition of valuing scientific detachment and objectivity in a medical student/practitioner has caused an emphasis on science courses and scientific journals plus the development of technical skills to the detriment of students/doctors learning how to communicate with the patient as one human being to another. Consequently, the value of humanism remains hidden for some medical caregivers. However, since empathic communication has now been shown to be financially profitable to the medical profession, this skill will become increasingly desirable. Clearly, the patient-as-customer will References:
shop for knowledgeable, friendly service at a reasonable price. But, in addition, because of the personal nature of clinical practice, many patients will also want to be able to like and respect their physicians as people. The poet Anne Sexton (1928-1974), a patient herself, knows and forgives her doctors: They are not Gods Though they would like to be; They are only a human Trying to fix up a human. Many humans die. They die like the tender, Palpitating berries In November. But all along the doctors remember: First do no harm. They would kiss if it would heal. It would not heal (9). In a marvelous reversal of the usual doctor-patient relationship, Anne Sexton voices empathy for her doctors, saying, I understand you are only human and that you are doing your best. Empathy or sympathy expressed in simple words would be a precious addition to many of our social interactions. Doctors could say something like, I am sorry, this must be hard for you, when dealing with a patients suffering. They could add sincerity by a touch or eye contact. I guarantee both parties would feel better.
(1) Joanne Trautmann, Carol Pollard, eds. Literature and Medicine. Topics, Titles and Notes. Phila, PA. Society for Health and Human Values. 1975; 1, 151. (2) http://endeavor.med.nyu.edu/lit-med-med-db Accessed 6 March 2006. (3) Harmony, vol. 6, 2004-2005; 1. (4) Rita Charon, Martha Montello, eds. Stories Matter. The Role of Narrative in Medical Ethics. New York, Routledge, 2002; 119. (5) www.narrative.medicine.org. Accessed 6 March 2006. (6) John L. Coulehan, Marian R. Block, eds. The Medical Interview. Mastering Skills for Clinical Practice. Phila, PA. F.A. Davis. 2006; 339, 281, 283. (7) Michael S. Woods, Hilda J. Brucker, Healing Words. The Power of Apology in Medicine. Oak Park, IL. Doctors in Touch. 2004; 69, 56, 67, 3,14. (8) http://www.nytimes.com/2003/09/23/health/policy/23ESSA.html?ex=1065498653&ei=1&en=e672150e64bad6df, Accessed 6 March 2006. (9) Anne Sexton. Complete Poems. Boston, Houghton Mifflin, 1981; 465-466. HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES
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LITERATURE QUIZ:
Many of these authors are represented in Richard Reynolds, MD, John Stone, MD, et al., eds., On Doctoring. Stories, Poems, Essays. New York, Simon and Schuster, 2001. How many of these authors do you recognize? Who are your favorite authors? Did you like what they said? Lori Alviso Alvord Sawako Ariyoshi Jane Austen Jean-Dominique Bauby Simone de Beauvoir Charlotte Bronte Mikhail Bulgakov Rafael Campo Albert Camus Raymond Carver Anton P. Chekhov Kate Chopin Daniel Defoe Charles Dickens Emily Dickinson Fyodor M. Dostoyevsky Arthur Conan Doyle Andre Dubus Margaret Edson Barbara Ehrenreich George Eliot Gustave Flaubert Michel Foucault Gabriel Garcia Marquez Atul Gawande Charlotte Perkins Gilman Wolfgang von Goethe Thom Gunn Joy Harjo Nathaniel Hawthorne Victor Hugo Henrik Ibsen Henry James Kay Redfield Jamison Ha Jin Franz Kafka Susanna Kaysen John Keats Perri Klass Elisabeth Kubler-Ross Tony Kushner Jhumpa Lahiri Primo Levi C.S. Lewis Sinclair Lewis Robert J. Lifton Nancy Mairs Thomas Mann Guy de Maupassant Ian McEwan Herman Melville Michel de Montaigne Sherwin B. Nuland Flannery OConnor Danielle Ofri Tillie Olsen William Osler Boris Pasternak Sylvia Plath Edgar Allan Poe Reynolds Price Barbara Pym Philip Roth Rumi Oliver Sacks Jose Saramago Elaine Scarry Richard Selzer Anne Sexton William Shakespeare Mary Wollstonecraft Shelley Samuel Shem Carol Shields Elaine Showalter Leslie Marmon Silko Aleksandr Solzhenitsyn Susan Sontag Robert Louis Stevenson John Stone William Styron Dylan Thomas Leo Tolstoy Abraham Verghese Alice Walker Wendy Wasserstein Fay Weldon Walt Whitman Tennessee Williams William Carlos Williams Virginia Woolf, Richard Wright, Marilyn Yalom Emile Zola Take some time to google the authors youre interested in.
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CONTRIBUTORS
JANET ALESSI moved to Tucson in 1970 after 4-1/2 years in Hawaii, where she graduated from the University of Hawaii with a double major in Psychology and Fine Arts. Janet came to her present job as a Program Coordinator for the Director of Administration and Finance at the Arizona Cancer Center from a twenty-one year career in the printing and publishing industries. Painting, drawing, wood burning and carving, writing, reading, watching movies, and gardening have been her constant favorites, but recently shes added rockhounding to her list. If you know of any good local rockhounding sites, she asks you let her know about them. Also, she needs a publisher for the mystery she co-authored with her daughter, Tina! ROBERT ATTARAN is a medicine resident. He was born in England and spent most of his life there. He is now settled in the States. MATT BERNHARD grew up with the green hills and warm sand of California. Inevitably, the winds of change drew him to the cacti and intrusive igneous of Tucson. In medical school, Matt has dissected the human form into its individual units of consciousness, while still making time to camp and play frisbee. Some of