2022-2023
| ISSUE no 5
Identity
Cover art by: Alexandra Elias, MS2 "Face and Overcome"
The profession of medicine changes you. What parts of ourselves welcome this change, and what are those pieces of ourselves we should hold on to at all cost? The Human Ties Editorial Board hoped to encourage a moment of self-reflection to serve as a means of grounding ourselves as we each continue forward along our own uniquely complex yet interwoven paths in healthcare. So emerged our theme for this issue of the Human Ties Digest - “Identity”. These pages are a testament to how boldly and brilliantly the spectrum of identities at our institution shines. Whether our generous contributors are recounting Bollywood movie nights, Ramadan dinners, or lyrics to a Nigerian song, one thing remains certain: the power of identity is both an uplifting force and an unwavering light, to understand ourselves and our histories more deeply, while doing the same for those around us.
"To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment" Ralph Waldo Emerson
Patricia Marie Guzman MS2 Co-editor Nidha Sha MS2 Co-editor Megan Jiao MS3 Editorial Board Angela Gomez Copy Editor Anson Koshy Faculty Editor
identity
Moment
by Julia Hiner, MD Dept. of Geriatric and Palliative Medicine
I am the moment they placed my daughters in my arms and I instantly became their mother. My timeline started and stopped in those moments, with part of who I was disappearing, and a whole new part continuing on. I had a life before them, sure, but what of it anyway? I am the moment I wore a long white coat for the first time. I'd carried the title "doctor" for a month already, but it was official. I was really a doctor, finally, but I didn't become a physician right then - that would take time. I am the moment that the silence got a little too silent, and I could hear the doctor's breathing, see his eyes darting around the ultrasound screen, willing a heartbeat to be found again. In the silence, I could hear my own heartbeat, rising up, faster, knowing what was happening before he said anything. The nurse’s eyes were full of tears I couldn't cry. I am the moment I didn't get into medical school and had to apply again. That sinking feeling when the screen said I didn't get in a second time, but also when I went back to my computer and saw that there was an error in uploading match results. I was going to medical school after all. I am the moment that I scored a 90 on the first-day-of-pre-calculus quiz, thinking I was pretty happy with that "A", right until the guy near me scored a 100. The new kid. Who again? That guy that I found the courage to approach while waiting for the bus, changing the course of my entire existence, and somehow resulting in a very dinosaur-themed life. I am the moment my mother called me, but she was really confused and didn't seem to understand how to hang up the phone. She just kept saying "Bye" over and over and over again, until I hung up out of fear. I didn't know she was saying "Bye" forever. I am the moment that my mother was late coming down to Christmas, and I heard her call for my dad to come upstairs. Now. She sounded... not like my mom, but I didn't know why. But once I knew, it was all I could know forever. I am the moment that I entered that weird, bright, cold room, and didn't cry. I scared them I am sure, but I was here: 3:10 PM, a Friday. I like to imagine that my mother had a life before me, but what of it anyway. I come from my stories, my memories, my history. I am created and shaped by them, torn down and destroyed by them, and built back up by them. As my own life weaves its way around, it envelopes some along the way and discharges others from its fabric. I am from so many moments, different ones any given day, never quite the same Julia again. No, not really.
by Catherine Bryant, MS2
Royalty is a birthright, privilege running through my genes. It’s through this luck, my destiny, that God gave me my queen. “Chin up, dear! Shoulders back now!” I entered in as she had trained, and carried fresh hydrangeas to the palace where she reigned. Today my queen was white as snow, defeated by the toll. Her face revealed her story, wisdom tucked into each fold. She handed me a cup of tea that teetered on the tray. Shaky remains of bony hands that once taught me to pray. But the queen chose grace and courage with our kingdom upside down. She traded her cloak for a cotton robe, a silk scarf for her crown. Her body was the traitor, leaving me with none to blame. It hurts to see your hero hurt. I questioned why I came. The castle gate shut, and I shed tear over all I’d seen. It burned my cheek as I whispered to above, “God, save my queen”.
