CHART Vol 1

Ce lebrat ing the Humanit ies thro ugh A rt

The arts and humanities journal of the Phoenix Biomedical Campus

Vol. 1

April 2013

@Copyright , All Rights Reserved

CHART is an interdisciplinary, peer-reviewed/juried journal devoted to sharing the insights and experiences of the Phoenix medical community through original works of personal expression, including original art,

essays, ideas, photographs, poetry and prose.

Contact Jennifer R. Hartmark-Hill, MD, Chair

[email protected]

Phoenix Biomedical Campus 550 E. Van Buren

Phoenix, Ariz. 85004

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Table o f Con tents

_______________________________________________

Foreword, Jennifer R. Hartmark-Hill 4

Concrete Canvas, Tabbitha Mosier 6

there is no silence, Kay Rowe Gilliland 8

Delicate to the Touch, Sun Czar Belous 10

Roo, Michael Simmons 12

What is Health?, Leah Carnine 14

Risk Taking, David H. Beyda 16

Total Blast, Adolpho Navarro 20

First Code, Jennifer R. Hartmark-Hill 22

Boulder Canyon, Keven Siegert 24

Hospice, Michelle Sipe 26

Family—The Bond That Ties Us, Cynthia Standley 32

Parenthood, Michael Simmons 34

What Are You Looking At?, Amol Surve 36

Ride the Lightning, Sun Czar Belous 38

Betrayal, Tabbitha Mosier 40

Seldon Pass, Keven Siegert 42

Road to Valediction, Jessica Cole 44

Match Day Lanterns, Ray Chaira 46

Liquid Aroma, Kara Melmed 48

Desperate Measures, Sun Czar Belous 54

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A Fool’s Errand, David H. Beyda 56

HSEB Canyon Filter, Ray Chiara 60

First Code—The Narrative, Jennifer R. Hartmark-Hill 62

Blue Heron, Keven Siegert 66

Index 68

Untitled by Shifat Ahmed

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Spring 2013

Dear Phoenix Biomedical Community, Welcome to your new humanities and arts journal! We celebrate the diversity of perspectives, ideas and experiences of our campus with you and present both the familiar and extraordinary moments in human experiences. Representative pieces in our inaugural edition are drawn from the genres of prose, poetry, photography and painting. They showcase the many creative and artistic talents of our community. This print edition is a selection of editor favorites, thoughtfully pieced together for your enjoyment. Our full journal is published as an electronic version at: PBCchART.com. We hope that you feel inspired by the unique perspectives of the authors and artists presented. May these works lead you to a renewed level of commitment to self-expression and artistic exploration, and may your own efforts create harmony, balance and joy in your life. On Behalf of the CHART Editorial Team – Enjoy! Kind regards, Jennifer R. Hartmark-Hill, MD Chair, CHART Journal Executive Editor Board

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Journal Executive Editor Board Shifat Ahmed, Student Susan Barrett Jessica Cole Michelle Ona DiBaise Jacqueline Doyle Karen Gilliland Jennifer R. Hartmark-Hill, Chair Priya Raman, Student Christine Savi Keven Siegert Michael Simmons, Student Sue Sisley Cynthia Standley Acknowledgements Jacqueline Chadwick – Support and recommendations for our endeavor Howard Silverman – Publication recommendation and guidance Amol Surve – Cover and Logo Design Susan Barrett – Print Layout Design Keven Siegert – Website and Logo Design

Corazón Del Desierto by Amber Perry

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Concre te Can vas

Who can take the elements of earth and remake them? This is not a cold, corporate structure. This is the beauty of elements reborn. Tabitha Mosier _______________________________________________

Tabbitha Mosier is a senior media technician for The University of Arizona College of Medicine – Phoenix. She is an Indiana native with a deep love for writing, technology and the arts. Her primary passion is to see inspirational/religious media change the lives of young people. For more than six years, she has spent most of her extracurricular hours involved in non-profit organizations, striving toward that goal.

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there is no s i lence

Kay Rowe Gilliland _______________________________________________

Author, poet, and performance artist from Brooklyn, N.Y., Kay Rowe Gilliland’s work focuses on spirituality and celebrates the richness of the Caribbean-American experience. Kay is the founder of Sisters of the Desert Sun, a literacy advocacy group promoting cultural competence through the exploration of literary works from around the world.

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there is no silence

_______________________________________________

there are whispers in the stillness of the night

soft breezes kiss the leaves of an oak

whisking secrets into a black night sky

crescent moon shimmers light like

silver dollars hidden in my mother’s closet

footsteps echo

a call and response

a question and answer

crickets chirp to break the monotony of quiet

singing ballads

telling tales of heat and passion

the creak of a rocking chair becomes a prayer for slumber

while the winged disappear against the darkness

love fills the void of loneliness

as the sliver of light pierces the depth of sky

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Del ic ate to the To uch

A mother’s touch, a baby’s toes, and a family’s commitment share similarities in concept – all are delicate to the touch. In some instances, it can also seem that a husband and wife can be held together effortlessly with the mutual bond with their child…even at the dangle of their toes. Sun Czar Belous _______________________________________________

Sun Czar Belous has worked for The University of Arizona for more than 11 years and has nurtured a growing passion for media arts, not only throughout his career but his entire life. Growing up in the small mining town of Globe, Arizona, he found opportunity in developing skills in video production and eventually made his way to The Art Institute of Phoenix. While in college, Sun Czar’s exposure to all aspects of art culture strengthened and broadened his abilities beyond video production and opened many doors of creativity, including his current and strongest passion – photography.

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Roo

"Wide-eyed, grinning flap dance" is really the best description I've ever been able to come up with for how my daughter (age 6 months) used to act when she was excited about something. Michael Simmons _______________________________________________

Michael Simmons is an MD candidate in the Class of 2016 at the UA College of Medicine – Phoenix. He is also the proud father of Lydia Simmons, who was born in 2011, and who is Michael’s chief source of artistic inspiration.

