Obliterants: Fall Issue 2012

  • Published on
    15-Mar-2016

  • View
    214

  • Download
    0

Embed Size (px)

DESCRIPTION

Journal of Humanities and Social Sciences in Medicine and Public Health.

Transcript

  • 1OBLITERANTS

    OBLITERANTSV O LU M E 2 | I S S U E 1 | FA L L 2 0 1 2

    H U M A N I T I E S A N D S O C I A L S C I E N C E S I N M E D I C I N E A N D P U B L I C H E A LT H

    DESTINATIONS

  • 2 OBLITERANTS

    Volume 2 | Issue 1 | Fall 2012

    Front/Rear Artwork

    WELCOME TO THE NEWLY-FORMATTED OBLITERANTS! As you can see, weve gone through a design overhaul. We believe that layout design is a work of art in itself, and as a frame it enhances the other articles and artwork within it. This issue was a joint effort between student editors at the regional and Miami campuses, with guidance from Dr. Agarwal and Dr. Lichtstein. As such, it is a truly collaborative creation and we are excited to share it with you.

    The theme for this issue is Destinations and its par-ticularly highlighted in our Features section, where weve received submissions from students who did projects in various places around the world this past summer. The At The Bedside section showcases insights gleaned from the journeys weve taken with our patients. The Education section offers experi-ences and lessons from students on their passage through medical school from the first year all the way through graduation. Additionally, the pictures and paintings studded throughout the publication are meant to enhance the readers experience, and we hope that-- through the eyes of the artist-- they provide to you a window into another world.

    Our vision for Obliterants this year is to publish three issues during the academic year, with the release of each issue coinciding with the changing of the sea-sons. Our next issue will be released in the Winter solstice, with a theme on Diversity. We are always accepting submissions year-round from students, fac-ulty, and staff on any topic, medical or non-medical, in any form and in any medium. If youre interested in being a part of the Obliterants Team, feel free to e-mail us at obliterants@gmail.com.

    Wed like to thank all the contributing writers, poets, artists and photographers for creatively sharing their experiences with the Obliterants and its readership.

    Sincerely,Myra AquinoBrigitte Frett

    Mary Lan

    Front/Rear Cover Photo by Myra Aquino

    about obliterantsObliterants is a journal published by students, faculty, and staff of the University of Miami Miller School of Medicine. Its mission is to

    publish writings and artwork that promote the humanities and social sciences in medicine

    and public health. Obliterants is not an official publication of the University of Miami School of Medicine. Expressed written opinions are solely those of the authors and artists and do

    not necessarily represent those of the University of Miami, the School of Medicine, or the

    Department of Epidemiology and Public Health.

    SUBMISSIONSObliterants is published quarterly.

    Faculty, staff, and students are invited to e-mail their submissions to

    obliterants@gmail.com

    Letterfrom theEditorsOBLITERANTS

    Journal of the Humanities and Social Sciences in Medicine and Public Health

    Editors (2012-2013)Myra Jon Aquino

    Brigitte FrettMary Lan

    Editorial AdvisorGauri Agarwal, MD

    Assistant Regional Dean for Medical Curriculum

    Editors (2011-2012)Brian Garnet

    Paul Rothenberg

  • 3OBLITERANTS

    CONTENTS

    9 FEATURES PAGE 18

    THIS ISSUE: DESTINATIONSThe summer after the first year of medical school

    is the per fect opportunity to pursue research, complete a project, or simply relax. Turn to

    page 18 to read and see what students did.

    EDUCATION

    FEATURES

    AT THE BEDSIDE

    ARTWORKPhotographs by Larissa Lester, Myra Aquino, Joanne DuaraPaintings by Jen Schwenk, Ekaterina Koustioukhina

    13 I Wrote This Poem In Learning Community BY SHARI SEIDMAN

    14 Nuns at Church BY MYRA AQUINO

    15 Rose Ceremony Speech BY ALEXANDER KAPLAN

    4 27 BY NATASHIA LEWIS

    7 Creepy Cranial Nerve Exam BY CAITLIN HODGE

    8 Abdominal Exam BY ANTHONY PARK DANDREA

    11 Not Just Another Jane BY DANIEL LICHTSTEIN, MD

    18 Summer, O Summer BY ISAAC LEE

    Basic Combat Training in Fort Sam Houston, Texas

    20 Privileged BY BRYAN STEPANENKO

    22 Death by Powerpoint24 Butterbars BY ALEXANDER KAPLAN

    25 Clinical Research in San Francisco, California To Brain Or To Spine BY MAI TRAN

    PHOTO GALLERY26 Public Health Research in Tikantiki, Panama ELAN HORESH, ANNE KIMBALL, ADAM CROSLAND

    29 Public Health Research in Nyarushanje, Uganda GREG MILLIGAN

    31 Public Health Research in Cornwall, England JASON HEFFLEY

    Public Health Research in the Dominican Republic 34 NICK CNOSSEN, CARLY RIVET, BRANDON HENDRIKSEN37 RAMMY ASSAF39 KELLY GRANNAN41 Public Health Research in Haiti JULIE LEVASSEUR

