Harmony Magazine (2010)

Harmony
a humanities magazine
The exploration of the human experience in its entir ety -- and thr ough all available mediums -- is the goal of the medical humanities pr ogram.
2010
Reflections
Shanaz Sikder
Harmony
Director Ron Grant, MD, MFA Editor-in-Chief Bess Stillman Visual Arts Editors Mary Cozby Hal Strich, MPH Copy Editors Betty Creath Anna Marie Lopez, MD Stephanie Pearmain Anne Coleman Graphic Designer Roma Krebs, AHSC Biomedical Communications Special Thanks Steven Goldschmid, MD The Hill Family T. Philip Malan, Jr., PhD, MD Helle Mathiasen, Cand.mag, PhD Kenneth J. Ryan, MD Nancy Koff, PhD Rebecca Parada
For more information, please visit the Program in Medical Humanities website at http://humanities.medicine.arizona.edu Complete guidelines for subscriptions, donations, and submissions may be found in the back of this journal.
On the front cover:
a humanities magazine
Harmony is a publication of the Arizona Health Sciences Center and is sponsored by College of Medicine and the The University of Arizona
Medical Humanities Program
Kenneth Hill Memorial Foundation as a gift for the community. All works in Harmony,
both visual and literary, of the artist or author and are published
are the exclusive property
with her/his permission. Authors retain their copyright for all published materials. Any use or reproduction of these works requires the written consent of the author. Views expressed are solely the opinions of the individual authors and are not representative of the editors, advisory board, or AHSC.
On the back cover:
Railyard Painting
Dan Shapiro
Exuberant Autumn
Dan Shapiro
PR OGR AM IN MEDIC AL HUMANITIES
Harmony
A HUMANITIES MAGAZINE
Editor
Welcome to the 6th issue of Harmony: the UA College of Medicine Program in Medical Humanities journal. After reading and publishing in Harmony during my first three years of medical school, Im honored to be choosing this years recipients of the Mathiasen writing award. Before coming to medical school, I was a graduate student in creative writing. I took classes in literature, grammar and linguistics. But it was the language of the body I yearned to know better. I remember the thrill of first-year anatomy lab, cracking a body wide open, the marrow spilling forth a stunning new vocabulary: cuneiform, symphisis, zygomatic, lunate surface. I felt, like many writers, that the best stories we have to tell are the ones we carry around inside us our whole lives only I believed it literally. I didnt know it right away, but those words, and the stories they told of the body, and of the people inhabiting those bodies, would transform me as both a medical student and a writer. Being a healer, like being a story teller, is an art. Our ability to be good health care workers relies on our ability to connect to other peoples stories, whether they come from a patient, doctor, nurse, or even peer reviewed journal articles. But opening ourselves to stories does more than make us more observant, it makes us human; it reminds us why we wanted to bind our lives to the hospital in the first place. It is a rare gift to be surrounded every day by real human dramas with so much at stake. This kind of narrative tension is rarely found in every day life, or even art. But the inspiration that fills the pages of Harmony go beyond medicine. These are stories of healing and illness, but also of the lives that go on beyond the walls of UMC. Writing is an act of intimacy it can be intimidating to submit your work to a wider audience. I want to thank everybody who had the courage to send in their stories and poems and to congratulate this years writing award winners: Nandini Ganesh, for Letters and Science and Janet Alessi, for Waiting. I believe a strong medical humanities program is vital if a medical school is to develop good doctors who are also good people. Harmony exists because you agree that science and art are not separated by some invisible rope, but bound together by one. I encourage all of you reading today to submit your work for publication in next years issue, and help us carry Bess C. Stillman on this great tradition. bess@email.arizona.edu
Welcome
Director
How important is it for us as medical professionals to use the nonanalytical parts of our brain? I dont want to go to medical school because I hate chemistry, my humanities minded daughter ron grant, md, mfa said a few weeks rgrant@email.arizona.edu ago. Does this mean she shouldnt aspire to have a career in medicine? Is it only the math and chemistry whizzes that make the best clinicians? In response to my daughters vehement opposition to my suggestion to keep her mind open, I did a little research into medical school admissions and found an interesting program at Mount Sinai Medical School in New York City, where the admissions committee accepts a limited number of students who have studied in a humanity tract major. In looking at the data they complied, I learned something interesting. Though these students struggled a bit in the basic sciences, they did remarkably well as practitioners in their clinical years a finding that Im sure would surprise many medical school curriculum directors. Not that we all should be poets and writers, but there is something to be said for expanding our horizons beyond the usual textbooks and journals of medicine. And if the surgeon is like a poet, then the scars you have made on countless bodies are like verses into the fashioning of which you have poured your soul, mused Richard Selzer in his famous essay, The Knife. So open your mind as you pour your soul into the beautiful art and prose that makes up this years Harmony. Then you decide. Does using the other half of the brain add anything to the artful practice of medicine?
I hope you enjoy this years issue.
Harmony
Mathiasen Prose Award Winners
Award
winners
Janet Alessi has lived in Tucson for forty Waiting years and has worked at the Arizona Cancer Center for eight of them. Last year diagnosed page 24 with breast cancer, she feels fortunate to have been at the Cancer Center when the diagnosis came, not only for the skills of the doctors that have tended her, but for the kindness and the support of those she works with.
Nandini Ganesh was raised in Arizona, and Dear Naveen received her bachelors degree in psychology at UCLA. During her undergraduate work she page 16 was involved in Project Literacy, a program that focused on increasing literacy rates among children and immigrants in underserved areas of LA. After working for several years, she returned to AZ for medical school, where she hopes to continue her interest in the humanities.
Kenneth Ryan Visual Arts Award Winners