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Roo

_______________________________________________

I am a smile at every glance

I'm a concentrated furrow

I'm a wide-eyed, grinning flap dance

I'm a tipsy-topsy tower

I am the apple of Dad's eye

I'm a rosy-cheeked spring shower

I am an Arizona sky

I'm a brilliant, budding flower.

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What is Heal th ?

'What is health?’ examines some of the many components of health and wellness. It aims to highlight the diversity of factors that influence different communities’ abilities to achieve adequate health statuses in a society riddled with inequality. This piece is inspired by the work of Promatoras a la Salud—a local group of migrant health promoters creating spaces that allow lay community members to be part of the changes that make their communities healthier. Just as social determinants of health, such as discrimination and poverty, influence one’s wellness, working towards social justice has the potential to improve health and well-being. Leah Carnine _______________________________________________

Leah Jo Carnine is an NAU physician assistant student in the class of 2013.

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Risk Tak ing

David H. Beyda, MD _______________________________________________

David H. Beyda is a pediatric critical care specialist at Phoenix Children’s Hospital, having served as Division Chief of Critical Care Medicine for over 23 years. He also serves as Chairman of the Bioethics Committee of Phoenix Children’s Hospital and is Professor of Pediatrics at the University of Arizona College of Medicine – Phoenix where he directs the Ethics and Humanism Theme for the medical school and also directs the Global Health program.

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Deliberation about the risk of therapy is more than usually difficult, and this I think, is a concern worth taking seriously.

The attitudes underlying the practice to do “good” for all our patients, seems not out of keeping with

the spirit of healing that we all subscribe to. But nobody is at his best every day. And that includes those of us who call ourselves physicians. Despite our best intentions, we have on occasion, made either small or large errors in our practice. Although medicine is supposed to be a science, there is certainly a great deal of experimentation that takes place, which in itself is prone to error. To think that physicians are far from the common road traveled is to bask in the realm of idealism. This very human character of “imperfection” which we possess is however, not readily accepted by our patients and their families, and yes, by our own colleagues at times. The feeling that lives are at stake lends credence that error is unacceptable. I attend particularly to how our patients are affected, not by neglect, but by day-to-day patterns of medical practice, decision making in particular: to risk therapy or not. But we do take risks frequently with our attempts at heroics. And despite some skepticism, we are more often than not successful. We celebrate life and watch our patients get better, joyous in our triumph. But sometimes, we fail.

A while back, I traveled to Sri Lanka as one of 3 founders of the Children’s Heart Project, determined to

make a difference in some child’s life. Idealism filled my mind and charity filled my heart. We fulfilled a mission to teach and established a foundation upon which the local physicians could grow on and correct as many congenital heart defects as possible. For over 10 years we made as many as 4 trips a year. Aside from the primitive environment and the lack of sophisticated equipment other than what we brought with us, the types of heart defects we saw were no different from those we see here, the goals not unlike what we try to achieve in our country. What was different is that we cared for children who were malnourished, debilitated and headed for an early death. They were clutched and thrown into a river of medical expertise and technology that we brought with us that rocked them from side to side with each wave. Tension was thick; humor was the fashion and emotional outbursts predictable.

I remember one little girl in particular. She sat, legs crossed, hands clasped in her lap on a gurney, her

mother at her side in pre-op holding: a hall with walls half bare from peeling paint and rust stains from the water that leaked constantly down its sides from the corrugated roof that could not, would not, keep the rain out. At ten years of age, she looked at me through eyes that had seen more than someone twice her age. She came to the hospital by bus, some two hundred miles away, months before our arrival to take her place in line. Her mother knew nothing about us, except that we could fix her daughter’s heart. There was no question that this little girl had not been given a fair start at life. We were a hope, a second chance for life. That very morning I held her hand as she lived. Twelve hours later I would hold her hand as she died. The surgery had been difficult, the post-op course even worse. Her mother thanked us for doing what we could, prostrating herself in front of us as if we were gods, never once berating us, accusing us or blaming us for her daughter’s death. She had trusted us to do the best we could with what we had and accepted the risk of therapy.

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Challenges in medicine continue to center around technological, pharmacological and physiological

advancement. We don’t allow nor accept the status quo. And that holds true for battling mortality. I take a chance here and suggest that the natural selection that Darwin proposed has never applied to the human population. Or at least medicine doesn’t let it. We prolong lives that should have ended, we bring to life those who would not have been able to do so on their own and are better for it, and we determine the outcome of births by genetic selection. For this ten year old girl, we took a risk and went to war with Darwin. Not to imply that we contributed directly to her mortality, but the thought occurs that her life would have come to an end without surgery sometime in the near future. By operating on her, with her reserves depleted, we took a chance and perhaps cheated her out of some precious time that she would have enjoyed. A statement I make for discussion purposes only.

What about the fact that this little girl entered into a relationship voluntarily expecting to come out of

surgery a little better than when she went in? What were her last thoughts before she fell asleep under anesthesia? Did she say a little prayer? Was she afraid or was she joyous that she was soon to have a new life? I can’t begin to imagine what she thought. I just hope that it was pleasant and full of love. Her innocence could not allow her anything else.

I concede that as a physician I hold no special enchantment, no singular magic. I have an old think

attitude when it comes to deliberating risks of therapy. And that is, that virtue is the warm glow of satisfaction that comes with knowing you’ve done the right thing. That caring enough for someone else to take a risk is worth it. As far as that little girl is concerned, I can find comfort that operating on her was the ethical thing to do, the human thing to do. We did the very best we could. That’s all we knew how to do.

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To tal B l as t

When a person reaches complete total excitement, they feel fulfilled or they fall apart wanting more. Adolpho Navarro _______________________________________________

Adolpho Navarro is a Media Specialist for the UA College of Medicine-Phoenix. He has been creating various Photoshop images since he was a child. He prefers to focus on the more odd and unrealistic entertainment approach. He enjoys the challenge of creating something unique that draws the best reaction from the viewer. He loves it when someone looks at his creations and asks, “How did you do that?” or, “I thought that was real!”