God Save my Queen
The Nigerian Factor
. “One day, one day! One day e go better”, as early as I can remember, I remember repeating the lyrics to the popular song by eLDee, the Nigerian music legend. This is a song of hope. The song says that one day, it will all be better. One day, Nigeria will be better. This is the Nigeria that many people are aware of around the world. The one that is riddled with instability, corruption, and many vices that one would attribute to a “third-world country”. In fact, it is common to hear Nigerians speak about the “Nigerian Factor”, a term used to describe the intrinsic nature of Nigeria to destroy something that otherwise would be good. As Nigerian artist Eedris Abdulkareem said, “Nigeria jaga jaga”, meaning Nigeria is in chaos. In a more literal translation, Nigeria is scattered. But this is not all Nigeria is to me. I grew up in the bustling city that is Abuja. Like every major city, it was alive, loud, and busy. It never slept. My fondest memories involved sitting in the passenger seat as my mom drove my siblings and me to school. One was often ushered into the day with the horns from buses, streets piled with cars, and hawkers running from car to car looking for customers. Sometimes after school, my siblings and I would walk back with my uncle. The air in the evening as we walked was often a mixture of the smell of suya from the Mallam’s shed, the smell of overripe oranges on the floor, and the smell of the gutters. This unique smell was home. I traded all of that for the gentler Texas air. For the majority of my adult life, I have lived in America, and in more ways than I would ever accept publicly, this has adulterated my Nigerianess. My accent has always been a topic of discussion, but it is interesting how this has evolved over time. When I speak to Nigerian patients, it surprises me when they cannot tell that I am Nigerian but still to Americans, I have an accent. This is one of the many ways that my newfound identity, being Nigerian-American, has stood out to me. I have found that I am neither completely Nigerian nor completely American. I am somewhat of an outsider to both worlds. Initially, this made me quite sad. As the popular Nigerian musician (often mistaken to be Ghanaian) Mr Eazi said, “I am constantly searching for home”. This, however, is not necessarily a bad thing. As Mr. Eazi explains in his TEDTalk, this search is a search for progression. I am making a new home and bringing the old along. I find the courage to continue to persevere in my nomadic ways through the Nigerian Factor. For me, the Nigerian Factor has come to be the spirit of my people. The laughter despite the suffering. The zeal to find home, knowing that one day e go better.
Homecoming
by Naahanna Akahara, MS3
by Courtney Huynh, MS1
I forgot how much it rains in Houston. I forgot there are street signs in Vietnamese, and that the tops of skyscrapers are lit orange and blue as the Astros go deep into October. After four years away at college, my return to Houston for medical school has been somewhat of an awakening. As I relearn how to navigate living in my hometown while also learning how to make it through medical school, I am distinctly aware of how much my identity is in flux. Though parts remain, I am not the person I was when I left for college, nor am I the person I was when I left college for Houston. As I adjust to my new existence, I’m acutely aware of how much I grew while away, and how much I’ve grown since returning. Four years without the constant crutch of my family gave me the confidence to speak up for myself and navigate the world more independently. A few months into school and I am shocked I’ve made it this far, that somehow I’ve managed to find a community and a way to catch at least some of the firehose of information I’ve been inundated with. But returning to Houston, I’m also reminded of parts of me I’ve lost. I left behind pieces of me in college in the organizations and places and people I loved. I’ve also realized pieces of me were lost when I first left Houston. It had been so long since I’d been to a restaurant without English on the menu, since I last heard an unfamiliar language at a store. Being home, once again surrounded by family, I’ve begun reconnecting with my heritage. I can now go home on weekends to make Banh Baos with my family while listening to my grandpa recount the Fall of Saigon. I now know there are pieces of me I would like to rekindle. Beyond reminders of these pieces that could do with an extra spark, being in school, in the TMC, I am surrounded by glimmers of who I may one day be, reminders of how much I still have to learn. I still stumble through my interactions with Standardized Patients, I am not yet able to give directions without Google Maps whenever I am stopped to ask where this clinic or that office is. I am once again the new kid, marveling at those ahead, hoping I might one day shine as brightly as they do. Returning to Houston, starting medical school, I’m not sure who I am or what my identity is. I’m not only the girl holding up her old baby shoes, marveling at how much she’s grown, but also the girl stumbling upon a forgotten favorite pair of boots, hoping she might still fit into them, and the girl playing dress-up in her mom’s closet, standing in front of a mirror in too-big heels, wondering at how much she has yet to grow, and who she will one day be.