his greatest pleasures include beach bonfires and mangos. LINDA LARSON CARR, PhD, directs the Office of Learning and Teaching at The University of Arizona College of Medicine in Phoenix. She holds a PhD in Higher Education from The University of Michigan, where she specialized in learning and teaching, academic administration, and innovation in medical education. She provides academic support to medical students and residents and works with faculty to enhance their teaching outcomes through better understanding of the scholarship of learning and teaching. Carr founded the Educational Development Advisory Council, which provides oversight for the Best Practices of Medical Educators Seminar Series, Best Practices for Residents Seminar Series, and the Innovations in Medical Education Event held annually. She is married to Robert Calvin Carr, a practicing Interior Designer in Scottsdale. They have two dogsMonique, a black standard poodle, and Tate, a black Scottish terrier. During July of 2005, Robert and Linda were in the Philippines on a churchrelated mission project when this photo of the Mayan Volcano near Legaspi City was taken. YOVANNAH DIOVANTI is currently working towards a degree in Linguistics and Spanish Interpretations at The University of Arizona. Her recent experience working for E.N.C.A.S.A through the College of Nursing has inspired her to volunteer her services during her free time by giving presentations and doing art activities with children who attend Title I schools. CARLA DORMER was born and raised in Marathon, Florida, in the heart of the Florida Keys. She has lived in Tucson for 7 years, and is married to a wonderful husband who is a Loan Officer, who is in the Air National Guard and who is a drummer in a local alternative rock band! They have 2 kids...a chocolate and a yellow laborador retriever! Carla graduated from the University of Central Florida and is a fourth year medical student at The University of Arizona. She will be doing a residency in Anesthesiology at the Mayo School of Graduate Medical education in Scottsdale, Arizona. MARY FOOTE is a third-year (originally class of 05, now 07) MD-MPH student. In 2005 she spent 9 months working in Iquitos, Peru, in the northern Amazon basin, on a Tropical Medicine research fellowship through Johns Hopkins University. She spent the next three months (Oct.-Dec.) doing one of her dream trips traveling through the southern cone of South America down to Tierra del Fuego. Countries visited included: Peru, Bolivia, Chile, Argentina and Uraguay. PEGGY GIGSTAD, M.S., RN, CSN, is a Clinical Assistant Professor at the College of Nursing. She has practiced in hospitals, home health, schools and rehabilitation. She recently retired as a Colonel in the Army Reserve.
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LISA E. GOLDMAN has her undergraduate degree in History, Political Economy and Fine Art from Evergreen State College and her Masters in Social Work from Arizona State University. She raises ducks in her spare time. JOYCE GONZALES, MD, is a third-year medicine resident at William Beaumont Army Medical Center. She was in Medical Humanities as a part of the Geriatric rotation. She states, It was fun to take a medical course without medicine in it. Actually the medicine was there but in a special perspective, unconventional to everyday thought and both I and my patients have been enriched by an expanded view of seemingly ordinary daily events in medicine. CHRISTINA HAYHURST is a first-year medical student at The University of Arizona. She grew up in Prescott, AZ and has been painting since she can remember. She is currently looking forward to living in Sedona for the summer through the Rural Health Professions Program and is learning to play the harmonica. JOSHUA HOLEXA is a second-year medical student who likes to travel to distant lands and write bad poetry about his experiences. When not traipsing through tropical tierras he enjoys grape juice, NPR, making soups with rotting vegetables, and rock climbing. SERGE HOUGEIR is a fourth-year MD-MPH student and will be graduating in a month. He is originally from Syria and grew up in France and Algeria before moving to the United States in 1994. His passions are traveling, languages, learning about different cultures, and capturing adventures with photography. NANCY HOWE works in the Arizona Cancer Centers Cancer Prevention Education and Integrative Medicine Office. A former software developer, she left Silicon Valley after diagnosis and treatment for cancer and obtained her masters at ASU in Exercise and Wellness. She was a runner profiled in Runners World before cancer, and after, she began weight-lifting, eventually competing internationally as a pro in the drug-tested, bodybuilding circuit at age 46. This is her first public admission of her 1979 diagnosis of manic-depression. CHARITY JACKSON is currently a second-year medical student at The University of Arizona. She enjoys writing when she can find the time to do so, and has found that learning medicine has given her both ample issues to consider and the strong desire to write about them. LANE P. JOHNSON, MD, MPH, received his MPH from the University of California at Berkeley in 1979, his medical degree from The University of Arizona in 1983, and went on to complete his Family Practice Residency at the Arizona Health Sciences Center in Tucson. He is an Associate Professor of Clinical Family and Community Medicine and in the College of Public Health. Current responsibilities include Directorship of the MD-MPH Dual Degree Program, the Clinical Preceptor Program, the College of Medicine curricular revision project, and Principal Investigator for a study of herbs used by Hispanic patients with diabetes. His interests include public health and alternative therapies. NILAY KAVATHIA grew up in Phoenix, Arizona. He then went to college at Case Western Reserve University and received a Bachelors in Sociology and a Masters in Philosophy. He is now a second-year medical student who loves nothing more than telling stories.