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F i rs t Co de

This poem was written almost 10 years to the date of the first patient death I witnessed, during my 3rd year of medical school. No one on my hospital team talked about the patient’s death at the time — we just moved on to the next patient. Without an opportunity to “debrief”, I have carried the memory of this event ever since. When I wrote this poem ten years later, I felt that I had finally given voice, in some measure, to that pivotal experience. J. Hartmark-Hill, MD _______________________________________________

Jennifer R. Hartmark-Hill is a family medicine physician and faculty member at the University of Arizona College of Medicine — Phoenix. She has a strong passion for promotion and exploration of the human side of medicine through narrative medicine, the arts and literature.

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First Code

_______________________________________________

Siren-wailing breaks the silence—

Shipwrecked life force in distress!

Tampanade of vital organ—

Current-breaking crush of blood.

Circling torrent, dark and deadly—

Fatal as the River Styx.

Flash of silver light’ning downward—

Plunging down through the abyss.

Maelstrom forces; structures splinter—

Bodies blur in epic gale.

Straight as flat line Fates have woven—

Final as the River Styx.

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Boul der C anyon

Acrylic, 30” X 48”. Keven Siegert _______________________________________________

Keven Siegert is the Director of Media Services for the University of Arizona College of Medicine – Phoenix campus and an independent Media Artist living in Phoenix, Arizona. He paints, shoots photos, produces video projects and engages in a wide variety of other creative endeavors.

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Hospi ce

“Hospice” describes a woman’s visit to her loved one in a Midwestern hospice. It is, of course, about aging, sickness, and death. But it is also about the complexly interwoven lives of people and the way memories and nostalgia can ache. I wrote this story after volunteering in a hospice and thinking a lot about the aspects of patients’ lives I would never see or fully understand. Michelle Sipe _______________________________________________

After leaving the small town of Baraboo, Wisconsin (home of the Ringling Brothers Circus), Michelle Vita Sipe graduated from the University of Wisconsin – Madison in 2010 with a bachelor’s degree in psychology and a certificate in religious studies. Although most of her life has been spent pursuing the humanities, she is currently a first year medical student at the University of Arizona College of Medicine – Phoenix. She hopes to pursue family medicine, psychiatry, or both.

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Beverly Wick’s cat Meatball lies curled up on his own pillow, which Beverly keeps on the floor beside the bedroom door to minimize the amount of climbing and jumping the old cat must do. Her own bones are also old, and when she leans down in her flower-flecked cotton nightgown to pet Meatball’s dandruffed brown fur she feels aches she can no longer remember the absence of. A year ago there were two pillows, one tucked under the bed in Rosie’s hiding spot, but Meatball now takes his meals alone, shaking the kibbles to death as he has since kittenhood.

This morning, like most other mornings, Beverly stoops to scratch between Meatball’s ears on her way

to the sunroom. She does a crossword and watches the birds at the birdfeeder. In early April everything is thawing and the dripping of newly melted snow off the eaves keeps time as her shaky pencil fills the small squares with letters. Her grandson Brian gave her the heavy crossword book to “keep her mind sharp.” Brian had also placed a collection of index cards, bound together by a large metal ring and printed with instructions about topics like “How to Print an Email,” on his grandmother’s computer desk. Beverly keeps a framed photo of her only grandchild and his fiancée Emily on the sunroom coffee table, beside a stack of crafting magazines and an old Christmas photo. The sunlight is beginning to fade them almost imperceptibly.

It’s a fifteen-minute drive to the hospice, with the kind of scenery that’s everywhere in southeast

Minnesota in early spring. Beyond every brown jagged cornfield is a vast puzzle of densely interconnected skeletal treelimbs, which in the summer becomes a blanket of leaves lining the farm fields that stretch flatly towards the highway. Cars still carry sprays of salt sheen, and the roads are always wet from the slow apathetic snow melt. Along either side of the road are the ugliest muddy brown snow remnants, structurally unsound towers of snow-dirt where the tallest snowbanks stood all winter.

Beverly has never seen the hospice in spring, and there are no signs now of how full of plant life the

grounds will become in the coming months, as a fleet of gardening volunteers is released into the dormant spaces. The facilities are, as Beverly pulls her burgundy Civic into the gently sloping parking lot, all mud and wet straw-colored stalks bent from a winter buried under snow. She is wearing khakis and a pink sweater and some beige orthopedic shoes, and has a generic old lady hairdo of short tame grey curls.

Roger’s hospice cycles a massive amount of air through the facility every hour, so the place smells

unlike a hospital or medical setting; Beverly supposes it smells like nothing. The coat closet where she hangs her windbreaker already contains a dozen spring jackets and the same white sweater that’s always there, unmoved, forgotten.

At the main desk, a circular hub at which four hallways and three offices intersect, nurses flit between

rooms in their pastel scrubs holding syringes and applesauce cups laced with powdered medications. Beverly signs her name in neat slanted cursive on the sign-in sheet and onto a nametag sticker which she firmly affixes inches above her left breast, where she’d put her hand to heart to recite countless pledges of allegiance.

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“It’s nice to see the ground again, after the winter we had,” she says to the Lucie, the receptionist, who agrees. Lucie has a practiced polite smile involving genuine-seeming eye crinkles.

Roger is in room 12, between rooms 11 and 14. There is a spring-themed wreath on his door, which

includes a small fake bird nested in an arrangement of artificial flowers; the facility’s designers went to great lengths to make each room appear nonmedical. Roger’s room has smooth hardwood floors, pale green-and-white striped wallpaper, and an enormous floral painting that swivels to one side, revealing an array of medical attachments, including a small clear cylinder of bubbling oxygen. It is Roger’s third week in the facility. On his census sheet the nurses have noted that Roger is “declining. Admitted 3/20 for end of life.”

Beverly enters room 12 quietly with gentle steps as though she might wake him. He looks, as always,

much too large for the bed, too tall and broadly built for the small hospital bed and the thin pink knit blanket. His breathing is uneven, with periods of barely perceptible breaths, during which Beverly always leans in unconsciously, watching his chest until it visibly rises and falls again.

