Winter 2021 Digest Special Edition : Hope Amidst Uncertainty Spe
Cover art by Michael Talanker McGovern Medical School, MS2
Editorial Board Student Co-editors: Kaya Rymarz Megan Jiao Faculty Editor: Anson Koshy
How does hope survive when uncertainty is all around? The editorial board for the Human Ties Digest posed this very question to our McGovern community in 2021. Carefully housed within the submissions we received, we found frustration, anxiety, burnout, sadness, and a range of challenging emotions. Emotions all too familiar for each of us over the last two years. Yet woven throughout the reflections, art, and experiences in the pages that follow, hope is found. Sometimes hope is gregarious and bold, while at other moments hope may appear as the faintest light - a light you may miss if you are not willing to search for it.
Hope amidst Uncertainty
By Gabriel del Carmen
Hope has felt elusive.
That is, of course, to put it mildly. With the emergence of a more contagious variant and the concomitant plateau in vaccinations with a rise in case numbers, Hope may naturally seem a fool’s commodity, available only to those who do not pay proper mind to the externals around us. More precisely, and certainly more charitably, as despair abounds, Hope has felt like a scarce commodity, perhaps even an invisible one. As I have looked around, no matter with what degree of intention, Hope has often refused to show itself to me. And, although many days this may appear less obvious to me, I have learned that the nature of Hope is different than I had once understood it. Hope amidst uncertainty is balanced footing on uneven ground. It propels us onto the path forward when tomorrow refuses to guarantee its arrival. Hope is the apprehension of a lack, an understanding of what could be but is not the case, and the sustained refusal to believe that the way things are must inform the way things ought to be. But, perhaps most crucially, Hope is created. It is not found, it does not exist independently, it does not bear a necessary existence. It is generated. We generate it. Through our engagement with the world around us, through our compassion towards one another, through the forever growing and earnest but incompletely actualized desire to understand and empathize and love - from all of this, Hope. We cannot find Hope because we must create it, and we must do so continuously. If we can appreciate its absence, it is only because we have not established its presence. But how? How might we generate Hope when we are faced with a nearly infinite list of unknowables? At the time of this writing, we are a year and a half into a pandemic that will likely end not with a bang but with a whimper. Normal shall, slowly yet surely, return. Yet uncertainty prospers, as it always does. We hold no epistemic connection to the future, and our approximations of the future are simply that -- approximations. As we continue to be faced with uncertainty - one which seems immortal and unbothered by our anxieties - on what basis do we continue forward? We may subsist on Hope. We may recognize (and continue to remind ourselves) that uncertainty is a permanent fixture of our consciousness, a requisite component of that emergent driver of our beings that allows us to attend to and plan for possibilities. We may further act with compassion towards one another, and offer respect towards all others. To do so is to remind those around us that better is possible, that all is not lost, that this moment is not without end. We may accept what we cannot change - this nature of uncertainty - and instill within ourselves the courage to create the things we can - Hope. Through Hope. In the absence of all else, we move forward with Hope.
McGovern Medical School, MS2
Hope in the time of covid
By Olga Chumakova
Integrative Biology and Pharmacology
Sunrise oil painting
Miracle of hope
I prayed for the world to be kinder, gentler. To raise people out of poverty. For wars to stop. For the hungry to be fed. For the sick to heal. I had an uncle, sick with diabetes. He went on dialysis. I clapped my hands together and asked that God would heal him, that he would recover and live to old age. He died a year later. For a long time I stopped praying. Death is certain, everything up to that point is uncertain. We tell ourselves tales about how things “should be," a confusing concoction of statistics, stories, assurances, and moralism. But “should be” is never more than an idea until it’s past, which then becomes the certainty of “has been”. This past year is filled with the graves of things that we thought “should have been” but never came. Graduations missed, first days of school unattended, anniversaries uncelebrated. Instead we had Zoom meetings alone in small rooms, ventilators and packed emergency rooms and, worst of all, loved ones gone forever. We know now that those things were certain because they happened even if they were different from what should have been. As we awkwardly greet those we hadn’t seen for a year we stand uncertain and yet hopeful. So what is hope? Hope is only in uncertainty. Hope is moving to and from, filling our time with the aspiration that, even through the rough times, that life must mean more. But hope is a double-edged sword. Too little and we fall into despair; too much and we become foolish. It is an elixir of necessary proportion. We are or will be doctors. It's easy to forget in a life filled with such awesome power over so many just how much of an impact we will have. We’ve filled our heads with our own language, uniforms, culture, privilege, and mystique. It's easy in all the ornate ceremony to forget what we mean to others and what we don’t. For so many we are the embodiment of hope. That life can be a little bit better, a little bit longer. Not by virtue of our birth or who we are, but through the work we put forth. With diligence, humility, and the collective knowledge we’ve pooled we were faced with the greatest public health crisis in a century; we now have a vaccine. We challenge limits, make miracles happen, and the once impossible, possible. In that space where once the certainty of death loomed, now hope replaces it because we made it so. I started praying again, but my prayers have changed. I have yet one prayer: that God gives me the strength to do the things that are necessary to change the world. One day soon I’ll be a doctor, and maybe if I listen close enough, I’ll be the answer to someone else’s prayer asking for a way forward they currently can’t see.