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CHRISTINE KRIKLIWY was born in Lahore (formerly known as Paris of the East). She has traveled half the world and would like to come full circle. She has worked in arts administration and health and is the voice for those trying to be heard. AARON LEETCH is a second-year medical student. These pictures were inspired by a medical missionary trip to Guatemala. JEANETTE LONG is currently a part time graduate student (non-degree) with an interest in the MPH program. She is a member of the Navajo Nation and a U.S. Army Veteran who served in the Persian Gulf War as a Combat Medic. HELLE MATHIASEN holds a Cand.mag. degree in English and Ancient Greek from Copenhagen University and a PhD in English from Tufts University. She emigrated from Denmark in 1965 and has taught at The University of Arizona since 1993. Her research interests include medical humanities, Danish women authors, and Danish World War II history. In 2003 she became founder and director of the Medical Humanities Program at the UA College of Medicine. http://humanities.medicine.arizona.edu CHRISTINA MENOR is a travel and photography enthusiast. She is originally from Indiana and has lived in Arizona for 15 years. After completing a B.S. in Microbiology and an M.S. in Nutrition, she began medical school at The University of Arizona College of Medicine. Currently an MSIII, she aspires to enter a career in womens healthcare, working towards providing continuing prevention and care for female patients of all ages. JENNIFER NICHOLLS is an employee in the College of Nursing. She has her BA in Music and has recently returned from cruising the Caribbean as a cocktail pianist. Alan Olsen, captured in the photo, is proudly serving his Church in Argentina. TESSIE OTALLEY runs the Learning Resource Center for the Arizona Health Sciences Center and comes from a family of amateur artists and craftspersons. Her hobbies, in addition to photography, are genealogy, art, exploring different crafts, playing with her two cats and puttering around the house an ESKILD A. PETERSEN, MD, DTM&H, is the current Chair of the Quality Safety Board at University Medical Center in Tucson, AZ. He was Chief of Staff from 1999 to 2002. He is a Professor of Medicine, Family & Community Medicine, and Public Health. He is an Associate Department Head of Medicine and the Chief of the Section of Infectious Diseases. Dr. Petersens background in quality control efforts has been originally based in the area of infection control where he has been involved both locally, in Tucson, as well as internationally with reform efforts in both Central Asia and Russia. He has firsthand knowledge of different health care systems in countries around the world. RONALD PUST, MD, is a family physician who is also board certified in public health. He sees international health as part of the College of Medicines commitment to underserved people. He directs the FCM medical student teaching programs, focusing on Years III and IV. Born into an immigrant family in eastern Montana, he is thankful for basic elements in life, people and places. LUIS RODRIGUEZ grew up as the oldest of three children in a small rural town in central Puerto Rico. Before starting medical school, he attended The University of Arizona where he pursued degrees in General Biology and Studio Art. He is considering a career in a primary care field.
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KENNETH J. RYAN, MD, is Dean for Academic Affairs at the College of Medicine at The University of Arizona and Professor in the departments of Pathology and Microbiology & Immunology. His undergraduate, medical school and postdoctoral training were at the University of Washington in Seattle. He continues to teach medical student in the basic science curriculum of the College and also edits a textbook used U.S. medical schools for their second-year medical microbiology courses. The 4th edition of Sherris Medical Microbiology appeared in early 2003. In his spare time Dr. Ryan enjoys golf, tennis, and the arts. He is member of the Board of Trustees of the Arizona Theatre Company and is a regular preview lecturer for the Arizona Opera Company. KELLY SANDBERG graduated from BYU with undergraduate degrees in Biochemistry and Russian. He will be completing his third and fourth years of medical school in Phoenix. He and his wife Carrie have 2 daughters. DAN SHAPIRO is an Associate Professor in Department of Psychiatry. He is the author of two books, Delivering Doctor Amelia and Moms Marijuana (Random House.) His essays have been on NPRs All Things Considered and appeared in JAMAs A Piece of My Mind and in the New York Times. SHAMEEMA SIKDER is a true Wildcat, going to The University of Arizona for undergrad and med school. She is looking forward to an ophthalomology residency at Johns Hopkins and learning more about the eye, natures best camera! QUINN SNYDERs hands are a mess. He has broken every one of his fingers, often more than once, from a variety of colorful incidents. The left thumb was broken when his mother slammed it in the door of a doomed white Volvo outside his future elementary school at the age of three, the right thumb was broken when he himself slammed it in the door of his silver Honda Civic at a gas station in Scottsdale at the age of 17. Calluses rage after a long spat of