It bothered her at first to sit beside a motionless and dying person, but she’s become accustomed to

silence and the silly feeling of one-way conversation. “It’s Beverly,” she says, because the nurses have told her that “we never know” just how much a patient can perceive or understand. Roger’s eyes are shut and lined with crust. His still arms, positioned outside the knit blanket, are darkly mottled, some of the spots a deep purple, but his wrists are still sturdy and strong-seeming under the plastic identification bracelet. Beverly watches his chest’s shuddery rise and fall in the bright light of the room’s large windows. “Hi Roger.”

They sit in silence for a long time in Roger’s warm room. Beverly sometimes tells Roger about the

dramas unfolding at her birdfeeder, or news about their friends and their friends’ children. She hopes he feels her presence, even when she doesn’t speak. He’s turned slightly away from her, propped up by pillows placed by CNAs who shift his position every several hours. In the window seat’s ledge are several photographs – a young Roger in military uniform, Roger and his wife Kathleen on their wedding day, the braces-laced smiles of their grandchildren. Beverly watches the clear tubes that emerge from the bubbling liquid oxygen and end in two short branches thrust into his nostrils. She can hear the deep rumble of a metal lunch cart carrying lunch trays down the hall. Roger stopped receiving a tray a few days ago after they kept sitting untouched on the counter, the desserts filming over and the fruit drying and browning in the quickly recirculating air. Behind the cart’s rumble is the businesslike clacking of heels, increasing in volume until Roger’s oldest daughter appears at the door.

“Oh – Hi Beverly!” Marie is a tall mass of straw-colored hair and raincoat, her legs emerging below her

knee-length coat and rushing on beige pumps to where Beverly stands to greet her. Marie drops a huge leather bag to the floor and outstretches her arms to Beverly, pulling her in for a hug during which Beverly’s head

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spins with the intermingling odors of Marie’s expensive perfume and the nearby bag of Roger’s stale dark amber urine. “How good to see youuuu, it is so wonderful of you to come visit Dad.”

“Oh, well. It’s such a shame how things have gone. How are you all doing? How’s your mother?” Marie speaks on the exhalation of a deep breath. “Mom is doing well, doing okay, I saw her yesterday.

She has a caregiver now, at home – it was hard on them, when it was both of them at home. And…Hard to see them like that.”

“I’m sure.” “But.” Marie looks down at her father the way people look at sleeping young children, her expression

masking a twinge of sadness. “Dad looks peaceful today.” Silence permeates the room for a moment and Roger takes a stuttering breath. Both women’s heads

turn toward the small bed. The way his body has refused to waste away into frailty, as her husband’s had, prompts Beverly to wonder which is worse – the preservation of an illusion of vitality or the gradual warping of a loved one into something nearly unrecognizable.

Beverly’s uncooperative brain forces an unwelcome memory of a young Marie playing Monopoly one

Thanksgiving, surrounded by her family and by Beverly’s son and her husband Don, everyone loud and laughing and full of food. Behind this nice memory is the more sinister one, in which Beverly and Roger left to pick up a few dessert items from the Wick home. And of course no one objected to this because the two are “old friends” and everyone else is busy with Monopoly. Once in the Wick house they’d enjoyed a brief taste of each other while all their worries were sequestered at Roger’s, these worries full of turkey and deeply concerned about Marie’s recent acquisition of Park Place. Roger’s looming frame had enveloped Beverly in shadow in the already darkened home, his callused fingers and hot alcohol breath all over her cardigan’s buttons.

Beverly knows what kind of conversation this will be. Marie’s job, children, husband. Everyone’s health.

The doctors Marie liked and the ones she didn’t. Beverly’s children and grandchild. The unusually cold winter, the day seventeen inches fell in one day. No one will mention Don, or his good nature, or the way it made Beverly’s guilt cut in a messier way, but his memory hangs there, faint, in the familiarity of oncoming death.

“And the birds are out again, I love that.” Beverly peers through the window into the courtyard at a

small group of dull brown sparrows picking at the muddy wet ground.

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“I hope he can hear them,” Marie says, knowing her father loved birds and had, throughout his life, owned a much-ridiculed wall clock with twelve birds instead of numbers that chimed on the hour with a particular bird’s song.

“I do too. You know he once –“Beverly remembers the field guide under her doormat. The black-tipped

outstretched wings of the bird on the cover, the textured yellow binding, Roger’s small handwriting inside. A nurse enters the room, and her arrival offers Beverly a graceful exit and the opportunity to avoid a

conversation with Marie from which they would both gain exactly nothing. As the thin pretty nurse begins her update, Beverly gathers her purse and says she’d better be going. She places her hand briefly upon Roger’s, surprised by the heat radiating off the papery, mottled skin. In the moment she knows it may be the last time she sees Roger alive, if it can be called that, but the thought doesn’t linger. Marie gives a hurried hug and a promise to contact her soon, and Beverly is free in the cool quiet hall.

Outside room 12 is an oversized quilt with squares made by family members to remember their loved

ones. The hospice makes one or two every year. Beverly bends briefly to examine the sparsest white square, which houses nothing but a dog’s paw print and the words “Dad -- I’ll be waiting for you under our favorite tree.” The beeping of call lights sounds from both directions, plus a higher pitched and more distant bed alarm. Beverly’s head spins a little. She signs out at the front desk, manned now by a man with drooping eyelids.

The sky has turned overcast. Beverly’s once auburn hair is pushed in all directions by wind that sends

clumps of waterlogged fall leaves to her car’s windshield. It takes some effort to open the car door against the wind. From the driver’s seat Beverly watches the edges of damp brown leaves stuck to her car’s hood wave meekly in the wind. The naked branches of trees bob out of unison. In room 12 Marie watches her father’s chest stop rising. She leans in, waiting.

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Famil y—The Bon d Th at Ties Us

Mixed-media painting: acrylic, newsprint, ephemera, 16” x 20”. Cynthia Standley _______________________________________________

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Paren thoo d

Michael Simmons _______________________________________________

Michael Simmons is an MD candidate in the Class of 2016 at the UA College of Medicine – Phoenix. He is also the proud father of Lydia Simmons, who was born in 2011, and who is Michael’s chief source of artistic inspiration.