As a kid I used to pray.
By Christopher Busby
McGovern Medical School, MS3
UNTITLED
By Damian Crop
multimedia on canvas By Joshua Dorris Project Manager, Pediatrics
A human had a health problem, atop bigger health problems. Some other humans decided to solve it, right now. With no planning. That’s how you dominate obstacles – with expediency. I, a human, entertained this other human, as other humans acted upon this human to solve him, I mean his problem. This human told me about his career, what he’d been up to for 60 of 80+ years. Like, he told me what he spent his life doing. His life. He has a life. He does have a life. And he’s still alive. He’s actually here with me. Wait, why is he here with me? Oh yeah, I, a human, help with health problems. I get to help with his. Oh, I AM helping with his. Oh no wait, I’m done helping, we’re done. Humans shuffle out of this other human’s room. I stay. I want to linger with Mr. P, and do everything I can to ensure he gets back to his life.
By Marisa McDow
Associate Professor, Family and Community Medicine
Now I can Fly
No matter how bad the day, the sun still rises photograph
“Now I can fly!”, said my 8-year-old son; my 6-year-old daughter echoed the same with a question mark, “So, we can fly now?” I looked at the sparkles in their eyes making smileys bigger than a million colorful balloons flying away under a blue sky painting a happy face. They are becoming smaller and smaller. The tiny dots lining up to make a rainbow of balloons now. There is no horizon line. It is an ever-growing happy slide of rainbow! There is no end to this happiness. It was almost like a stone was removed off their chest of feelings. They are free. Amazing what the COVID vaccine can do to a child after being through a pandemic for 2 years.
By Nahid Rianon
Sometimes I feel like I’m shouting in a vacuum. I keep saying the same things, but no one is listening. It’s absolutely maddening. Why did I go to school for all these years, to be ignored, rebuked, and challenged by people who have no educational basis to stand on to challenge the medicine, the science, the facts, on which I stand. On which we stand, as medical professionals. But thank God there is a “we”. My vacuum is situated directly next to another vacuum. And another. And another. Creating an almost sort of echo chamber where I mercifully hear my own words, my own thoughts, the same science and medicine and rationality echoed back to me. That echo is a solace and a sanity. My colleagues. They are what give me strength in this sea of rising and falling idiocy, perpetuated by our “leaders”. Knowing that I’m not the only sane (or maybe insane) person out there, watching these chips fall exactly as expected, precisely as modeled, aggravatingly right. Just perfectly predictable. Math. Science. Graphs. I hate being right. I told a non-medical friend that the other day, when she confided in me things were in fact quite bad, much like I had told her they would be, just a few weeks, or maybe it was a few lifetimes, ago. The worst part of my job is being right. When I’m right, you have dementia. Or cancer. Or are dying. Being right isn’t a pleasure; in fact, it’s kind of the opposite. This grim appreciation that woohoo… I’ve come to the right answer again, I must have actually learned something in all those years of study, but simultaneously knowing that my accuracy is your worst day. You’re welcome? But again, knowing I’m not alone helps so much. Just a work friend nodding along, “Yes, yes! Me too!” brings so much relief from the weight of knowing things I don’t want to know. A shared frustration of shared experience builds comradery and friendship. And a weird and special cobbled together little family.
Echo
By Julia Hiner
Assistant Professor, Geriatric and Palliative Medicine
By Renee Flores
Collection of poems
By Austin Armstrong
AIDS & amor in south texas
Internal Medicine Resident
Braslav Lake in Belarus oil painting
My long white coat symbolizes more Today, than yesterday. The facade of a real doctor, The front- Providing good healthcare Actually run by CEOs, CMOs, UFOs, Case managers and insurance companies. This face of independence Not as individualistic as I thought Evolving with restrictions of the system - Oppression of a physician.
Associate Professor, Internal Medicine
A Physician Boss
Hospitalized, blind, and deaf from a sunken CD4. He met his partner twenty-five years before, at the quaint restaurant, where they worked and served tortillas not as good as home. Altered by infection not noticing us at bedside. His husband craned, down to kiss his cheek. A voice leaked out "I miss you querido."