bartending and now from countless afternoons of rock climbing. Blood stains the goat skin of his first Djembe due to many evenings of drumming with reckless abandon. He plans to double glove during his Surgery rotation. ZOE SORRELL is the daughter of Vincent L. Sorrell, MD, Associate Professor of Medicine in the Division of Cardiology and the Director of Cardiac Imaging. Zoe is 13 years old and an 8th grade student at Esperero Canyon Middle School. She is an Honor Roll Student and accomplished musician (Flute and Piano) who enjoys writing poetry for fun. The poem I am won second place in her schools 7th grade poetry contest. Her hobbies include traveling, soccer, running, shopping, and making her mum and dad proud. DONNA SWAIM was born in Nebraska. She holds a PhD in English from The University of Arizona where she teaches in the Medical Humanities Program. She has led discussions at Arizona Theatre Company, presented programs for the Arizona Humanities Council, taught classes and led workshops in prisons, taught several courses in the Adult Humanities Program, and worked as Facilitator of Spirituality and Medicine since the beginning of the Program in Integrative Medicine. Perhaps, among many other awards, the plaque from her prison students may be most highly valued as it presents her the august title of Honorary Convict. LISA TARRIS is a second-year medical student at The University of Arizona. She was a paramedic in her former life, and still works part time in the Emergency Department at UMC. She loves spending time with friends, doing crazy if somewhat dangerous things, and all forms of black humor.
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BRIAN TSUI is currently a third-year student at the College of Pharmacy at The University of Arizona. Finding the time to devote to the artistic side of his brain takes quite a bit of creativity in and of itself, but he feels that it is imperative to find a way to express himself. Although he enjoys taking pictures of landscapes and still life, he has found a new subject to photograph: his baby boy, Quentin. ANNE WELCH is a second-year medical student. She majored in English Literature at Northwestern University and then returned to the desert to begin her medical career. KEVIN YARBROUGH is a first-year medical student at The University of Arizona. He enjoys reading, eating, running, playing basketball, and the company of good friends. He would also like to take this opportunity to thank you for taking the time to read the authors biographies, not many people do that, he is very flattered. In the spirit of reciprocity, he would like to get to know you better, so please feel free to approach him and give him your bio. ADRIENNE YARNISH is currently a third-year medical student. She received a B.S. in Biochemistry and a B.A. in Spanish Language & Literature from The University of Arizona. Her main academic interests in med school have be Wilderness medicine, Environmental Medicine, Womens Health and working with underserved populations. Outside interests are traveling, cycling, swimming, hiking, writing and hanging with dog Josie and friends.
Cultural Competency Training
Kelly Sandberg 89
HARMONY is published annually. We welcome individual and corporate contributions and subscriptions. If you would like to guarantee a mailing of the next issue, please fill out the following form and return it in the envelope provided with your donation. Make checks payable to Harmony/The University of Arizona.
We would like to thank our subscribers & donors: Vincent Fulginiti, MD and Shirley Fulginiti James E. Dalen, MD and Priscilla Dalen William Dalton, MD and Karen Dalton Gordon Ewy, MD and Priscilla Ewy Ronald E. Pust, MD Nancy Howe Henning Ansorg, MD Daniel Levinson, MD Anna Geischen Anna Mae Story
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SUBMISSION GUIDELINES
Harmony is a literary journal of essays, short stories, art, photography, poetry, and other expressions of creativity. It is a publication of the Arizona Health Sciences Center. Students, faculty, and staff of the Colleges of Medicine, Nursing, Pharmacy, and Public Health are encouraged to submit original, unpublished work to our journal. Work on any theme or topic will be considered, but most of our published work speaks to medicine and health. 1. 2. 3. 4. 5. All submissions should be no more than 3,000 words. Work should be clearly titled. Previously published work will not be considered. Submissions are accepted either via email or mail. Submissions should include the authors name, a biography of approximately 50 words, a mailing address, and an email address. 6. Any work submitted by mail should also include a copy on a CD. 7. The preferred file form for documents is Microsoft Word. 8. Artwork submitted electronically is preferable in a .jpg file of at least 300 dpi or a .tif file. 9. If any submitted material is to be returned, please include a self-addressed stamped envelope. 10. Each published contributor will receive two copies of the journal. 11. Thank you for your interest in and submissions to Harmony.
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Send submissions to: Harmony Editor Medical Humanities Program College of Medicine Arizona Health Sciences Center P.O. Box 245017 Tucson, AZ 85724-5017 Send electronic submissions to: harmony@medicine.arizona.edu Please direct any questions to harmony@medicine.arizona.edu. Thank you!
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Dostoyevsky and His Fathers Polyclinic
Kelly Sandberg
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Vida (Life)
Yovannah Diovanti
A R I Z O N A
H E A L T H
S C I E N C E S
C E N T E R
M A G A Z I N E
O F
T H E
H U M A N I T I E S