    43 The Car Ride in Fall BY JOANNE DUARA

    44 9 NEXT ISSUE: CALL FOR SUBMISSIONS

    16 Forced Humanized Mice BY JOANNE DUARA

    17 Enough With The Puns BY ANONYMOUS, ARTWORK BY MARY LAN

  • 4 OBLITERANTS

    AT THE BEDSIDE

    27BY NATASHIA LEWISHE HAD JUST TURNED 27 YEARS OLD. A TALL, SLENDER, AND TALKATIVE YOUNG MAN, HE LOOKED OUT OF PLACE SURROUNDED BY THE ILL AND WEAK. Quick to laugh, and even quicker to tell you about his mothers home cooking that he had missed so much when

    he was away. The man I met that day in the hospital, at first seemed

    deceptively athletic and strong, but the tubes going in and out of his

    body betrayed him. As he talked, I glanced down to the leads on his

    chest and saw that his once powerful body was now frail and hollow.

    This man, who relied on his youth and physical strength to earn a

    living, was working 12-hour days as a contractor only months ago.

    Now, he could only reminisce about playing a pickup game with his

    friends on the weekend. He was always good at basketball, kind of a

    star in high school, but that was before it got so hard to breathe.

    Aside from a back injury last year, which he treated at home, he

    never got sick. So of course, he had not seen a doctor in years. Doctors

    were for people who needed looking after, like his girlfriend. She was

    living with him in Georgia 8 months earlier, when she found out that

    she was carrying his child. He knew right then, he would have to work

    even harder, since he had three people to care for now. His girlfriend

    needed expensive prenatal vitamins and regular visits at the clinic to

  • 5OBLITERANTS

    monitor her high-risk pregnancy. When the poor

    economy found him out of work, he had to find

    a job immediately; never mind that hed started

    feeling sick. He came back to Florida to cut costs,

    living with his mother while he worked and sent

    money to his girlfriend. His worsening stomach

    problems didnt let him enjoy the food hed missed

    for so long, and his clothes were fitting a little

    looser. But still, he managed to keep working, to

    be strong for his girlfriend, who needed him to

    provide for her care. How then, as she was set to

    deliver any day, did he wind up as the patient?

    Admitted to the hospital, on the telemetry

    floor, surrounded by people two and three times

    his age, his girlfriend had to fly in from Geor-

    gia just to sit by his bedside. At a time when he

    should be waiting for her water to break, there

    they were, facing concerns that his liver might be

    congested, and that soon he might be waiting on

    a heart transplant. I heard the diagnosis from his

    own lips. I had studied the pathophysiology, and

    I understood the mechanism by which this could

    happen to someone so young and alive , and so

    quickly. Yet as I stood there, the dissonance of the

    scene before me resonated more loudly than all of

    the monitors and alarms and noise of the hospi-

    tal. It wasnt the way in which his illness took over

    his life without warning, the existential unfairness

    of it all, or that he was fighting for his life as his

    sons life was about to start. It wasnt even the

    PREP AND DRAPE. EKATERINA KOSTIOUKHINA, OIL ON CANVAS

    AT THE BEDSIDE

  • 6 OBLITERANTS

    fact that he was only a few months older than my-

    self, that it could be any of my classmates lying in

    that bed, struggling with a disease that was now a

    teaching case for us. No instead, I was struck

    by how much strength he really had. What he

    lacked in physical firmity, he made up for in mind

    and will power. Even as he lay there, explaining

    what led to the eventual diagnosis of his dilated

    cardiomyopathy, his words carried a vibrancy and

    determination. He was articulate and intelligent,

    describing the tests and findings in a manner that

    would befit an entering medical student. He talked

    about how much he loved science, and that learn-

    ing about his disease has made him think about

    going back to school to work in a job related to

    science once he recovers. Laughing with him, and

    hearing him talk excitedly about the future and

    his plans, it was hard to reconcile that this same

    young man was supposed to be ill seriously ill.

    It made me question how I would react to similar

    circumstances, how my classmates would respond

    to such a life-altering diagnosis that could destroy

    the fabric of your life before you even knew what

    it was that was making you sick.

    We are taught that resiliency aids the heal-

    ing process, but the man before me was a true

    example of forward-looking against all odds. He

    maintained his positive outlook despite being out

    of work and living at home, with a pregnant girl-

    friend in another state, all while having his body

    ravaged by a sudden and severe stomach prob-

    lem that would later be revealed as anything but.

    As we study to enter the profession of medicine,

    we are often prone to thinking about how difficult

    our present circumstances seem. It can be easy to

    respond to life stressors in unconstructive ways,

    by acting out, pushing others away, or being over-

    whelmed to the point of giving up. Nevertheless,

    we owe it to ourselves, moreover to our patients,

    not to give up. Most of the patients we see will be

    facing far greater challenges than anything we are

    currently experiencing. Taking a moment to reflect

    helps bring this into perspective. It is not enough to

    just get by, no patient is just another patient,

    and no amount of stress justifies an attitude that

    makes you difficult to work with. Patients like the

    27 year old expectant father, remind us that we

    must take care to prevent burn out, and combat

    fatigue, because we have a duty to do our best for

    our patients and ourselves.