There is always something that will set us apart
by Shailee Modi, MS1
Exactly a year ago, I was living in a small Czech town a few hours outside of Prague. I was fresh out of college, eager to see the world and teach English under the banner of the Fulbright program before medical school. I was the first American to teach in this town, and my golden brown skin and rich black hair confounded quite a few people expecting a more stereotypical appearance. For that year, I was the authority when it came to all questions regarding American culture and identity. I could confidently discuss the origin of regional accents or the Electoral College system, but I constantly grappled with the best way to express the nuances of my own identity. I am the first in my immediate and extended family to be born in America. I had the unique experience of living in a suburb of Houston that celebrated the diversity of its residents. While I did embrace country music, Christmas, and American football, I also grew up celebrating Diwali, attending Sunday school, and learning classical Indian dance. It was important to my parents, and later became important to me, that I remember my roots and embrace this part of my identity. As a first-year medical student, I have been reflecting on the impact of identity in the healthcare setting, and one particular experience from this semester stood out. I went home for the weekend and decided to shadow a local orthopedic surgeon in his outpatient clinic. I was impressed by the surgeon’s calm demeanor, his ability to explain complicated conditions in layman’s terms, and how easily he was able to connect with patients. During a patient encounter, we listened to an older Indian woman describe the problems she had been having, as her husband patiently sat next to her and chimed in when appropriate. As we walked out, the couple turned to me and gently asked if I was a medical student. Unaccustomed to being addressed, I replied with a sheepish smile that I was a first-year student at McGovern. They smiled and wished me luck in my medical journey. It was a small moment that I did not fixate on in the moment, but later, sitting at the dinner table with my parents, I could not help but feel a warm surge of pride. Three generations of Indians sat in that examination room: patient, doctor, and medical student, all with different experiences but bound by a shared identity. Representation matters. It matters to see yourself reflected in the people who provide you with care, to see yourself reflected in the people who mentor you. I am still learning and growing, but for now I can say, my identity is rooted in community. It can be traced back to Bollywood movie nights and Navaratri weekends, but I discover it anew every day in the soft smiles of the older Indian couple, in the mentorship of an Indian-American surgeon, and in the ever-present pride in my parents’ eyes.
Identity in Community
There is always something that will set us apart, Your worries, your pain, your tears, My clinical judgement, the long list of unanswered emails. They say that empathy is not when you put yourself in someone else’s shoes, but when you listen to the story, you sit with it and make it your pain. I am sitting with your pain, and I remind myself not to open my mouth to ruin the silence. My mouth wants to show you that my mind knows better, what my mouth doesn’t know is that my mind is also trying to escape. That long list of unanswered emails keeps me safe from not thinking that your life is coming to an end, That you need to say goodbye to your wife, That you were brave enough to say “Let’s go home”. I am sitting with your pain but I still feel less. Your courage, lucidity and charm, My worries, my pain, my tears. I come home to my daughter and let her hold my hand while she drifts into deep sleep. There is always something that will set us apart, My long list of unanswered emails, my worries, my pain. Your love, Your presence, Your ability to sit with my pain.
by Dana Giza, MD Dept. of Geriatric and Palliative Medicine
Photo by: Rene Girard, Graduate Research Assistant GSBS, "Road Through Texas"
by Sarah Shin Research Assistant GSBS
When I was five, I was a horse. But no amount of galloping, neighing Gave me hooves or a mane. When I was ten, I was a tomboy. But no number of Power Rangers let me forget that Girlhood felt weak. When I was thirteen, I was a Korean-American. But I knew neither Wonder Girls nor One Direction enough to confidently claim either citizenship. When I was twenty-two, I was a medical student. At last, something I discovered and earned for myself, a webbed journey of wandering reflections, visceral self-interrogation, a culmination of my Passion, Mission, Hope. But as rich and nuanced as medicine is, It became the first factoid people learned, second only to my name. It anchored everything else that followed— Authentic connection stifled by shoddy cliche's from Grey-Sloan Memorial. When did my training replace my growth? Now I am twenty-five, and I wonder If my identity can be adjectives rather than nouns. Instead of a scientist, curious. Instead of an American, free. Instead of a woman, strong.