McGovern Medical School, MS4
Haikus are tacky But a self-aware haiku Now that is clever
By Evan Shegog
Who is your soul? Is it an old man by the sea, A classic solitary figure peeled from the pages of Dickinson One who tastes the salty breeze of his youth And played a simple safe game of life with the cards he was dealt Destined to grow young then fragile on the same streets his whole life, Content to know nothing more Or is your soul, a young child Peddling up that foreboding hill, The one the kids who sit two rows behind you call Impossible Are you the one who coasted to a stop at the apex of the incline? Ready to scorch down at a blistering pace Hoping the traffic is more aware than you, Or are you simply you, Your soul ready to be forgotten in the memoirs of others’ lives Not the most beautiful life, but not the most dull either Plainly a perfect one The one you created all for yourself.
hope hides in poetry
Where does the wind go, Gently jutted by the tops of trees, Careening sharply off peaceful hills. Does it skid off into ocean vistas, Swirling with the expired leaves. Or does it end with you, Inhaling its essence before taking in mine
By Morgan Lynch
ICU
whistles of vitality echoing and light merciless reality wounded made to fight same blue gown as yesterday different vital signs complicated interplay levels, lights and lines disconnected dialect falls on desperate ears unimpressive intellect fuels encroaching fears hopeful hand holds, begging eyes quivering balloons at the threat of last goodbyes louder get well soons
mE AND hER - THE lAST WORDS
WHITE COAT REFLECTIONS
Associate Professor, Medical Director of Lung Transplant Center
Angel of death harkens me towards heaven, voice beckoning me forth for eternal life My corpus withering away, pestilence afflicted body unable to sustain my breath Ties connected to my life on this earthly abode, kith and kin. Land and foal How can I break the bonds, my heart dreads the mere thought Here I am, a disciple of Hippocrates. Holding forth the staff of medicine with all its cures Many a disease and affliction I have cured and can cure My chest of medicine is bare of elixirs to cure your affliction My instruments can sustain your life for a few more moons but not any further I am no god to replenish your body and soul. Rejuvenate it again All I have to offer is my advice and empathy. This is your life and legacy Speak to your kin, see your pain through their eyes Will this be the memory you want to leave for them to remember Oh worldly bearer of caduceus, your staff does not bear the magic to heal me My mind is made up, I do not aspire for any elixir nor instrument My soul is ready to leave, my body embraced in the bosom of my kin I leave my gratitude as my offering to you, St Peter is waiting for me.
By Soma Jyothula
“I don’t have an answer to that.” “I honestly don’t know right now.” I have said these sentences countless times throughout medical school, and I’ve said them the most during my rotations. I’ve said it to my attendings as I’m getting “pimped,” to my classmates, to my patients when they ask a question, and even to myself as I go about my day in the hospital. It’s humbling to speak these words, to admit my lack of knowledge to people I admire and to people that count on me. Even deeper than that, saying those sentences feels like I am making an escape route when confronted with a difficult situation. I’ve been thinking about the unknown more often. Nearly finished with this whirlwind of clinical rotations, I find myself taking a step back and looking at the hodgepodge of pieces scattered around the floor. I am nervously attempting to connect fragmented experiences. Growing up, I often heard that everything happens for a reason. But what does a patient with intense emotional and family trauma, patients under 50 with terminal cancer, healthy newborns, and teenagers with borderline personality disorders have to do with experiencing my own personal mental health struggles? Is there a reason for that? Or is it simply the weight of the unknown converging upon me? If my past self from 5 years ago could see where I was today, they would be proud. I’m doing what I set out to do. Goals have been achieved. Milestones have been met. Immense growth has occurred, both personally and professionally. The end of medical school is starting to come into view, and I genuinely believe that I have helped people as best I can on rotations this year. I have attained the coveted privilege of knowing patients, to play a role in their lives at the most vulnerable and honest of moments, to positively impact their health and sometimes impact their lives as a whole. Yet midway through this year on the wards, I felt nowhere close to myself. Why did it feel as if medicine and its many demands were pressing in all around me? Why did I feel responsible for allowing myself to sink so low in challenging moments? Was I afraid of being like a patient – where things happen out of my control and I am left with questions rather than answers? I don’t have an answer to that. I honestly don’t know right now. Sometimes ‘not knowing’ is the most truthful and accurate response, and that is okay.
Finding Humility in the Unknown
By James Burden
Email your submissions for consideration in the in next edition of Human Ties to: humantiesdigest@uth.tmc.edu @mcgovern_center @McGovernCenter www.med.uth.edu/mcgovern/