Dan Shapiro was on the faculty at the College Snowmaggedon of Medicine at the University of Arizona for 13 years. He began shooting portraits and stills page 15 using a nikon D90 with off camera strobes about one year ago and has now had his work published in a few magazines including a cover of the journal Academic Medicine. He lugs his camera everywhere and frequently tortures his family and friends by shooting their photos incessantly and making them stop so he can take a photograph of a rusted car or dilapidated barn. He is now on the faculty at Penn State but his bones and heart are still in the desert. Kyle Jensen is a fourth-year medical student Cloudgate and is currently applying to a residency in diagnostic radiology. He graduated summa page 9 cum laude from the University of California at Santa Barbara with a degree in Biochemistry and Molecular Biology in 2006. When on a break from studying, he is usually found researching his next travel plans, cooking slowly, or listening to Musorgsky.
Harmony
Karen Brondel
Shadow of Morpheus
The sun was still slung low in the east but its unmerciful glare soon crept along the sides of my opaque windowshade. Though Id spent the night just drifting near the blurry edge of sleep, I had to once again confront morning. This insomnia began years ago, when I watched desperately as the delicate girl faltered. Ritas alarmed pediatrician had scuttled her from his office to our care, no doubt relieved to return to vaccinations and the various scrapes and bumps of otherwise healthy children. She came to us directly from school, dressed in a white cotton blouse with elegant maroon piping along the collar and one of those tartan skirts of many pleats that parochial schools favor. Her knobby knees seemed to jut forth, flamingo fashion, before the rest of her lanky legs as she strutted down the hospital corridor. Behind her, the anxious parents walked arm in arm, stiff as wooden toy soldiers. Rita politely feigned interest in my introduction as her primary nurse while I escorted her and her parents into the cream colored confines of the hospital room. Darting her head to the side, she cleared the mane of long, thick, auburn hair from her face. That freckled face. All eleven years of her were wild with sweaty energy that oozed through and onto her shiny face. She hurled herself onto the bed and played with its controls, manipulating the moaning machine into a reverse jackknife position. Her parents paced from one unadorned wall of the room to the other, as if measuring just how small their world could become. They were eager to meet the specialist, whose superior diagnostic skill would hopefully free them of the place. False alarm, they would chuckle brightly, followed by more vaporous expressions used by those who are eager to flee anothers company. Better safe than sorry though. Flanked by an entourage of doctors-in-training and a sad-eyed social worker, the oncologist entered the room, resembling a lumberjack in his red and black plaid shirt with buttonholes horizontally stretched in a struggle to stay buttoned over a belly that bulged over the waistband of his jeans. His glossy black hair meandered around his chin and throat and bristled out of his ears. He had a mesmerizing habit in which he slowly rolled forward on the balls of his feet and back on his heels while speaking to the families of children under his care. When he eventually confirmed that her only child had cancer, Ritas mother lurched toward her daughter, her pale veiny arms encircling her as if the lumberjack doctor was the real threat. After her first round of chemotherapy, Rita literally had a gut realization of her sickness. She retched and spit and gagged at the smell of the steamy chicken fricassee that wafted into her room at dinnertime. Staff pillaged the playroom, snatching crayons and construction paper. They covered Ritas door with bright crayola messages for the kitchen staff: Keep food trays away from this room! We tried all known antiemetics, but the hunger was in her cancer. Besieged with nausea each time she was admitted for chemotherapy, Rita gradually lost her gusto. As I passed her room one evening, I saw her in bed, propped up on pillows, her unwashed hair matted and stringy. Her mother was gently sliding the bedpan out from beneath her when Rita kicked it hard with her reddened heel. Her mother lost grip and it sailed forth, spilling dark, tea-colored urine onto the floor. Thats when Rita started screaming. To everyones horror, she kept screaming loudly that she did not want to die. I heard a soft, swift patter the soles of solid uniform shoes racing down the hall. It was me. I burst into the nurses lounge, my ears throbbing. The next day I began jogging and kept running for years. The oncologist tried different combinations of chemotherapy and I kept administering them to Rita. Her parents barred any discussion about halting treatment and making her as comfortable as possible.
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Her mother, especially, was stricken with fear. She would jump up from her chair, eyes wide and fixed on us as if wed swooped in, all red in tooth and claw. I half expected her to bundle Rita in blankets and carry her down the back stairwell in the stealth of night, never to return. One afternoon, Rita and I sat facing each other on her hospital bed. She dazzled in a sheaf of daylight that surged through a missing window slat. Only patches of her once luxurious hair remained on her head. Suddenly a strand fell out. It wafted up and turned in a corkscrew pattern, an exquisite, undulating filament of red and gold, sashaying lazily as it drifted down toward the dull gray linoleum floor. We both stared at it in silence. All these years later, the vigil in Ritas former room continues. A sable black night blankets the room, but for the nightlight that flickers like a votive candle. Bumping into chairs and stepping over a stack of DVDs, I maneuver my way to the childs bed and shine a flashlight near his head. His cherub cheeks are smooth, round and rosy. Barely audible breath whispers past his full, parted lips. The IV machine hums rhythmically like a metronome, infusing needed medicine and fluid. Two cots crowd the small space near the childs bed, accommodating both parents and the older brother. The snoring father is sprawled slack-jawed on the nearby cot that he shares with the mother, whose arm is flung across his chest. On a separate cot, with one hand cradling his cell phone, the older brother sleeps alone. It occurs to me that they are more comfortable in a hospital room than I am anywhere. The window across the room is hazy with reflections. I cant discern any image, just a single bright beam of light bobbing in the night. I sweep the ray of the flashlight over the family again, and realize that I am smiling at their sweet sleep.
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Jennifer Reich
Little Rays
Little rays of sunshine May you always know your truth And keep your wishes coming After your last shed baby tooth May you still giggle with your Angels When most have long forgot May you keep your curiosity And question what youre taught May you always find compassion To guide you through your fears And when sorrows come to meet you A loving friend to dry your tears May you know down deep inside your heart Youre a Divine gift here on Earth And the Universe is grateful That your light was given birth
Look Again
David Van Gelder
Harmony
Marrelle Frison
How to produce a bad patient.

Some tips from the real life.
Come to the home of a 5 year old, lie her down on the kitchen table, hold her firmly you and her parents can do it force an ether mask over her nose and perform a tonsillectomy. Take a 9 year old with albuminuria after an untreated scarlatina and order a hospitalization for 10 days observation. The same scene is repeated but the hospital has more resources in personnel and your 9 year old is stronger. The urine collection procedure requires 6 adults in white coats to lie her down on the table, to keep her from moving, to force her legs apart while the 7th adult inserts the catheter. Take a just turned 15 year old and send her to the hospital for an examination. No periods yet. She is alone. She has never heard the word gynecology and has no idea what a gynecological examination can be. Its the big university hospital in the city. She waits, half naked as she was instructed, totally alone in a room with a strange table. Shes is more curious than scared. The door opens. An old man comes in, followed by a troop of 8 younger males, all in white coats. For these 21, 22 year old, shes probably an interesting specimen, a good object for observation and experimentation (OK they look embarrassed and many of them are blushing). The old man helps her on the table. Oh! Shes a virgin, he says and then murmurs something to the group. She finds herself lying on the table, helpless, exposed, there for all the world to see, invaded by probing fingers. She is abandoned, a nonperson. What can she do? What can she say? Go on, everyone, help yourself. She is completely at their mercy, unable to protect her body: her body is worthless anyway. Take a 17 year old. She suddenly stops menstruating. Hospital again. All the same old procedures. Nobody needs to hold her by force. She doesnt care at all anymore, she just turns her head and pretends. Take her body, now, tomorrow, anytime you want, shes gone, shes not there. Shes away, far away. Lets stop here. Lets forget all about obstetricians, their nonchalance and arrogance. Yes, lets forget because, thanks to every one of you, the next generation of patients will be those good patients every doctor dreams about. the bad patient
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Howard Fischer MD
Paul Rousseau
Paterfamilias
Take a good look You son of a bitch: She freezes and becomes mute When a man raises his voice. She flinches When someone makes a sudden move. Lived most of her adult life thinking that the world is full of lies, happiness is abnormal, and love does not exist. This is your legacy to her: May God forgive you.
Final Words in the ICU

hum of monitors buzz of ventilators gutter of last breaths dying lub-dubs final words uneasy memoirs _______________ I know this must be hard. He is a strong man. No words I can say will make it okay. We need to ask what her wishes were. Did he ever tell you what he would want? I cant imagine what you must be feeling. We can hope for good days. Have you ever heard of hospice? I think its time. Does he have a Living Will? Its time we discuss withdrawing the ventilator. You were blessed to have her as your Mom. Would you like me to call the chaplain? Is there anything I can do for you? Im so sorry.
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Cloud Gate
Kyle Jensen
To The Top
Kyle Jensen
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Patti Aguilar
Passion and Privilege