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Parenthood

_______________________________________

I never realized

When she gave birth

That it would be my insides

That came out

I've grown up

An adult

Learned to protect

My soft spots

Shield them

And yet, small and noisy

With a soft spot of her own

She turns me inside out

Where are my protections

When she splashes in the bath?

When she sleeps so gently in her crib?

When she talks to me with only

Two consonants?

I am a mess

And she smiles whenever

She sees me looking at her.

Blue eyes, and a toothless smile

Have taught me

Pain

So sweet by nature

So innocently terrifying

I am an Achilles heel

And it's her fault.

It's not really she

Who is vulnerable,

It is me

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What A re Yo u Loo king A t?

Broccoli? French fries? Coral? Porcupine spines? Nada! The "broccoli" and “coral” are partly silica aerogel imaged by scanning electron microscope (SEM) and partly silica aerogel with cells cultured in it imaged by an optical microscope. The "French fries", “porcupine spines” and “sea plant stems” are copper wires grown via electroplating, imaged by SEM. When re-imagined a billion times their actual size and slight digital enhancement these mysterious, scientific nanoscale structures transform into familiar everyday objects. An artistic reflection on our visual perception and the fractal nature of the world we live in. Amol Surve _______________________________________________

Amol Surve holds a BArch and MS in design and is a designer at the UA College of Medicine – Phoenix. Amol specializes in branding, design and web technology, or as we usually say, magic. His job perks include continuous doses of caffeine and scanning the world for design inspiration.

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Ri de the Li gh tnin g

“Flash before my eyes…” Sun Czar Belous _______________________________________________

Sun Czar Belous has worked for The University of Arizona for more than 11 years and has nurtured a growing passion for media arts, not only throughout his career but his entire life. Growing up in the small mining town of Globe, Arizona, he found opportunity in developing skills in video production and eventually made his way to The Art Institute of Phoenix. While in college, Sun Czar’s exposure to all aspects of art culture strengthened and broadened his abilities beyond video production and opened many doors of creativity, including his current and strongest passion – photography.

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Betray al

This piece is a first-person allegory to the anguish that an author feels during “writer’s block”. If prolonged, it may even cause the writer to feel as if their own talent has betrayed them. Tabbitha Mosier _______________________________________________

Tabbitha Mosier is a senior media technician for The University of Arizona College of Medicine – Phoenix. She is an Indiana native with a deep love for writing, technology and the arts. Her primary passion is to see inspirational/religious media change the lives of young people. For more than six years, she has spent most of her extracurricular hours involved in non-profit organizations, striving toward that goal.

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Two Weeks. Four Months. Six Months. Now? Now, nearly a year has passed, and I've barely written anything.

Writing is more than an art form; he is a living, vibrant being. He was my best friend, my sanctuary; he was a predictable, stable, unchanging force in my chaotic world. We met in junior high, and I fell for him the moment I discovered his oratory beauty. He was my high school sweetheart. We were head over heels in love. Destiny beckoned for us to be eternally and incandescently happy… Or so I thought.

Without warning, September struck. It brought none of the autumn comforts that kindle our passionate fire. Writing, as I had known him, slowly began to change. He became cruel, harsh, and mundane. For two months, I sought to repair our eroding romance. I would sit with a pen or behind this screen, begging for his return.

I thought that November would bring some solace, with her cool days and cloudy eyes. But she was a cruel mistress that beguiled my love, and stole him away. I found nothing but tragedy in November. She was a stake in my broken heart. On a windy and harsh afternoon, I watched as she whisked away what was left of my lover. There was nothing but the shadow of death that loomed upon my heart. I lost something in that moment….I lost the magic that I found in his love.

Since that cruel and fateful day, I have not seen Writing in the same light. We have our fleeting moments, where I look into his eyes and allow myself to remember what once was. My reverie is always cut short, for I no longer see my darling looking back at me. I see a stranger, calloused and cold. Oh, how I long for his hand in mine! How I yearn for him to sing sweet nothings into my mind. How I wish for his whisper, guiding me to the doors of undiscovered worlds!

My love! Don't you remember? Your absence has not killed me. No, I am left with a fate worse than death. I am left barely breathing to suffer the torment of your infidelity. Please come back to me, my dear. I miss you ever so much.

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Se ldon Pass

Seldon Pass, John Muir Wilderness, California. Keven Siegert _______________________________________________

Keven Siegert is the Director of Media Services for the University of Arizona College of Medicine – Phoenix campus and an independent Media Artist living in Phoenix, Arizona. He paints, shoots photos, produces video projects and engages in a wide variety of other creative endeavors.

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Ro ad to V aled ict io n

Road to Valediction is a poem that uses interlocking lines in a form of poetry known as the pantoum. This pattern uses repetition and subtle line variations to create a slowing effect, which can intensify reflections of past times. This poem is a glimpse at the initial realization, which occurred while driving cross-country, that the time to say goodbye to two grandparents was rapidly approaching. Jessica Cole _______________________________________________

Jessica Cole is a health sciences librarian who supports NAU’s students and faculty at the Phoenix Biomedical Campus. Analytical by day and creative at night, she is thrilled that CHART presents the PBC community with an opportunity to celebrate both sides of the brain.

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Road to Valediction

_______________________________________

A beautiful day for silence

Driving, 106 miles from Des Moines

Grandma sucks imaginary candy

Uncle Steve drives the family

Driving, 106 miles from Des Moines

Grandpa’s face is so old

Uncle Steve drives for grandpa

Cuz they don’t trust him to drive anymore

Grandpa’s face is so old

The day sky so blue

“They don’t trust me to drive no more”

His wrinkled hands fidget

The day sky so blue

We’ve run out of words but not thoughts

His wrinkled hands fidget

Cows spot a rolling hillside

We’ve run out of words but not thoughts

Under the jet-streaked sky

Cows spot a rolling hillside

Grandma thinks in silence

Under the jet-streaked sky

Hay bales melt into brown ground

Grandma thinks in silence

Of the tumor in her brain

Hay bales brown into the ground

Grandma sucks imaginary candy

The tumor grows in her brain

A beautiful day for silence.