by James Burden, MS4
In medical terminology, a word often thrown around, especially on discharge summaries, is “baseline.” A baseline represents a standard or starting point used for comparisons, and it is often used in medicine to determine treatment or disease progression and prognosis. In psychiatry, the term seems to carry more weight, attempting to capture the very essence of who the patient is and how they see the world. Psychosis, with its bizarre, illogical behaviors and hallucinations, is an obvious deviation from baseline. It is a force to be reckoned with if the baseline is ever to be restored. Wrestling with a first episode of psychosis is a psychological gauntlet with high stakes for adolescents, whose critical period of self-discovery and identity formation is interrupted by hallucinations, delusions, and disorganized thoughts and behaviors. For our patient’s family, it was as if a whole different person had moved into the body of their child. “We are just trying to get them back to us,” their mom said over the phone. Behind her audible desperation, I could still hear the unflinching determination of a mother’s hope for her child. She believed in her child, believed in medicine, and believed in us. It was empowering. In combination with medication, this belief proved effective as their functions, mannerisms, logic, and personality gradually returned. The return to baseline completed its course when I saw the light come back to their eyes on the eve of their discharge. Eyes are often said to be windows into the soul, and this was like seeing the power come back on after a blackout. As their identity and personality was restored, they were discharged home to their family. The illogical behaviors, hallucinations, and paranoia they initially presented with were now in stark contrast to the hope I felt for their future. But my first adult patient seemed to contradict this newfound hope. I remember him vividly. He was a middle-aged man enduring a chronic, unrelenting bout with schizophrenia, which prevented him from sustaining any form of relationship, employment, or housing. The only clear and consistent part of his history was the cycling pattern of psychoses and subsequent twenty-plus psychiatric admissions. The hospital provided him with safety, resources, and temporary respite from the symptoms plaguing his psyche, but his symptoms never fully resolved. As we prepared his discharge, I was shocked to learn our patient was “consistent with baseline” despite his persisting psychotic symptoms. Years of unyielding psychoses had shifted his baseline beyond apparent recovery. As medical trainees, our baselines have changed and will continue changing as we progress from premed, to preclinicals, to clinical rotations, to residency, and beyond. Our identities and perspectives of the world and the populations we serve will change too. As we peer into the murky uncertainty of clinical medicine, it will be easy to reminisce on the wonderfully naive hope we held on to in the beginning. But it’s okay to cling to that hope, to maintain some naivety at our baseline. A baseline does not solely show how things have changed; it can also show how things ought to be.
Consistent with Baseline
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Adjectives
by Asia McCleary-Gaddy, PhD Office of Diversity, Equity, and Inclusion Dept. of Psychiatry and Behavioral Sciences
The story of my name is a girl born in conflict. May Ali Al Ameri. Ali, the man who carved in stone to give his little girl a chance at a normal life away from bombs and a world muddled in grey and red. Al, meaning The; an incorporation of how important family keepsake is where I come from. means you’re never standing alone, you’ll always have a home, feels the sun shine brighter on me in a different part of the world, tastes like oranges sweeter than any organic fruit Trader Joe’s can carry; sounds like the wind chimes my grandfather put up in their house in the 90s and my grandmother’s morning radio playing Fairouz throughout the house. Ameri has the bittersweet taste of assimilation, of Ramadan dinners sitting only at a table of 4, of yearning for the noise and chaos of family and cousins playing outside. Ameri feels like the scratchy white coat that has a shortened name made more digestible for others, Ameri sounds like my mother tongue sounding unnatural out loud. Ameri has the sound of what I’ve built on my own; of the girl born in conflict who learned to carve her own way. May, oh I always seem to forget about that one; May—the one I have yet to figure out.