Today at work I cried. I couldnt get out of Michaels room fast enough. Tears welled up and flowed freely down my face. Caring for sick children and their families is my job. Ugh the word job is so trite. Caring for sick children and their families is a privilege. Hospitalization of children is often far more traumatic for the family than it is for the child. Kids are much more resilient than their parents. Resiliency: the ability to recover readily from an illness. Children often recover from devastating illness, and sometimes they do not. But through the process children, not aware that they are the instructors, have the ability to teach life lessons to hospital staff. Looking into the eyes of a dying teenage boy makes my heart ache. Who am I? I am a nurse. I work at University Medical Center. More specifically, I work on an extraordinary floor dedicated to pediatric care 3 East. In my 20 years at UMC I have seen countless children come and go on this floor, many lives mended by the incredible nurses and doctors devoted to our next generation. However, out of this large assortment of patients, there lies a group of children who spend far too much time in the pale corset of hospital bed sheets. These children, mainly afflicted with cancer, may spend many of their tender years in the hospital, and while many miracles have been performed in this haven for the ill, lets face it, nobody wants to grow up in a hospital. The families and friends of these children make the small confines of a hospital room their home sometimes for weeks on end. Longer than expected hospital stays expose family dynamics; sometimes raw, occasionally obnoxious. Staff become the brunt of anger, sadness, fear and devastation. As medical professionals know from experience, we lose respect at times, mostly for self -preservation, although sometimes the scenarios we are forced to confront are just too freaking bizarre. In the world of medicine, we refer to these adult patients who become all too familiar to us as Frequent Flyers. Whether they refuse to take their medicine, have a debilitating lifelong disease process, or are your average hypochondriac, they always seem to end up in the hospital bed they call home. However, one group of patients has escaped this admittedly insolent moniker. Children. No matter how often they are admitted to 3 East, children will never be referred to as Frequent Flyers. We have the utmost of respect for them, perhaps not their parents, but always for the child. His eyes desperate, scared, knowing please, help me... Im hurting and afraid, Im dying. Twenty plus years of nursing experience offers a rich history of stories, some life changing, often hilarious, a few intensely sobering, and a handful so unforgettable that a core group of nurses and doctors can recount them as though they were yesterday. Over the years many local pediatricians earned their stripes during residency from these nurses and patients, spending hectic, drawn out day shifts and even more tortuous nights in the confines of hospital sterility creating memories which only time would allow to heal as the edges become blurred. But, as health professionals, we really dont want these experiences to become too smudged because they are the didactic lessons which academia cannot teach. These are our bread and butter, so to speak. No, we dont get paid more for having outrageous unforgettable experiences, but we do become a bit wiser, are more adept as caregivers, and develop an outer shell that is less pliable. Michael is dying from metastatic cancer. Pediatric nurses undoubtedly love what they do. Often adult nurses will say, I could never be a pediatric nurse. They are probably right. Young spirits are pure, honest and filled with hope and it is painful to see innocent children suffer. Pediatric nursing is our passion and privilege. As nurses we all have our favorite types of patients to care for. Some like surgical patients; some trauma or neuro; there are those who love the cardiac patient; a few enjoy diabetics and the teaching that goes with these patients (no thank you); and others are amazing with the cancer patients; the list goes on. I have the utmost respect and awe for my colleagues who so readily take on the challenge of giving skilled nursing care and nurture to families who find themselves in the depths of despair after learning their precious mijo or mija has a disease; no not a disease,
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their child has cancer. We hate to use that word, but it is necessary. It seems absurd that you can enjoy something so much, yet at times feel so sad when you process through how unfair life can be for a child with cancer. Perhaps enjoy is the wrong word. In the big picture of pediatric nursing we all enjoy what we do. Although, some moments, some days, some weeks leave us exposed, melancholy, overwhelmed, hopeless and angry. He will be discharged from the hospital, but he will be back, be it a few days or weeks. Nurses are able to do the turn it on- turn it off emotional roller coaster with skill and finesse when at work. Unable to hold back tears as we look into the eyes of a dying child or comfort a family member who has been given the news the cancer has come back and within a few minutes bounce into another patients world of questions and their need to speak to a doctor now. How do we do this? We put up walls so thick it takes years to penetrate; in the off time drink alcohol to escape the hurt although then it becomes much more intense; find a hobby or sport to dive into during downtime, eat, eat and eat some more, become involved in a spiritual support community or social awareness group, or look at our own personal lives and family support systems and realize how much we have to be thankful for. For most of us, it is a combination. But, when we are in our work zone, our nurturing, bonding, consoling instinct kicks in, whether we have great admiration for our coworker or sometimes feel we can not tolerate one more complaint before we shake them to their core and say, JUST DEAL WITH IT! During these emotional roller coasters nurses do care for each other. We cry, we hug, we laugh, we become sarcastic, we vent frustration about those who are less skilled and aware than we are. Sometimes we break and fail to keep it all together. Even though being in the hospital with such frequency sucks, Michael feels safety and comfort knowing the nurses and doctors are doing everything possible to make him feel better. Young children with cancer are less affected by the diagnosis. Their innocence serves them well when
they encounter the side effects of chemotherapy and complications of the disease. Hospital stays become home away from home and each visit is another adventure with lots of electronic game playing, TV and movie watching, gifts from the exclusive toy closet, special visitors (even a pony with tennis shoes!) and tons of attention from staff and volunteers. Dont misunderstand, the nausea, vomiting, pain, fatigue, and fear of needle pokes are forever dreadful and part of the cancer treatment one never gets used to, but the littler ones are more forgiving, always looking forward to the surprises in store. Teenagers are less trusting. They know about cancer. At least enough to understand that people with cancer get really sick, lose a lot of weight, their hair falls out and often times they die. None of these things are cool. Being a teenager is a tough job. Throw cancer into the mix of emotional turmoil, hormonal changes, peer pressure, wanting to fit in, and the realization that life is finite WOW. So many questions. Some kids will ask them all, others will hardly speak. The day is coming for Michael when leaving the hospital after a drawn out stay will be his final trip home. If you want to say good bye, this would be a good time to do it, suggests a coworker who has just said their own farewell to a patient that has been a regular on 3 East for several years. Saying a final goodbye is the single most difficult, dreaded, heart wrenching part of my passion and privilege. I hate it and oftentimes wont do it. Why? Im not sure. Maybe there is too much pain involved. Maybe my soul is compelled to open up to past grief. Maybe I am forced to confront present and future loss. Maybe it allows me to let the tears flow even though I fight desperately to hold them back. Maybe I am overcome with the reality that some day one of my own children may be the one other nurses are saying their goodbyes to. As a parent you never want to see your child die. And as a pediatric nurse, this thought crosses your mind more frequently than it does for the non-medical parent. I remember a conversation I had with a pediatric intensivist several years ago. My oldest son, TJ, who is now 21, was just two years old. He was a healthy kid but in my own myopic view seemed to complain frequently of
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headaches. I was panicked. Did he have a brain tumor? What parent jumps to that concern with a headache? A pediatric nurse, thats who, one who has seen way too many kids suffer and die. Michael is a special kid. They are all special kids. Its just that sometimes certain patient deaths are way more difficult to work through than others. Why do I do this? Because I love kids. Everyday is fresh and filled with learning experiences. Whether the experiences are emotional, academic, heart wrenching, joyful, mundane or delightful they are all very tangible. We, as pediatric nurses who care for children with cancer, have learned to prepare ourselves for our patients death. Sometimes we are ready and sometimes we are not and never will be. Michael is one of those kids for me whose death I will never be prepared for, and I am not really sure why. Maybe because my younger sons name is Michael, maybe because he is in-between the age of my own two boys and there are many similarities, maybe its his own quiet perseverance and strength in the midst of such a devastating and painful disease process, or maybe its because he is a special guy who has made his way into many hearts over the past several years. Life will go on after he passes. But, as caregivers, we are blessed and made richer to have a special memory to hold onto.
Blue Moon Over Madera Canyon

Keven Siegart
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Mary Maher
Dream Haiku
When Coyotes Sing Little Girls Laugh in my Dreams Nightime Wonderland
Stacy Nigliazzo
Manic
Bustling flesh dangling from the moons icy sliver. Swelling stars splintered through his free hand. Tiptoe, skipping across the apex of the earth. Winding freefall blurring, blinding silver.
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Ana Marie Lopez
THE SOUNDS OF VIOLENCE

Enemy UAB Target found Target down Whirring helicopter Running footsteps Blood splattered On the screen No human voices Just a game.
Homeward Bound at Sunset

Michael Ossipov
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Snowmageddon
Dan Shapiro
Ana Marie Lopez
MY FATHERS DAUGHTER
I am my fathers daughter. I love books. Do you remember our weekly pilgrimage and the reverence as we entered our place of worship? There, we bibliophiles found peace and sanctuary. I love small pleasures the first glimpse of morning sun, a cup of tea at dusk, fresh basil from the garden and the saguaro bloom in spring. I learned to trust the cadence of the universe. I learned to look for opportunities to make each day better. I learned responsibility. So today, Ill live as if it were my last full of the wonder of my first. And everyday, I will show up and work on the dream.
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Nandini Ganesh
Dear Naveen,
The word of the night in yoga today was drishti. It means vision, or as my instructor so loquaciously put it, looking with your eyes to the thing that you want to see. Most of the class is made up of undergrads, whose thing that you want to see is likely the weekend. Or spring breaksix pack abs Or an actual six pack. So he explained a little more. The reason he chose drishti as the word of the night was because he wanted us to practice our poses with the purest of intentions and the most ardent of efforts. He wanted us to put forth those intentions and efforts, so that when we found ourselves balanced on our right foot, with the left foot wrapped around our right calf, and our knees bent, and our upper body hunched over in an exact imitation of a little kid badly needing to go to the bathroom- we would look down at the point on our foot where most of our body weight was centered. The base of the big toe. But we wouldnt see our big toe. We would look, with drishti, and see further. To what we wanted to see- the ultimate manifestation of our purest intentions and most ardent efforts. Essentially, we would see the face of God. In our big toe. Yeah, I didnt buy it either. So my second year of med schools going well. I had a moment the other day that I would characterize as a turning point. It was one of those moments where two blurry concepts in your head finally get together and click, and afterward you wonder how you ever didnt understand how things were supposed to work. Basically, in my first year, I sat in pathology lecture after pathology lecture and memorized all the things that could possibly go wrong in the human body. And then I went to Societies (our how to look and sound like a doctor program), and memorized all the right questions to ask a patient. They give us a cheat sheet/mnemonic- OPQRST, and most of my brainpower went into trying to remember what the T stood for. (Youre starting to wonder now how I got into med school in the first place right? You and me both pal, you and me both.) Anyway, the two groups of knowledge never really integrated together in my brain until a couple days ago, when I realized that I could listen to patients random complaint (one that hadnt been carefully designed to match the lecture from the previous day), file through my list of memorized diseases, and rule them in or out based on the list of questions I was supposed to ask. Example: hey man, good news! You probably dont have an aortic dissection because your abdominal pain only shows up after you eat things coated in lard ( T. For timing. I know you were wondering). Essentially, I was able to look with my eyes to the thing that I wanted to see the practical application of my endless hours of studying. Maybe not quite the face of God, but possibly, a glimpse into the face of medicine? But heres what Im thinking. This whole vision/drushti business seems to have a timing component. You cant seem to have that moment of clarity without putting in day after day of drudgery- where youre learning the different types of lung cancer, or how exactly to position your left foot around your right calf to achieve maximum balance. You cant seem to have that moment of beauty without building a foundation from things that, at the time, have very little actual meaning. Which is common sense, I guess- but also mildly depressing. Because Id like for the things I do on a daily basis to have some meaning already. By my count, its been 12 years of school, 4 years of college, 3 years of work experience, and innumerable hours of application writing. And Im ready to be useful now. But Ill wait. Ill keep studying and Ill keep waiting. Because thats how we roll here in med school. Thats the news from my end- hope lifes treating you well out there in the real world. Love, your sister, Nandini
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Gathering Storm
Snake Bridge Tucson, Arizona
Skip Kriegel
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Zoe Sorrell
Lost and Found
There is nothing like returning to a place that remains unchanged to find the ways in which you yourself have altered. Nelson Mandela
I was lost. I had soared through the challenging symphony of adolescence without fault, hitting every note and every rhythm. Seventeen years and I hadnt missed an entrance yet. All I knew of myself, all I needed to know of myself, was that I was a musician and music was my language; this compass had guided me thus far without flaw, an unyielding metronome that kept the rhythm of my life. But come senior year, I lost my way.
a moat, separating my reality from my past, my reality from the unfortunate reality of everyone else. There was a whole world out there of loss and pain and hunger, but none of it mattered. It was all so far away from he and I. We stared down at it all from our castle, all of the unfortunate unloved on the other side of the moat. I was the untouchable princess and he, my knight in shining armor. My heart pounded assuredly. That was the moment when the pounding started. Like water from a burst pipe, it had rushed through my veins; it had been unquenchable ever since. Thump. Thump. Thump. However, the thumping had remained simply a quiet reminder in the corner of my mind, the distant reverberations of a timpani. But during that evening with him, as the sun had lowered in the sky, and as the beautiful silence had thickened, it had crescendoed to the persistent tap of a bass drum. The next time that I heard that pounding was nearly two weeks later
Movement IAllegro Maestoso