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Match D ay Lante rn s

Lanterns for UA Match Day Celebration. Ray Chaira _______________________________________________

Raymond Chaira works for University of Arizona College of Medicine – Phoenix. He works for the college Media Services Team as a media technician. He has always been heavily involved in all aspects of technology but learning a new passion of photography.

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48

Liq ui d Aroma

These are the details that we accumulate in order to deal with the burden of our careers. The plot seeps out, and I am left with images, brief memories. These are the words that are the hardest to write, as they accompany the images that I will retain forever. Kara Melmed _______________________________________________

Kara Melmed is a 4th-year medical student at UA College of Medicine – Phoenix, starting a residency in neurology in 2013. She has been writing ever since she learned to read, beginning with her seminal work, written on a 1987 Macintosh computer, Poems about Gnomes. In her spare time, she loves discovering new music and exploring the mountains of the Sonoran desert and the great rivers of the Southwest.

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Liquid Aroma

_______________________________________________

This sterile lab is like a silent forest on the brink of winter. Still water of looming lake, Black ice will soon crown its majesty. I open the snow white body bag, and I dive into that crystalline lake. The waltz of oxygen, holding desperately onto hydrogen, is slow enough and I must remind myself to breathe. And I want to scream at the shock of the freezing water, but I don’t, because now the bag is unzipped, and we are all going to die in the end anyway. In there we learned not science, but humanity. Acquiring the tools that we will need to deal with the burden of our careers. Just as she had said. We learned how to look at what death left behind. Afraid until I touched it, perfection in my hands. Yes, perfection is attainable, and I know this because I have seen this beautiful stranger’s heart. I held your perfect heart in my hands, sir, and every metaphor I have ever written instantly became obsolete. Your heart is perfect, and thus you have softened mine. I never met the man who inhabited this body but I fell in love with the body who inhabited that bag. My cadaver, my first patient. my son, my child. I give you second life, watch you emerge not from the womb

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but from the very skin that restrains your immortality. Emily Gibb’s words echo in the caverns of my brain. It all moves so fast, and I can’t look at everything hard enough. I can’t look at everything hard enough. I looked into the caverns of your brain, sir, and that is no metaphor. Those molecules of water in all their splendor, that was no magic. Yet surely improbable to no end. But to exist, to have sung, to have loved, to have despaired, the unlikelihood of this is far greater yet occurs and disappears each day in this evolutionary blink of eye. Thermodynamic miracle that your organs retain their shape. Perfection. I held your perfect heart in my hands, I fell in love all at once, with all, all at once. Love like every poet had ever promised. Every word ever spoken suddenly rang true at last and beautiful. No sound emerged from your dead cracked lips. And that is no metaphor. No, I saw you, demure now open, skin peeled back, naked organs exposed to the world. Naked like the desert, naked as the desert. Barren. No wet grassy moss to cover your immodesty, No trickling stream to cleanse your wounds No crimson stained snow to soak up your blood. Open and honest and dusty. All paths, all paths, lead to dust and smoke and ash.

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In there I understood not my own mortality, but yours. My child, my son, my patient. Dark midday living rooms and unfed cats, and old water bills piling up, and you are freed. I wanted to be your shelter from the storm, my child. Huddle in close, and let me keep you dry, and warm. Let me protect you. Only now it occurs to me that I am forced to bear the rain myself. I want your sons to know that I have grieved with them, and I thank them. I have shed tears with them, and I have mourned the loss of your life, time and time again. I draped you with your own skin to keep you safe, and that is no metaphor. There before me, beautiful stranger. And you were perfect, I assure you. You are a marvel, a superman, a testament to life and perfection, and every single spark that ignites my passion for science and medicine. You gave me not a sacrifice, but a gift. I stand before you as a child who can tell you that I have seen death, and it is beautiful. I stand before you a child who swears that I will hold these images in my head, its liquid aroma and the tugging of smile. And it will continue, the details. That’s what this is about. It is about the details, that get lost in between the lines, the details rinsed from our dissecting tools as the cool sterile water showers over them. It is about the details that get lost to memories, it is about walking click clack against wet pavement, just after it rained.

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It is about the means, not the end. The means to an end. Simultaneously aware of how much, and how little, everything matters. It is about scarlet mornings and coffee breath afternoons. And you are freed. The plot seeps out and I am left with images, brief memories. And I can’t look at everything hard enough. I can’t think about everything hard enough. For science is no theology, and I don’t mean to cheapen your beauty with words attempting at an understanding. But you are beautiful, and I am incapable of appreciating the ineffable fragility of your name without these words attempting at an understanding. It stormed this morning, only now it occurs to me that I am to bear this rain myself. Not alone, but with all the details you have given me. There before me, beautiful stranger. And you were perfect, I assure you. And I can’t look at everything hard enough.

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54

Despera te Me asure s

In my youth, there was a set of stairs in downtown Globe, Arizona that my friends and I would walk up and down on a daily basis to go downtown and back home. These stairs are apparently off limits nowadays and based on the method used to barricade the path, the title was appropriate. Sun Czar Belous _______________________________________________

Sun Czar Belous has worked for The University of Arizona for more than 11 years and has nurtured a growing passion for media arts, not only throughout his career but his entire life. Growing up in the small mining town of Globe, Arizona, he found opportunity in developing skills in video production and eventually made his way to The Art Institute of Phoenix. While in college, Sun Czar’s exposure to all aspects of art culture strengthened and broadened his abilities beyond video production and opened many doors of creativity, including his current and strongest passion – photography.

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56

A Fool ’ s E rrand

David H. Beyda, MD _______________________________________________

David H. Beyda is a pediatric critical care specialist at Phoenix Children’s Hospital, having served as Division Chief of Critical Care Medicine for over 23 years. He also serves as Chairman of the Bioethics Committee of Phoenix Children’s Hospital and is Professor of Pediatrics at the University of Arizona College of Medicine – Phoenix, where he directs the Ethics and Humanism Theme for the medical school and also directs the Global Health program.

