September 2016 — S Y N A P S E
Photo of the Caribbean Sea and lettering design by Tiffany Chan (M2)
Five Minutes by Nazish Malik, M2
It was my first month working as a scribe in a new emergency room, and my shifts so far had been physically taxing but mostly uneventful. With a seemingly never-ending line of URIs, abdominal pains, benign chest pains, psychiatric holds, and minor MVAs, this particular day had started routinely enough. The only notable exception was the volume of charts I needed to complete by the end of my shift. When I worked with Dr. O, the number of charts was always double of any other physician. By the time the ambulance call came, I was already physically and mentally drained. Even though he would never admit it, Dr. O was, too.
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Photo by Shohaib Virani (M1)
The medics called shortly before our shift ended. Thirty minutes after putting her healthy eleven-month-old son to sleep, a mother had found him unresponsive, with no explanation. It had taken the ambulance a little under ten minutes to arrive on the scene and start full CPR. Estimated Time of Arrival was five minutes. By habit, I did the mental math. At worst, his heart and lungs had stopped over 45 minutes ago; at best, it had been only 15 minutes.
When the medics finally wheeled him in, the baby’s skin was already ashen. The difference in size between his tiny body and the full sized gurney was hard to ignore. The gurney had never been meant to hold someone so small. The contrast was made even more obvious by the hands doing the CPR. They enveloped his whole torso, highlighting his tiny frame. As I watched the patient being taken into the trauma room, a part of me already knew the outcome.
In hindsight, this is when I probably should have taken a deep breath. I should have allowed myself to take stock of my own emotional needs. I had witnessed death before, multiple times in fact. But those patients had lived full lives and their loved ones had seen it coming. I should have taken a moment, but I didn’t. Adrenaline kicked in, and I hurriedly followed the team into Trauma Room 1.
Dr. O ordered the team to continue CPR, but the baby’s heart did not restart. His chest never rose for a purposeful breath. Yet for fifteen minutes, the team worked hard despite the slim chances. Throughout this time, his mother stood in the corner of the room fervently, tearfully, praying for a miracle. I didn’t speak her language, but her hope and prayers were like a universal tongue. God. Dear God. Any God. Just bring him back. Let him be all right.
Every few minutes Dr. O would glance over at her, his fear palpable. How was he going to tell her? How do you tell a parent that their healthy, happy child suddenly died with no obvious explanation? Dr. O’s pain, like most others’ in the room, was written across his face. As the fifteen minutes drew to a close and the team’s continued attempts at resuscitation remained fruitless, he moved toward the mother and made his first attempt at breaking the news.
“I am sorry. He’s gone. There’s nothing we could have done for him.” She didn’t understand him. She spoke only Spanish. One of the nurses took a deep breath and began translating.
Before the nurse had even finished, the mother began pleading repeatedly, “ No, por favor, es mi hijo! Por favor, continue! No, por favor, No!" Her voice was a combination of pain, desperation, and hope. While she prayed, the team continued CPR. Everyone in the room waited for a miracle.
However, with each minute of CPR, it became harder to watch the situation unfold. A thick curtain of tears blurred my vision. The more I heard the mother’s pain, the thicker the curtain became. When no amount of CPR or prayer restarted her son’s heart, Dr. O humbly turned to her, motioned for the team to stop, and called time of death. Once the mother fully comprehended her loss, her pleading stopped and she began to scream.
I have witnessed loved ones grieving before, but this mother’s pain made my very being hurt. Her screams were raw and primal. So desperate, so human. Her voice no longer held any semblance of hope. To this day, nearly three years later, when I think about this case, I can still hear her screams. And her pain still brings tears to my eyes.
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By Anand Jayanti (M3)
When there was nothing left to do except to let her grieve, I followed Dr. O out of the trauma room. I still had many uncompleted charts, and there were still patients waiting for care. Yet, as we stepped out of the trauma room, there was a mutual understanding that we both needed a break. Attempting to do more, without addressing our own needs, felt futile, like a waste of effort and energy.
Dr. O. looked at me, said, "Five minutes," and walked away.
“Five minutes,” I whispered to myself.
With my vision still blurred, I quickly walked toward the staff lounge. I could still hear her screaming and crying for her son as I punched the access code. I pushed the door shut behind me, needing her screams to stop. Over time, I had become accustomed to the physical and mental tax that my work required, but this was the first time I had felt so emotionally drained from a case. I knew that before I could help others again, I needed to help myself first. I walked to the back of the staff lounge, slid to the floor, and let the tears flow until there were no more.
Lingual Carcinoma by Krystha Cantu, M3
Her tongue was halved
Filleted open by a whir of smoke
A cauliflower mass stood where other lovers’ mouths had been
An accumulation of uninvited cells anxiously piled on top of each other
“We will have to take the nerve,” he said
Behind a cable-laden headpiece
Now her tongue would deviate, further handicapped by aberrancy
“The lovers,” I thought
How many beloved lips had been there, quietly coveting in theater seats to know
The secrets of her mouth
Dark eggplant mitotic figures
Boldfaced, sharp lines of spindles flaring on a slide
The teeth of nightmares
My mouth became sacred
A chapel with closed doors where speech and taste remained guarded and asleep
Within the vacant cavity the carcinoma had
Declared a path
An overturned flowerbed of taste buds
What would become of the taste of chocolate?
Would it be a fossilized remnant of her past?
How would she tell her stories? Had they all been told?
How many chapters would go unpublished?
A conservative mound of coral flesh remained in the hollow of her mouth
Derelict and barren at the hands of nicotine
An empty house ...
Advanced Maternal Age by Krystha Cantu, M3
A neurologist sat in the examining chair
Twirling her hair rhythmically
Angst hanging heavily in the air around us
The ultrasound probe served as the conduit
A lens with which to view, inspect, dialogue
But doctors were used to holding the probes
The instruments, the clipboards, the diagnostic decisions
“Everything looks normal”
Her eyes glistened
Voice cracked
Hands nervously questioning her abdomen with gentle pressure
“I will go a step further,” he said
Probe rearranged, gliding slowly over her like a paintbrush
“The septum pellucidum is appropriate ...
No herniation of brain matter ...
No evidence of cleft lip or cleft palate ...
Germinal matrix intact ...
No sign of nuchal translucency ...
Anterior horns visualized and appropriate ...
Biparietal diameter normal ... head shape oblong and within normal limits …”
A tapestry of words delineating normal brain development
A language, a familiar song, a long kiss on the cheek
From physician to physician
A secret code of reassurance
She finally rested her head back on the pillow and
Turned to the screen
As if looking out of the window from a train piercing through a beautiful vista
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Daimari Beach, Santa Cruz, Aruba. Photo by Tiffany Chan (M2)
Welcome, Texas A&M College of Medicine community, to the 2016–2017 academic year!
CJ Conlon, Copy Editor
Joseph Joo, Copy Editor
Sneha Raghunathan, Copy Editor
Nina Tran, Design Editor
Hanna Chen, Chairman of the Board
Cindy Roman, Managing Editor
Nida Virani, Acquisition Editor
Tiffany Chan, Design Editor
Submit to us!
Share your work with the Texas A&M medical school community. Please email us at COM-synapse@tamhsc.edu to submit work, make suggestions, or ask questions. We are looking forward to hearing from you!
THANK YOU
To our amazing faculty mentors: Barbara Gastel, Gül Russell, & AJ Stramaski
A special thank you to Barbara Gastel for helping with final edits.
Faculty Editor: Karen Wakefield
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