We lay side by side in the grass. I could feel the top of his hand ever so lightly touching my right hand. My breathing was rapid, a violins spiccato; I could hear that his was as well. My left arm was bent at the elbow, my forearm creating a pillow for my head. This elevation allowed me to view the fiery explosion that was the sky. Oranges, yellows, and exquisite purples shot out from the tree-lined horizon like racehorses from the barracks. These colors skipped around the sky, holding hands and doing the do-se-do. The world was silent except for our heavy breathing. No words could contest with these heavenly flames. My neck ached slightly from the strain of maintaining this position, but I ignored the dull throbbing. The last minutes of the days heat were as relentless as any. The beauty of the moment caused a single tear to slide unexpectedly down my face. It veered right at my cheekbone and dropped into the grass. More tears than I had borne witness to in years quickly and unexpectedly followed. I do not know how it happened, but suddenly he had oriented himself around me. I was sitting upright and he was behind me, his arms around me, his chin on my right shoulder. I felt his warm breath on my neck and knew that I was safe. I wiped below my eyes and my fingers came away black with damp makeup. He did not speak. He breathed, slowly, reassuringly. And just as slowly I felt my own breaths begin to keep rhythm with his, I felt my heart begin to dance with his. It was stiflingly hot, yet still I wanted him close. Where his left cheek touched my right cheek, our sweat merged and ran down both of our necks. I imagine that it created
Movement IIAllegro Appassionato