I am a tall Black girl. But lately, as I navigate the professional world filled with politics and expectations, the identity that becomes most salient is my identity as a millennial. In this intergenerational workforce, my ideals as a millennial seem to emerge at the forefront of my mind when talking about policy and professionalism. Yes, I am that millennial who truly believes in work-life balance. I understand that thin line between being passionate for your job and overworking for your job. I value my quality of life and understand that working is what I do to sustain my life. But my life is the priority. Right? As a millennial, I can be seen as juvenile in the eyes of others and as a result, I somehow have the extra energy, the extra time, and the eagerness to jump onto every opportunity available. But my time… how precious it is. In the words of Maxine Waters, “I am reclaiming my time!" Where is the boundary to say NO? Is there an assumption that some can attend the after-hour work event but others cannot because [insert child’s extracurricular activity here]? My internal dialogue of wanting to climb the proverbial ladder of success but also understanding that ladder comes with more responsibilities, time commitments, frustrations, and politics, that may not align with my priorities or values. I am floating. Trying to find the right vibration where I make myself proud by honoring my LIFE, my time, but also being prominent in my work. It bothers me that I spend the majority of my LIFE at work. (Yes, get your calculator! 24 hours in a day - 8 hours at your job – 1 hour getting ready for that job – 1 hour getting to that job – 1 hour driving home from that job – 2 hours to cook, eat and meal prep that lunch to bring to that job (because eating out gets pricey and you can only budget but so much of your salary from that job) - 8 hours for sleep - to get ready to go to that job the next day (because that's what the Doctor says) = 21 hours per day…5 days a week!) And people have the nerve to ask, "Why don’t you have a hobby?" I yearn to spend my time in a space where others know the vibrant multi-layered human that I worked so hard to become. Know my family, my prayers, my dreams… can you only attest to how I work… minimalizing my existence, my essence, my identity to “how good she can labor”. My ancestors are rolling their eyes at me! My identity? An identity of conflict: to be the authentic millennial comprised of multi-dimensional layers of thoughts and behaviors versus this workforce-engineered robot that is plugged into this Matrix we call life. *Sighs* …. onto the next Zoom call.
In A name
A millenNial's stream of conSciousness...
by May Ameri, MS3
Photo by: Ananya Iyyangar ""Inner Child"
by Gabriel del Carmen, MS3
Thank you to our artist submissions: Ananya Iyyangar Rene Girard and our cover artist Alexandra Elias
ipsum
To choose the self
Identity, though persistent, is dynamic. It is being which emerges from the process of doing. Through my clinical and professional development, I find myself reflecting upon the importance of my experiences and my responses to them. My choices. Clinical rotations have, most eminently, revealed to me the depth and breadth of the human capacity for suffering. The most salient challenge has been to not lose myself in these depths, to not internalize their persistence as failure, to not become passive in the face of impotence. Each patient - including those wading the thick swamp of delirium and blinded by the fog of confusion - is a universe within themselves. Their experience is an immediacy which commands our awareness. Their anguish echoes, reverberates, manifests itself in their physicality. We witness many of the most vulnerable events in the lives of these patients and their families. The child, an unrestrained passenger, who was ejected from her family’s car. She receives intensive care in the emergency department. Her family waits outside, pacing, speaking loudly on the phone, their faces manifesting concern. Her path to recovery is obfuscated by uncertainty, by the unknowables. They must wait longer. The son, whose father will die to suicide, mourning the imminency of his loss by the bedside, the sounds of sorrow muffled by his desire to maintain composure in an open setting. His eyes, reddened, give him away. The elderly woman, cachectic and confused, who has had steadfast progression of her dementia. The memories of the life she constructed have atrophied with the cortical matter that housed them. Her daughter must remind her that her siblings have not been alive for many years. The hospital continues to run. We round on other patients, or prepare other rooms in the emergency department, or resume those activities as required by our respective roles. How might we appreciate the extent of suffering - such that it moves us to act with informed empathy - without drowning ourselves in its immediacy? Must we always compromise sensitivity for competency? And give way to compassion for self-preservation? I am told that it becomes easier, that the prolonged and continued exposure to trauma and sorrow and loss and grief will lead to my desensitization to those experiences. These experiences will become normalized, they say, because they must be. For how would I function otherwise? Is the only response to the intractable nature of suffering to practice patient care at a distance? How I choose is who I will become. Identity, though persistent, is dynamic. I choose not singularly, not today, not in the solitude of my composition of this piece. I choose actively, daily - on each rotation, with each patient, with their families. Through each of my words and each of my actions, however limited by scope at a given point in my development, I choose. And, from there, I become.
The Human Ties digest welcomes UTH faculty, students, staff and all employees to submit creative works for consideration in our next edition. Email submissions to: humantiesdigest@uth.tmc.edu
Welcome to our post-doctoral fellow Margarita Ortiz
@mcgovern_center @McGovernCenter www.med.uth.edu/mcgovern
Email your submissions for consideration in the in next edition of Human Ties to: humantiesdigest@uth.tmc.edu