    Although I cannot say whether I would be

    able to keep such an optimistic disposition in the

    As we study to enter the profession of medicine, we are often prone to thinking about how difficult our present circumstances seem. It can be easy to respond to life stressors in unconstructive ways, by acting out, pushing others away, or being over-whelmed to the point of giving up. Nevertheless, we owe it to ourselves, moreover to our patients, not to give up.

    AT THE BEDSIDE

  • 7OBLITERANTS

    face of circumstances as difficult as his, I know

    that I will think back on the 27-year-old man I met

    that day, and how he chose to combat his chal-

    lenges. I will think about the man whose inner

    strength grew steadily as his physical strength di-

    minished; choosing to engage all those around

    him and participate in his health, instead of mere-

    ly accepting his illness. I hope that as I face chal-

    lenges of my own, as a student and a physician, I

    will remember his limitless resolve and find with-

    in myself the ability to stay positive and perse-

    vere. Our patients can teach us so much more than

    the process of disease. That day on the telemetry

    floor, from a man not much older than I, I learned

    that attitude really is everything. O

    AS SHE WALKS INTO THE OFFICE, YOU SET THE MOOD WITH VANILLA CANDLES TO TEST HER OLFACTORY NERVE. You look deeply into her eyes, and her visual fields are full, of you (optic nerve). Wide-

    eyed (no ptosis) her eyes lock to yours without straying

    (oculomotor). As she looks around the room, you assess

    her oculomotor, trochlear, and abducens nerves. You gently

    touch her face (trigeminal sensory), and she clenches her

    teeth at the unexpected touch (trigeminal motor). She may

    smile, frown, or wrinkle her forehead, but if her face remains

    expressionless, it might not be you. It might just be that her

    facial nerve is lesioned. You whisper in each ear, to test her

    vestibulocochlear nerve. Dizziness or loss of balance would

    suggest a lesion here. Or she may just gag, but then at least

    youd know that her glossopharyngeal nerve was intact. You

    ask to check for symmetrical elevation of her palate. If she

    whispers hoarsely that you make her stomach churn, she may

    have a vagus nerve lesion. Fed up with this exam, she shrugs

    her shoulders and turns her head towards the door (spinal

    accessory nerve). As she leaves, she turns back toward you

    and sticks out her tongue. It is midline. Her hypoglossal

    nerve is intact.

    CREEPY CRANIAL NERVE EXAMBY CAITLIN HODGE

    AT THE BEDSIDE

  • 8 OBLITERANTS

    ABDOMINAL EXAMBY ANTHONY PARK DANDREA

    YESTERDAY WE WERE TAUGHT THE ABDOMINAL EXAM (THIS IS ONE OF THE FIRST PARTS OF THE PHYSICAL EXAM THAT FIRST YEAR MEDICAL STUDENTS WILL LEARN). I have seen this exam performed many times in the past as I have spent the year

    before medical school doing research in colorectal

    surgery. This training session was different,

    however, because it was the first time it was

    performed on me.

    For training, our class of 52 students was

    divided into groups of four (two male and two fe-

    male students). We played paper, rock, scissors

    to decide who would serve as the patient for ev-

    eryone else. Three papers defeated my rock, and

    therefore I was the one reluctantly lying on the

    table with abdomen exposed. My shirt was lifted

    up from xiphoid process to pubic symphysis. May-

    be not everyone would feel as awkward as I did at

    that moment, but I am not used to my belly being

    UMMSM MD/MPH CLASS OF 2015.

    AT THE BEDSIDE

  • 9OBLITERANTS

    poked, prodded, and talked about (and stared at).

    The intensity of the overhead lights forced me to

    shut my eyes. I could barely see by squinting. To

    help relax my abdomen, I was asked to bend my

    knees with the plantar surfaces of my feet facing

    down on the table. Our trainer started by talking

    through the four parts of the abdominal exam: in-

    spection, auscultation, percussion, and palpation.

    I waited there listening with my eyes never being

    able to adjust to the light.

    On inspection, my peers looked for pulsa-

    tions and asymmetries. They immediately noted

    that I was very skinny with no abnormal hair

    growth. I also had a visible abdominal pulse.

    The words abdominal pulse for some reason

    grabbed the attention of nearby groups, and they

    rushed to our exam room to see. My audience tri-

    pled (or quadrupled) in size, and the chatter added

    to my discomfort from the blinding light. I lay on

    the table patiently and waited for the next part of

    the exam.

    The commotion died down, and the other

    groups left. My peers continued with the train-

    ing exercise. They now had to auscultate the four

    quadrants of my abdomen. I felt the diaphragm of

    a stethoscope being placed onto my right upper

    quadrant and then my left. My body had no choi...