I was sitting on my window seat. The far wall was plastered with pictures of various attractive male actors. I leaned my head back against the pillow I had propped up. As I sighed, my stomach heaved upward and my eyelids drooped. The corners of my lips twitched upwards. My back was arched as my feet rested on the wall, next to the posters; I walked my feet up the wall until my legs were fully extended. All around my feet were vague black smudges of footprints from times when I had done this before. My hands were clasped together on my stomach, my fingers interlocked. My backside sagged into the green plaid cushion that covered the seat. My hands sweated profusely, causing my stomach to feel the slight resulting dampness. I contemplated the text message I had just read. You are so much more than music, Zoe. You are a beautiful person, inside and out. It was as though he had reached into me and embraced my soul, and retreated bearing witness to the very thing I had unconsciously been hoping to hear, waving it over his head, a talisman to represent his deep understanding of me.
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Harmony
I tilted my head and looked out the window to my right; a stout woman with short and messy brown hair atop her pinched face stood down on the street. Her left hand rested on the arm of a man who was about a foot taller than her. They were standing about a foot apart and he was looking down into her face as if he saw the world reflected in her soft wrinkles. Similarly, she had eyes for naught but him. They were smiling; so was I. My heart pounded loudly in my rib cage, an unvarying tam-tam. Thump. Thump. Thump. The comforting rhythm continued. And it did. For a while at least. But mid-September, the world fell truly silent, and this princess tumbled off her horse
I scooted along the bench towards him. He did not budge. My arms yearned to reach for him. It would have been more than natural to put them around his neck and to lean my head on his chest. But this was not natural; this was wrong. The air felt the way it does when tragedy ensues but you have slept the night and awake the next morning not quite sure why there is a weight on your heart. It tasted the way the air tastes when you slam shut the end of a heartbreaking novel and cannot convince your brain that it is the life of a fictional character and not your own that has fallen into shambles. But this was not fiction. And no blissful sleep had erased my memory of why I felt this way. I was reeling, falling through memory after memory of my past, each one reaching out and ensnaring my neck, a noose that tightened minute by minute. I continued to gasp desperately for air. The empty husk in front of me did not move. I lay on the ground for a long time. Once again, music was all I had. I crawled into the melodies; I lodged myself into the spaces between the notes, and curled my back to the world. Then, when all seemed lost, another knight trotted into my life to rescue me, a most unexpected knight, a different kind of knight. Not a lover, but a friend.
Movement IIIMorendo
The bench that I straddled bored into my backside, and I tried to burrow in my hands, hiding my face. My whole body shook uncontrollably, the corners of my mouth were stretched across my face, my eyes were squinted, and my chest heaved. My wet eyelashes felt strange on my cheekbones. My throat made repetitive cough-like noises as I sobbed. My hands were not big enough to cover my face; I spread my fingers desperately but I could not block out the world, could not block out the truth or the pain. I momentarily remembered that I was not supposed to cry in front of people, that I was strong and had not cried in public in years; yet here I was with hundreds of people wandering by. But it did not matter. The tears poured out, unhindered. I could not stop them. I was drowning. I tried to draw breath, but could not. The same words echoed in my head over and over again, bouncing off the sides of my skull and reverberating just as loudly: We are too different for this to ever work. When I finally emerged from the shelter of my palms, still gasping and sobbing, I saw that he had not moved. He sat, resolute as stone, staring down at the table. His hands clutched at his hair, which he had pushed back from his forehead. It sat as a messy mop, causing him to look deranged and angry. His shoulders were hunched upward, completely concealing his neck, and his legs angled away from me under the table, causing his torso to twist awkwardly. Past his vein-ridden forearms, his face revealed no sign of emotion. He might as well have been an empty shell, a cocoon of the man I once knew. His soul might have broken out and flown away in the night.
Movement IVLargamente
It was early in the morning and I was sitting in the band room. The dials of the lockers pressed into my back uncomfortably and I hugged my knees to my chest. I inhaled slowly and a smile crept across my face He was kneeling next to me, looking down into my face. His legs shook gently with the effort of maintaining that position. His shorts hung limply from the sides of his legs and his oversized orange t-shirt crumpled and sagged where it hit his legs, revealing his lanky frame. His shoulders were hunched forward and his skinny arms held a plate covered in wrinkled saran wrap. I know that youre going through a rough time, and I couldnt sleep for I was worrying about you, so I got up and baked you these cookies. His face showed a semblance of attractiveness that would be perpetuated with time. From his neck protruded thick blue veins and his chin hinted at the
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signs of a coming stubble. His glasses were perched on the end of his straight nose, and they hung slightly lower on the left side. His skin shined lightly with adolescent oils, and his raised cheeks were bronzed. His dark searching eyes were wide and lined with long effeminate lashes. His scarlet lips were pursed, revealing the tips of white teeth adorned with delicate pink brace brackets. His hair was thick with gel, manicured back in a wave at the crown of his head, and slicked back at the sides; the comb lines were deep and apparent. He was in close proximity to me; I could feel the heat of his body reaching out and enveloping me. He did not need to touch me or hold me close to remind me that I was loved; he did that with a plate of cookies. This knight had rusty armor, well worn. This knight had leaned down from his horse, had held out a chainmailclad hand for me to grasp. I could reach out and in an instant be flung up onto his horse; we could ride off together and live happily ever after. But I was not ready to turn my back on my knight in shining armor. And I was scared to clamber onto the back of another horse. I knew that this knights trot would not be as smooth as that of my knight. He could so easily trip and spill me to the ground. And I wasnt sure my brittle body could handle another fall.
perspiration and the screen slightly foggy. I peered through the darkness of the morning at the screen and read the powerful words there, simple yet significant: Delete All Messages?. My finger hovered over the button that would secure this fate. A tear slipped onto my lip and hung there. My whole body shook fervently. I allowed my finger to fall and watched as my phone flashed and read Deleting. I thought of all of the declarations it was erasing. The way you make me feel is all I need. You are amazing, Zoe. Sweet dreams, my sweet dreamer. The words that had left me smiling drunkenly as I drifted off to sleep and so elated as I woke up every morning. Gone. I tore my eyes away and saw a flock of birds take flight from a tree, as if startled by my action. They soared up and up, constantly morphing into different formations. I remembered reading once in a magazine that birds took turns being the vulnerable members on the outside, and that they would move to the inside when they were tired. Constantly watching out for one another. On the far side of the field, I spotted a rabbit grazing, its hindquarters wiggling from side to side as its nose sniffed through the grass. From a far distance, I could hear approaching sounds of people, laughing and talking. The rabbit heard this too. It cocked its head, froze, and then ever so quickly darted off into the cover of the trees. Several other rabbits that had been grazing nearby, unnoticed by me, scampered off after the first rabbit. In the distance, the world was becoming pink. The color spread like ink across the sky. Delicate yellows and pastel oranges followed. The sky was soft, a fleece blanket over the world. The warmth proliferated as the light did, executing a slow march from the mountains to the patch of grass upon which I sat. And so I clambered onto my own horse, and rode off into the sunrise. I had embraced the knight in me. And in my head once again: thump, thump, thump
Movement VVivace
A few weeks later, I made my decision. I sat on the field where I had first been shown love and pondered my next move. My throat burned painfully as I gasped for air. My sports bra stuck to my upper back. My eyes burned as the sweat ran into them. My hair tickled the back of my neck and my temples as it blew gently in the wind. I could feel my stomach folded in on itself, the bottom half meeting the top as I leaned forward. The grass cooled the backs of my legs and I could feel the faint tickling of an insect on my right ankle. I stared straight ahead, looking at the distant outlines of mountains and trees. Tears rushed down my face but I remained silent. The last time I was here, he was with me. I was balanced on my left arm and a rock jutted into that palm; I could feel the pain, but I did not readjust my position. In my right hand, I grasped a slender black cell phone. It had traveled with me, the 5 miles from home to here, beneath my sports bra in the space between my breasts and was thus slightly damp with
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Harmony
Horseshoe Bend
Jarrod Mosier Jan Degan
My December
Be kind to me The winter snows are warning Walks grow slippery Winds turn sharper, bone-aching Be gentle with me Time will ease the change As beauty and wisdom grow deeper still Be with me Your presence seeps and warms Lifes worth shimmers, glows, fades, endures
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Rachel Morenz
Barrio Adentro
Body temperature 39 C, 102.5 F. Head swaying in the exam room, eyes slowly swirling over wall-spanning Venezuelan flag, yellow smearing into blue, invades red, a brighter red than the ruby jewels of blood dripping out of my doctor-pricked finger onto the glass microscope slide, red coagulating blue as yellow dribbles onto sterile white. Liquid Louise for analysis. Nmero de pasaporte 401973335. American citizen, at a Cuban-run clinic, in Venezuela. Hemingways house still stands in Cuba, me cay bien, I liked, Carter, Obama reminds me of Carter, he tells me, hands warming stethoscope head, pausing to listen to crackling chest, and catch, yellow speckled red, mucus in a cup. 401973335 scrawled on the side. Che, killed by the CIA, did I know? S. Its a blockade, not an embargodid I know? 401973335-results are in. Platelets-normal embargo Eosinophils-nomal embargo Basophils-normal embargo Lymphocytes-elevated blockade Neumopata inflamatoria. Azitromicina x 2. Ambroxol x 3. Abundance of liquids. Come back in a week, todava-no sabemos, viral or bacterial-we dont know, talk or change-we dont know, yet.
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Harmony
Janet Alessi
Monsoon
Scent of creosote Signals rains passage over Summers desert heat.
Monsoon
Jarrod Mosier
Harmony
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Philly Homeless
Dan Shapiro
Janet Alessi
Waiting
A graceless gown marks Me a patient waiting for My Fortune Teller.
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Harmony
Lane Johnson
Old Doctor Tales

He was a sundowner, according to the staff at my parents nursing home in Prescott. He was relatively quiet during the day, though he kept up a steady stream of high pitched muttering, but as soon as it turned dark, he would get more shrill, and after his wife would leave, he would scream and moan in an incredibly loud voice that upset not only the other residents, but also, at times, the staff. Even though this was in the days of physical and medical restraints, nothing seemed to take the edge off his agitation or vocalization. He would keep it up for hours on end, every night, until the early morning when he would finally fall asleep, exhausted. Kind of strange, dont you think, him being a sundowner, seeing as how hes blind as a bat, said the night nursing assistant, in a not at all unkindly manner. By all accounts the patients wife was a saint. Always impeccably dressed, she dutifully came every day right after breakfast and stayed until just before dark, when she drove herself home. She talked gently with her husband, listened to his complaints, tried to make him comfortable, reassured him, and assuaged the staff that she knew they were doing all they could. Everybody loved her and felt sorry for her. Sometimes the patient would rage against her as well about the unfairness of his blindness and his anger and frustration. I left after the end of summer to go back to college. When I came back at the Christmas holiday, the patient was gone. The wife died, the night nursing assistant told me. I guess she just couldnt take it anymore. He got even worse at that point and they sent him back to the Midwest where he came from. I guess he had some kids there or something. You know, turns out he was a doctor. An eye surgeon, back in the Midwest somewhere. Brilliant, they said. I heard back in the 30s and 40s he invented a bunch of surgeries that saved peoples eyesight. Kind of strange, dont you think, him being an eye surgeon, seeing as how he was blind as a bat, said the night nursing assistant, in a not at all unkindly manner. I was a second year Family Practice resident on my general pediatric rotation at the University Hospital. I was admitting a pediatric patient who was sent down from the White Mountains with an asthma attack the local hospital couldnt control. Dr. T came in and explained that, while he didnt usually admit patients any more, the referring physician was an old colleague and so he came right in. After we got the patient taken care of, we sat at the nurses station and talked for awhile. Dr. T told me how, in the old days, they didnt have much to treat patients with asthma, and resorted at times to Syrup of Ipecac, which made the patient vomit, and sometimes broke the asthma attack. There was often nothing else to do, he continued, but to sit with them by the bedside, trying to help them stay calm, until the episode had run its course. He was grateful, he said, that he had practiced long enough to see new medications and new specialists that could really make a difference for these patients with asthma. When I left to go take care of the next admission, Dr. T went back into the patients room and stayed there with the young fellow and his family for an hour or so until the patient feel asleep. I was struck how, even with all the new medications and specialists, he still believed sitting by the bedside was the most important thing he could offer.
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Mark Joseph DiNubile
A Portrait of a Doctor as an Old Man An Inevitable Trilogy