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His whole life was a “should” instead of a “want”. We met on the beach years ago after I watched him for a few days, talking to some unknown person out there in the ocean, waving his hands and bowing. He spent days alone, lying on a dirty blanket, always in the same place right at the edge of the sand where it met with the high tide. No one would sit next to him even when the beach was crowded. He wore the same clothes day in and day out, long hair matted, dirty finger nails, and drinking from a bottle in a paper bag. I was intrigued by his actions and embarrassed by the actions of others and myself: avoidance and distrust. I made the move to meet this man, but before I did, I watched.

In the early evening, every evening, he would stand at the edge of the water, look west, and lift his hat

and bow, to nobody. He would raise his hands, wave, and make the shape of a heart in the air and I could hear him say "I love you" over and over again. He would stay there and do this until the sun went down behind the horizon, the sunset on occasion yielding the green flash that sunsets display when they want to, and with his head hung low, shuffle up the beach and disappear for the night. I was to find out who he was and to whom he was talking to.

I went up to him late one afternoon, introduced myself and asked if he would like some company.

Without any hesitation, he said yes, and for the last 15 years every summer during our vacation time in Oceanside, we met and talked for hours. We would meet around 5pm almost every day, talking and sharing stories, he more than me, and then he would get up without notice as the sun began to set, go to the edge of the water and begin his ritual. I’d stay and watch, embarrassed that I was intruding, but happy to be a small part of his life, validating his need to do what he did.

Hugh was 64 years old, had 2 master's degrees, taught poetry in college, and lived “la vida loca” high

on LSD from the time he was 20 until he crashed at the age of 40. His life got bent a little, and later that bend took him around in circles. His face was drawn, eyes dull, with an old-fashioned ponytail loosely pulled back, gray through it all. He had a face that had not been given a privileged passage during his drug-infested years. He had been homeless off and on (more on than off) living in a never ending state of rebound between bad choices and second chances. His mind was burned with LSD, flashbacks were frequent, but during his lucid times, he was smart, gentle and humble. Those times became fewer and fewer, and one summer it was obvious that he was getting worse; he couldn't remember where he taught, went to college, or when we saw each other last. He slept in a park off the beach now after the residents of the houses on the beach complained to the police. The last summer I was with him, I took him to one of our favorite places, the Prince of Peace Abbey atop a hill in Oceanside. We attended mass, prayed, and talked for several hours, looking at the ocean from atop of the hill. I listened as he moved from one subject to the next, sometimes making sense, most of the time not. We talked about Joe. She was the person he talked to, who he saw on the ocean in the evening, his love, his life. He said she lives on a sailboat and occasionally stays in the marina near the beach. He said that she would sail close to the beach in her sailboat every evening to say hello. I checked down at the marina the next day. She didn’t exist. I never saw a sailboat come close to the beach in the evening either. I told him so, only to

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see his eyes water up. He got a faraway look in his eyes, as if memories were coming back to him, nodding as the images came into focus. He became quiet, and went on talking about her as if he hadn’t heard me. Memory, I discovered, is reconstructive, not reproductive, a collage of half-remembered names and faces. Many of us can't reproduce or remember exactly what happens in our lives gone past. We bind bits of facts with pieces of our hearts, making the past easier, sweeter, and less painful. I didn’t bring it up anymore. I had strayed far from the sense of decency of letting a man have his dreams.

On the last day of our vacation that summer, I dropped him off at the park where he slept. I hugged

him, held his hands as we prayed, and felt comfortable being with him despite what he was: a homeless, wasted, lonely man. I had grown to love him for who he was: a brother who seeks only that to which he is entitled to - dignity and personhood. He was not my patient. I didn’t have a duty to “save” him. But he taught me something priceless. He was no different than the rest of us. We look to others for love and support, and welcome the warm embrace of those we love, the softness of a touch, the smell, the feel, the words, and the look they give us with their eyes. Our dreams. Hugh looks to Joe for all of that as well, raising his hat and waving his hands making the shape of a heart to someone he loves out there in the ocean, wanting to feel her warmth. He believes in her. A fool's errand. But a sweet and gentle fool, who lived a life as a consequence of what he did to himself in the past. And that brown paper bag with a bottle in it that he drank from? The bottle was simply filled with water. I look past all that was thought of him, and see someone "forgotten". One of the many innocent, abandoned, lonely, and forgotten persons who live isolated lives. Hugh passed away a while ago. Hugh...I think of you often and may you find "Joe" wherever she is.

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HSEB Can yon F i l te r

Photo of PBC Health Sciences Education Building using a Photoshop filter. Ray Chaira _______________________________________________

Raymond Chaira works for University of Arizona College of Medicine – Phoenix. He works for the college Media Services Team as a media technician. He has always been heavily involved in all aspects of technology but learning a new passion of photography.

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62

F irs t Co de—The Narrat ive

One physician’s recollection of her first witnessed patient death a decade prior, and reflection on the “code of silence” too often present in the medical culture. Jennifer R. Hartmark-Hill _______________________________________________

Jennifer Hartmark-Hill is a family medicine physician and faculty member at the University of Arizona College of Medicine — Phoenix. She has a strong passion for promotion and exploration of the human side of medicine through narrative medicine, the arts and literature.

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I almost made it through my third year of medical school without experiencing a patient death. Almost. But then the Code pager went off that night. I was on my Internal Medicine clerkship rotation at a local hospital, with one month to go. My team

consisted of a senior resident, a transitional year Psych intern and me. We were on-call. While working together in a patient’s room to complete a fairly straightforward admission of an elderly woman with pneumonia, halfway through our questions, the shrill alarm of the pager calling the Code Team sounded. We immediately rushed to the nearby patient room indicated on the pager, dodging our way through the effluxing stream of family members being expelled from the room.

Once inside, the Senior resident flew into action, assessing the monitor and the patient—airway,

breathing, circulation—pulseless! Straddling the patient, she heroically performed CPR while the Psych resident and I mostly stayed out from underfoot as the respiratory therapists and other Code Team streamed in. They got a rhythm back, and hurriedly got in orders.