Harmony Magazine, Volume 8 (2006-2007)

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Harmony Magazine, Volume 8 (2006-2007)

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V O L U M E

Art Essays Ideas Photographs Poetry Prose

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

HARMONY ARIZONA HEALTH SCIENCES CENTER MAGAZINE OF THE HUMANITIES

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REKINDLING THE SPIRIT

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Seattle Public Library

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Past Homage to a Pediatrician

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WRITINGS BY THE UNIVERSITY OF ARIZONA GERIATRICS RESIDENTS AND THEIR INSTRUCTOR

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THE DEATH OF ROBERT ATTARAN

It doesnt hurt anymore.

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CAN THIS MIRACLE HAPPEN

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ECSTASY AND AGONY

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A MYTH FROM THE SEA: WAGNERS BREAKOUT OPERA

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Wagner and the Supernatural

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The Mysterious Stranger

The Eternal Feminine

Things to Look for in the Music

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The Dutchmans Monologue

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Winter, Helmchen Falls, B.C.

Warming Hut, Wells Grog, B.C 32

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Pyramid Mountain, B.C.

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La raz que nos conecta (The Root which Connects Us)

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Un rezo por la humanidad (A Prayer for Humanity)

El ciclo de la vida (The Cycle of Life) 40

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The Beast, Sevilla, Spain

La Mezquita, Cordoba, Spain

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