A PhysicianFathers Lament:
[The Doctor as Dad] Love is not love Until it is tested Tides will recede Once the pain has crested Peace cannot be Unless the swords rested Good can then come When better is bested
Ebb Tide
Sometimes I feel like Im dying Bit by bit Piece by piece Slowly but inexorably First my father Followed by my mother Then my childhood dog Now my childrens dog Tomorrows have become yesterdays So much of me is already gone Soon there will be nothing left
55
I still walk and talk, but its not the same Greeting an old friend, but without any name And the shortness of breath upon climbing the stairs No longer dismissed with a flippant Who cares? That ache in my shoulder which returns every day Might portend a MI soon on its way But now worst of all, when my jaw gets sore Its Temporal Arteritis I most deplore
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Harmony
Lifecycle
Patti Aguilar
Cactus Shadows
Patti Aguilar
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Paul Rousseau
Ridin
I sat in the back of the car as William, my black driver, drove us down a dusty red road to the end of a desolate and filthy lane for a plate of pie. Rhubarb pie to be exact, grown in the backwoods of southern Alabama in the heat of July. I asked William about rhubarb, and he explained that rhubarb is a member of the buckwheat family and is actually a vegetable and not a fruita rather strange ingredient for a pie. Blackberries, yes strawberries, yesbut rhubarb? Best pie in the world William told me. Aint nothin like it. Im takin ya to Mary Lousbest rhubarb pie around. Mary Lous Caf. One of those small white paneled buildings framed by an old screen door that inhabit the back roads of the South, and, according to Southern legend, serve the best food this side of heaven. An hour later, drinking a cup of coffee with an empty plate ringed with the residue of rhubarb, William asked me what I thought was the meaning of life. What is the meaning of life? I repeated. Yes sir, what do ya think is the meanin of life? Why did the good Lord put us here? I thought for a while, my right index finger tracing the edge of my coffee cup as the hypnotic lull of the overhead fan dusted the air. Ill have to think about that William before I can give you an educated answer. He looked surprised. Ya never thought about it before? Well, yes, I guess I have William, but I never came up with an answer. But I think life is full of suffering, and I wonder why, if there is a good Lord, why there has to be all of this suffering. But I also think that amid all of this suffering, there are moonbeams of happiness that jump out every so oftenbut not too often William, not too often. Sufferin makes us stronger, William opined. Yes, I know what they say William, but I just dont buy that explanation. Let me tell you something William20 months ago my wife died, she died an ugly death, it was brutal and callousand I asked God why? Why did she have to suffer? Why did my two daughters have to watch their mother die a horrible death at the young age of 52? Why William, why? William moved his dishes to the side, looked down at the table, then straight into my eyes. My momma died when I was 7, I never got no schoolin, I had to take care of my 5 brothers and 2 sisters. Then, when I was 12, my Daddy died, dropped dead watchin TV. I had to git a job in a factory, did that for 20 years, then started drivin this car, takin all you visitors around. I felt embarrassed. Im so sorry William, it must have been hard. The good Lord has plans for usI reckon I dont know mine yet, but He has plans. And some of us, we never know. But if I didnt drive this car, Id never be meetin people like youI got me a real education drivin this car. I heard bout San Francisco, Atlanta, Paris, Chicago, New York, learned some recipes from a chef from New Orleans, got a book from a famous writer, even put some money, just a few dollars mind you, in a bank, helped my brothers and sisters, heck I even paid off this car last yearI done alright I guess. I sat there ashamed of my grievances, ashamed of my self-importance, ashamed of my impulsive appeal for pity. I looked at William, a smile residing on his dark, worn face, nodded, and uttered Yes William, you done alright.
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Blurred Wing
Tessie OTalley
Harmony
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Big Sky Country

Nancy Huff
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Harmony
Allison Theony
The Skinning of a First Year Medical Student

During my first year in medical school there have been some nights in which I have experienced more difficulty falling asleep than before. Perhaps there is just more in my brainits a jumbled mess of anatomical structures, my to-do list, and neuronal wiring pathways. On certain nights, after a long day of particularly intense studying, I dream medicine. It is in the morning following such a night that I am jolted awake and the first thought I have is lenticular nucleus! or some other previously obscure term that has now become mundane. I am bleary-eyed and for the remainder of the day I find myself in a foggy limbo where the distance between dream and reality narrows. It is not a rare occasion, then, when the contents of my dreams push their way into my consciousness during daily tasks. One day, sometime after our first dissection, the image came back to me that had helped me fall asleep the night before: the scalpel was in my gloved hand and I was delicately and rhythmically trimming the fascia from my cadavers back. With each precise stroke the wispy, web-like fibers were pulled back, elegantly presenting the deep pink of the trapezius that lay beneath. There was something soothing about this actionthe ease with which the layers separated and the beauty of the anatomy it exposed. As this image came to me in daylight, however, it felt deeply uncomfortable. I was conscious enough to recognize the bizarreness of what I had dreamt; I was effectively recreating the skinning of my cadaver. Removing the skin is a necessary dissection step but nevertheless an eerie and troubling task to perform on the body of another human being. Strangely enough, I realized my discomfort this day was not in the action itself; I had mentally prepared myself for countless acts I would perform as a medical student which would fall within the definition of obtrusive or extraordinary. Rather, the discomfort was in the recognition that this crude and almost inhumane action was the very thing that had calmed me the night prior and helped me drift into sleep. I understand that in order to become a successful physician a level of easiness during bizarrely intimate or grotesque situations is advantageous, perhaps even required, yet I cant help but to be shocked at myself. Does this uncover darkness or morbidity about my character never fully realized? Or is it simply an unveiling of my capability to maintain composure under stress or psychologically disturbing situations? I had hoped upon entering this career that I would be able to change or make an impression in the medical field, at least in some small manner. I did not expect, however naive, that medicine would change me, and certainly not so soon. Regardless, I am a little saddened at this transformation; I am hesitant to lose the comfortable distance that most people have with the human body and with death. I remember a particular conversation with a psychiatrist for whom I did research as an undergraduate, when I expressed my excitement over the Body Works exhibit. She said that she did not have any desire to see the exhibit, as it was important to her to maintain a level of uneasiness about deatha quality she viewed as essential to her humanity. Although I see her point and I too have hesitancy to breach that distance, I tend to disagree. When I return to the anatomy lab a semester wiser, I am comforted by the familiar structures I can identify by name or by touch. I can feel the smooth encasement of the external jugular vein of the body on the table, a body I have come to know with great intimacy and respect, and then feel the pulsations of this great vessel on my own body. I am discovering that it is especially when you are faced with stark discomfort, such as dissecting a dead human body, and forced to maneuver in it and learn from it, that the essence of being human is most realized and admired.
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Peggy Gigstad
Strings
The weary one sits on her hollow bones On hallowed ground Her home, the hooked rug, her sleeping dog Outside the long windows red veined leaves scatter on the deck, beyond are piles in the grass, burnished like old brass, Inside, she doses in her soft chair Where she has rocked so many babies Watched her husbands every breath at the last a heavy sweater and afghan cover all but her pale hands thin from years of cookie baking and temperature taking Late autumn holding back winter the white and the cold of it with thin blue strings and parchment paper Diamonds turning inward, saving their light.
Glacier Framed
Nancy Huff
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Harmony
Jan Degan
Switchback
Life lumbers lazily along up the roads, down the troughs, on and on Back and forth, year follows year, the path grows steeper the cliffs grow closer more rocks than stones, twists and turns, switching back Impulse loses ground while wisdom sidles in Here and there, a glimpse, a revelation fleeting, hopeful The path winds wide, opens, fills with light Switchback breathe, slow the pace, the sun lies just ahead
Havasu Falls
Jarrod Mosier
Harmony
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Steven Cushman
When Summer Hits