The intern and I found the family, (still in the hallway resisting efforts of the nurses to be escorted to a

nearby conference room to wait). We briefly updated them as to what was happening, and that their loved one would be going to the ICU. I remember talking to the granddaughter, who looked to be about 12 or 13. She also looked scared speechless. Not to worry, I told her, she could see her grandfather once he was in his new room. We were just moving him to watch him more closely.

We returned to the room as the patient was being wheeled out. Amazingly, he seemed alert. As I stood

near the doorway, he grabbed my hand as he was wheeled by and said thank you. I stammered my praise of the team, not me, but desperately wanting to take part in caring for him, I spoke the most heartfelt wishes for feeling better I had ever wished anyone. It was all I had to give.

That was the first time he died. Adrenaline still rushing through our veins, my team returned to the patient with pneumonia we had

left behind. We picked up our history gathering where we had left off. “Are you on any medications at home? Do you have any allergies? Have you had any health problems or surgeries in the past? Do you have a family history of…”

The Code pager went off.

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We ran out of the room. The senior resident headed towards the stairs at a run, calling over her shoulder, “Third floor!” As we bolted up the stairs, I gasped out, “That’s where they took that patient!” “It’s not him. Do you know how many patients are on the third floor?” the resident retorted in a dismissive tone.

As we burst through the doorway at the top of the third flight, my heart caught in my throat. Running

down the hallway from the direction of the ICU came the same patient’s granddaughter, her hand clasped over her mouth, sobbing. We knew it was him.

After 27 blurred minutes of resuscitation efforts, the Intensivist “called the code,” stated the time of

death, threw his gloves on the floor, and strode out. So there it was, no bringing him back. The second death was final. I took one last look at the waxy, ashen skin, the cool, lifeless hand I had held, and followed my team out.

We walked silently down the same hallway the patient’s granddaughter had escaped in tears. Not one

word amongst us, though. We were holding it together. We took the elevator instead of the stairs this time, and I thought as the down arrow was pushed, maybe we would talk about this when we are away from the other patients and families. When the heavy metal doors of the elevator closed, with just our team inside, I waited. Silence. From what I could see as I stole sideways glances at the residents, each stared at their own shoelaces, not looking up. We emerged from the elevator, and instead of going to our workroom to talk, we went straight back to the patient with pneumonia.

“Do you have any family history of heart attacks, stroke, cancer. . . ”. We finished the admission on

“our” patient, and many more that night. We worked efficiently and did our job. Post-call, I reflected on what I had learned. I had learned through experienced what I assumed was the

way doctors should react. Keep on going. Next patient. Next order. Objectivity. Distance. Got it. Back at home, over 30 hours after the shift had begun, I stepped into the shower as preparation to go to

sleep. Suddenly, standing in the hot stream of water, I began to cry. At first soundlessly, then in great gulping sobs that wracked my body. My husband rushed into the bathroom. “Are you hurt? Are you ok? What’s wrong?”

I gathered myself enough to say, “It’s nothing. I am just overtired.” With a little more reflection, I

realized that wasn’t true. I was mourning the loss of the patient who had died. Not even “our patient”— but a patient on another team’s service. But he was our patient. We had cared for him. We had lost him.

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I cried for the loss of a fellow human being. I cried for the loss to his granddaughter. I cried because I

was part of a profession that cannot always save lives and can be defeated. Then I got up, and went on. There were other patient deaths over the years. Most were expected, like the patients with end-stage

COPD or kidney failure, admitted for palliative measures in the active stages of dying. I witnessed “good deaths,” too—a patient on home hospice with family gathered round the bed in vigil, patients who had “lived a good life,” had carefully enacted their living wills, and were at peace and ready to go.

All were memorable, but none in the same way as the first. Two Codes, two deaths, one patient, one night. Silence. Almost 10 years after my first patient loss, I awoke one morning to realize I had several phrases that

kept recirculating in my head. I got up, wrote the poem, and realized it was about that patient. I hadn’t known I was still carrying his story (what very little I knew of it—the end), close to my heart all these years.

Like a piece of glass or cactus spine buried deep in flesh, it had worked itself out in its own time. After I wrote the poem, imperfect as it was, I felt a great burden lifted. I had finally given voice to this

experience. I had finally told someone, even if it was me. I remembered, and I cared. I vowed to break the silence in the future, to share with team members who shared that journey with me. I promised myself that I would be there for future students, if given the chance. Out of the silence, there would be healing and good.

Thank you, my nameless friend. You held my hand on that night you let go of your life. I wish you and

your loved ones peace.

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B lue He ron

A blue heron surveys the Aravaipa Canyon in Arizona. Keven Siegert _______________________________________________

Keven Siegert is the Director of Media Services for the University of Arizona College of Medicine – Phoenix campus and an independent Media Artist living in Phoenix, Arizona. He paints, shoots photos, produces video projects and engages in a wide variety of other creative endeavors.

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Index

_______________________________________________

A Fool’s Errand 56

Belous, Sun Czar 10, 38, 54

Beyda, David H. 16, 56

Betrayal 40

Blue Heron 66

Boulder Canyon 24

Carnine, Leah 14

Chaira, Ray 46, 60

Cole, Jessica 44

Concrete Canvas 6

Delicate to the Touch 10

Desperate Measures 54

Family—The Bond That Ties Us 32

First Code 22

First Code—The Narrative 62

Gilliland, Kay Rowe 8

Hartmark-Hill, J ennifer R. 22, 62

Hospice 26

HSEB Canyon Filter 60

Liquid Aroma 48

Match Day Lanterns 46

Melmed, Kara 48

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Mosier, Tabbitha 6, 40

Navarro, Adolpho 20

Parenthood 34

Ride the Lightning 38

Risk Taking 16

Road to Valediction 44

Roo 12

Seldon Pass 42

Siegert, Keven 22, 42, 66

Simmons, Michael 12, 34

Sipe, Michelle 26

Standley, Cynthia 32

Surve, Amol 36

there is no silence 8

Total Blast 20

What Are You Looking At? 36

What is Health? 14