she hopes it will be better this year she doesnt expect the heat she knows is coming but prays will not
When Summer Hits she buys new clothes leggings and long sleeved t-shirts she hates shorts anything that shows her flesh she stays in her apartment with the blinds drawn
Steven Cushman
Walking
She walks forth back hears nothing but the cries
When Summer Hits she cranks the AC down to 64 she colors her hair she calls home tells her mother she thinks she is getting better Fall that glorious season of corduroys and sweaters is just around the corner.
and screams of her unborn child.
She goes to counseling the bow-tied, tea-sipping man tells her these things happen for a reason, reasons that may not be clear for years, but she should not blame herself should let it go.
So she walks back forth hears nothing but the cries of her unborn child and waits for that moment when the only sound shell hear is her bare feet slapping the hardwood floors.
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Harmony
Brian Bateman
THE FLIGHT
With little conscious effort I pull a colorful, classic card with a detailed lithograph, probably from some forgotten new age bookstore. Not wanting to be any later for work, I tuck it into the personal pocket of my briefcase with a few others for births, an anniversary, and one general greeting. Feeling relieved, amazed and a bit on edge, I bustle off to work, settle in, sort mail and scan the morning paper. After scrawling off the other cards, my spontaneous selection remains stamped and ready to mail. Greeting cards have served me well. Thousands of the same kind printed to legitimize and convey feelings I could not express. Dismissed, perhaps, as saccharin wholesale prose marketed and printed to fill the appropriate social space, but on this day, this card seemed to fit. It really doesnt say My Dear Dad, I am scared to Death to Lose You, but it is inspirational, upbeat and colorful. Rarely do I ever just sign my name to a card. My consumer decision to buy it meant it approximated potential future feelings, but there always seems a need for updating, personalizing, supplementing, or qualification. As I sit at my desk, I am hard pressed to add to his greeting. With great effort I pen a prayerful line of assurance to Dad and Mom. I enclose a recent cartoon and a vacation photo and set out to the mail box on the corner with a noon pick-up. On my walk back to the office I realize my uneasiness and tension from this, my fourth phone call from Dad since I left for college. Two were about heart surgery and one for Moms treatment. I feel an odd mixture of peaceful urgency different from my alarmist reaction to the other crises. Dads description of the procedure sounded so clean, necessary, corrective. And with 80% odds it made surgical sense. Now three weeks later, I remember that card. Despite the last minute bereavement fare, the sympathetic agent found a window seat for me on a full plane. I sit in 22A and swear I was over the wing in this same plane last week when I sat in 14A. My tearless goodbye to Mom has left a swelled, solid mass aching in my throat. The muscles of my limbs are weak from the exhaustive lifetime that I have lived since that phone call. Yet my body is a taut, still well holding tears too tired to cry. I settle into my seat, grateful for the modern day angel, the effortless, efficient travel of the airline. And then the wing... that endless expanse of riveted metal reminds me... wings. The carefully etched design must have been centuries old and now that rich image is forever etched on my mind. The wings of the angel on that card come flooding back. Some careful card company creator matched the type style to the ancient print. It read, I give you wings and on the inside the simple enthusiastic expression, Fly! A collage of memories from the Cardiac Intensive Care Unit, the late ride home, the cemetery, the church and funeral home, and meals at the house seem faded distant details now. I knew in the depths of my being that it was time for my Dad to fly and only today am I realizing what that truly means for me. I acknowledge the power in that simple mass manufactured note card. Gazing across the wing of the massive mechanical marvel that carries me home, I notice that a whole cloud can cover an entire neighborhood of homes. And across the expanse of the earth I see mountains lighten from charcoal to blue until they fade into the bleached sky, thousands of cities, with neighborhoods of homes where people live. As I allow myself the freedom of this vantage point, I understand that I have tapped into a deep well of pain the pain of all the people who have lost parents and their parents parents. I feel that profound collective pain. I also acknowledge the brief glimpse of this small part of the universe. In a minuscule way I feel a sense of the
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whole, a taste of the oneness my Dad must feel a sense of the relative insignificance of this life, this pain. My humble earthly utterance through that note card was not about human permission, rather a brief recognition of the universal love and divine sense of purpose. This journey home is my flying, my living metaphor, helping me to realize the spiritual significance of letting go. It reminds me of the transitory nature of a heart beat. It enables me to feel the powerful, poignant emptiness, the awesome loss, grief and sadness of transformation. I see clearly today and the peace that passes understanding surrounds me, granting a glimpse of the infinite wisdom, the ultimate freedom a freedom that allows me to Fly with my Dad!
Moon in Aspens
Phyllis Kabin
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Harmony
Evamaria Lujo
Surcease
So everything must come to an end. I talk to my long gone friends as if there were still around. I can remember them. Remember their voices, their mannerisms, their laughter, their beauty. At first I thought losing my friends was the end of those friendships. But I was wrong, the lovely conversations continue in my solitude. And so I go on telling myself my story of two. Me and each friend. Off course I know I am not going to go on forever here, sitting at the caf, sipping my delicious coffee, staring at a newspaper like I am reading it and thinking of things I could discuss with these lovely people I miss. But if we put things on a scale and measure the pain of their loss against the joy I had in their life moments with me, I would have to say yes. And the return on my investments would be the conversations that go on.
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Madelon Cook
Sunrise
Im never up early and if I can avoid a sunrise, I do. My central Tucson home of the past two years would only show the sun more than an hour past its rise with trees and homes blocking the view. Not much to get excited about. Then we moved to the far northwest overlooking Pusch Ridge of the Catalina Mountains. The newly built house had picture windows facing east and, unfortunately, no curtains or shades. The only way to sleep past dawn was with nightshades. On my second morning, the unwelcome alarm clock beeped me awake. The sky was a dull gray. No clouds. Flat. So I decided to watch the sunrise. Its nothing like a sunset awash in skyblue, pink and orange. The gray tonalities lighten in the smoothest increments previewing the luminous sun. Still no color but the brown silhouette of the craggy peaks against a lightening sky. The sun seems to swoop down in the west but this was slow as syrup. I considered my friend who was in the hospital after one night in her new house. The gray matched my mood. She wouldnt get to see this sunrise or any thereafter as she was on the path of dying. She would never return to the home she had built, but I didnt know that at the time. Finally, a ray of light tangential to my line of sight peeked between two mountain tops. At first gentle, then airborne, its light blinded. I needed sunglasses in bed and it was hot as a laser. The sky blossomed into white-blue, the dawning of the day. I readied for work, but had to put on a visor to cut the suns intensity. Dread filled me as I left for the hospital prior to my job commute. My friend was agitated and tried to communicate something through her respirator; I couldnt understand what. I finally told her I had to get to work. She shooed me off with her arms since she couldnt speak and that was the last time I saw her conscious. Soon after my one bright sunrise, my best friend, at deaths door, succumbed to her permanent darkness. I returned to central Tucson, where I can avoid the rising sun.
Cat Woman
Tina Alessi
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Harmony
Stacy Nigliazzo
Bare
He has lost his words swallowed them up deep inside the plastic tube through which he now breathes and yet, I still hear him. His pupils quivering, fighting fruitlessly to stay intact slowly spilling over his steely eyes like bursting ink wells. His fist clenching mightily around the locking silver siderail refusing to let go. His very flesh weeping Magdalenawhose name is marked across his chest in striking red script, bordered with roses. I reply with my fingertips flowing through his thick black hair a quiet whisper of flesh, assuring he is not alone.
Waterfun
David Van Gelder
Harmony
39
Shawna Thompson
FINE
I have often felt the aloneness of my life riding shotgun in my wayward conversations. I am no longer a stranger at the University Medical Center North the Cancer Center. They call out my name with assurance knowing I will answer to their call. They blithely ask, How are you doing today? seeing the aloneness in my eyes-they reach out to encompass me with gentle words anchoring me to this world. I answer that I am fine remembering that FINE stands for Fucked up, Insecure, Neurotic, and Emotional. Laughing within my core at the silliness of my mind-I feel my aloneness once more. I always ask then how they are doing-looking at their healthy bodies, catching myself staring at their breasts remembering. I remember waking from the anesthesia with unbounded relief that my breasts were gone. Laughing inside because I feel more whole with the absence of my womanly bosom. It is not my way to say, I am soul sick deep inside but you have cut me, chemo-d me, radiated me and talked me back into existence. Later, I sat through a few support groups listening to complaints and desperation, laughing I turned my back to them knowing in my aloneness that laughter was all I held against the evil invading my body. I am no longer a stranger to that funny little word cancer. It has feasted on me and been cut away from me- leaving me alone deep within my marrow. I laugh, giddy with near vitality.
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Ronald Pust
Full Circle
From Circle to Lamberta mere fifty miles on a straight, lonely road. But today, Im taking a wide circlethe long way home to Lambert. I have just crossed Burns Creek a mile from its mouth at the Yellowstone River in eastern Montana. Burns Creek, which rarely has any water at all, is one of the three streams into which I want my ashes to be scattered. I am not quite ready to have this done. Still, thoughts of cremation can be comforting when faced with the prospect of a cold, crystalline demise. The Yellowstone and Missouri Rivers, respectively, are the southern and the northern borders of the expansive sector of east central Montana best known as the Big Open. And a big open space it is, sand hills scarred by scores of coulees like Burns Creek. One of the least populated places in the continental U.S., the Big Open is home to Jordan, a ranch town of about 200 which serves as its unofficial capital and the headquarters of the anti-Federal Freemen movement. Yet the next town east, Circle, Montana, is the home of the former representative in the House (in Washington D.C.) from Eastern Montana. I say former because in the 1990 census the already sparse population of Montana had not grown enough to maintain two Representatives for the entire state. So in 1992, the Eastern district and the Western district Representatives ran against each other in what is now the largest Congressional district in the lower 48 states. Ron Marlenee, the man from Circle, lost. I, too, nearly lost at Circle. Fifteen miles east of Circle on Feb 24 it was 1 p.m. I had the opportunity to spend 19 hours thinking about the rest of my life, or the lack of it. It was snowing. The northwest wind was blowing. But not until my small rental car came to a sudden and quite involuntary stop did I realize how heavily it was snowing or how little I had actually seen during the previous hour. Forcing the door open a crack, I realized that the front wheels of the front wheel drive car were unceremoniously stuck in a snow drift in the middle of my east-bound traffic lane. The sheer effort of opening the door, and the sharp sliver of snow that blew in during the three seconds it took me to assess the situation outside made me realize that I my situation was not auspicious. To anyone in Montana, ten degrees below zero is not cold. But even Montanans know, from decades of experience back in the days before the wind chill factor was invented, that a minus 65 wind chill temperature feels exactly like 65 below zero. A quick check out the window, down wind, was not exactly reassuring. I was stuck exactly at the 15-mile post fifteen miles east of Circle and 13 miles west of Richey, even smaller than Circle, but Lamberts basketball arch-rival. Driving east in the blinding snow at noon, I had not been able to see any ranch houses on the way. Knowing the sparse population of the area, I knew that the mathematical chances of finding one, within the half-mile I judged I could possible walk in the storm, were quite remote. This realization took about twenty seconds, followed for the next two or three minutes by a palpably real sense of dj vu. I had felt this trapped only once before, eighteen years earlier, when my family and I were caught in an equally impenetrable white-out of storm clouds in the mountains of New Guinea The pilot was trying to find his way out of the evening tropical storm. He had just picked us up on the remote Porgera grass airstrip in a single-engine plane. We were in Porgera because we had been eager to see what was over the next mountain. Unabashed enthusiasm had led us to Porgera and thus into the storm that could have been our last. At that time in the tropics I had felt as I now did in this Montana blizzard: pretty stupid that I had gotten into such a dismal situation. Had the 18 intervening years lent me a little more maturity, I would not have been so intent, on seeing my Lambert High School alma mater play in the local basketball tournament 36 years after my graduation in the midst of this storm. But in Montana in 1994 as in New Guinea in 1976, foolhardy enthusiasm again prevailed. I was faced with a second chance to contemplate not having another chance. The moment after I plowed into the snowdrift, I recalled having heard on the eleven a.m. news two hours earlier that a small plane had gone down in Minot, North Dakota. Oblivious to any implications of
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that event, the survival mode of my left brain kicked in and I began to consider my immediate options: I could wait for another vehicle to come along. I could see only twenty feet in front of me, yet it was clear that the snow had already drifted too deeply for anyone to come west from Richey. Even in the best of weather Montanas Highway 200, which runs through the heart of the Big Open, sometimes sees no vehicles at all for hours on end. Then on the radio came the news that, along with several other roads, Highway 200 between Circle and the North Dakota border near Sidney had just been officially closed. So no one would be along anytime soon. That was the bad news. The good news was that nobody would rear-end my rental car in this blinding blizzard. Could I walk to the nearest ranch house? How many miles would that be? Just opening the door to check my position had already convinced me of the folly of that course of action. The most obvious option was to dig myself and the car out and retrace my tracks to Circle. Could that work in a 65 below wind chill? Was Route 200 drifted in behind me by now? First I had to find out if I had a shovel in the trunk. A quarter hour later I was out-fitted in virtually all the clothes in my baggage, which was in the cars back seat: a scrub suit, two pairs of cotton pants, nylon storm trousers. These, interspersed with four pairs of socks of various lengths and my oversize shoes, might be enough in the wind and snow. Adding two undershirts, a shirt, a pullover sweater, my Lambert Montana 1989 Diamond Jubilee red high-school lettermans jacket and a green wind breaker outer shell would do for the torso, especially with head band and a stocking cap with a liner that pulled down to cover the whole head and neck, except, burka-like, for the eyes. Two pairs of gloves, one cotton and one leather, completed my space suit. Exiting through the downwind south door of the 1993 Dodge Shadow, I opened its trunk, unprepared for what I found nothing. No tool kit, no shovel, no chains, not so much as a window ice scraper. I had lived in Arizona too long and had been as negligent as the rental agency in ignoring the instinctive precautions that any true Montanan would have taken. This fruitless search took only fifteen seconds, leaving me enough extra-vehicular time to look under the front wheel drive car, only to find that in the short few minutes it had been stationary the entire front
suspension was drifted in with snow. I looked under the hood and was greeted by more snow, which had blown inside the engine compartment. Two minutes in the wind forced me back inside to contemplate the next move. Without abandoning the idea of retreating to Circle, I scanned the fifty foot radius of eerie translucence visible through the blowing snow. A barbed wire fence was down-wind on the right. I saw a three-foot elm stick that tightened the fence wire; I knew from experience in building such fences that it could be removed. After running the engine and the heater enough to warm myself for the next extravehicular foray, I ran through the snow downwind and easily unwound the potential lifesaver from the fence. It would serve as an excellent digging stick for the snow, in much the same way that similar sticks serve New Guinea women as they till their hillside gardens. Making my way back to the car against the wind was another story. The three or four minutes this took was enough to numb my nose and ears even under the face stocking. Crouching behind the right rear wheel on the sheltered downwind side, I began to dig out. I cleared the minimum amount of snow from the wheel that I judged necessary in order to back out of the drift. Then I surveyed the upwind side of the car, finding less snow of course. But enough snow had blown into strategic chinks and channels to completely encase the front suspension and axle in ice. Yet dislodging the car was still worth a try. So, gunning the motor and attempting to rock the car from reverse to low and back no small task without a stick shift I soon realize that the wheels continued to spin helplessly, seemingly not making any contact with the pavement at all. A second inspection under the car clinched the diagnosis: the snow had drifted so tightly into the cars front end that the heat of the motor, which had I alternately turned off and on, had thawed the snow. It had then quickly frozen again into distinct layers of ice. The ice locked the steering mechanism. To make matters worse, it had literally, as a result of the expansion of the water as it froze, lifted both front wheels half an inch off the pavement on a literal pedestal of ice. No wonder the wheels spun so freely. This was not the time to have a front wheel drive car, but I did. Standing on the front bumper and rocking up and down had no effect. Another reassessment: Without help the car was not going anywhere until it thawed. Montanans know that a thaw may not come for weeks. I would be there for a while. All other options foreclosed, repressing the realization of what
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those foreclosures logically led to, I considered how well prepared I was to spend the night in the Dodge Shadow Motel. It was still only two-thirty in the afternoon, 90 minutes after I had driven into the snowdrift. This should be the warmest part of the day, but the blizzard showed no signs of abating. Still, through a variety of circumstances not easily explained as merely fortuitous, I was not ill- prepared. The many layers of clothing I had on had kept me warm when I was inside the car, even with the motor off for fifteen minute stretches. Perhaps those stretches could be stretched out even longer. It was still four hours until dark if it could get any darker and then thirteen more until dawn. The 2:30 p.m. radio weather report predicted that the blizzard would be over at dawn. It also gave an update on the plane that crashed in Minot, N.D. It had been chartered by the Indian Health Service. The three Indian Health Service employees and the pilot had been killed, having missed the runway on the third approach in same storm in which I found myself. Maybe three chances is all anyone gets. The next of kin had not yet been notified. I repressed a premonition that I knew who was aboard the plane. Earlier, when I filled my gas tank at Miles City, a town of 8,000 and the largest in Montana east of Billings, I had just happened to choose a truck stop. This truck stop just happened to have a convenience store in which I had bought two dozen cookies to go with the large bag of peanuts that I always carry around, even to office meetings in Arizona. Curiously, I bought a travel alarm clock, event though I had no need for one on the trip, and therefore no need for the batteries which I had also felt a compulsion to buy. Hearing on the radio that the Lambert High School basketball game to which I had been headed in Wolf Point had been postponed for at least a day, until the blizzard blew over and the roads were unblocked, I contented myself with listening to another tournament, from the southern part of Montana, where the storm was not so severe. Somehow or other, I would get my fix of Montana high school Class C basket ball. In Montana, Class C is reserved for those high schools with fewer than 100 total students. In Lamberts case, the present years count is 44. When I graduated it had been 36 and it had fluctuated between the two numbers ever since. Eastern Montana is not a place that has changed a lot. But my respect for Montana winters
had waned, weakened by ten years in the tropics and even more in Tucson. I knew I couldnt stay awake until morning, but I knew equally well that it might be fatal to go to sleep. The exhaust system was intact and the tail pipe free of snow, so carbon monoxide was not a danger. But I calculated that I did not have enough gasoline to run the engine continuously to keep myself warm. Equally, I knew that I would freeze or the motor wouldnt start again, or both, if I did not run the engine with some regularity. The casually-purchased Miles City alarm clock, batteries now installed, gave me the confidence to commit to what any Montanan foolishly backed into this corner would know was the only plan. Fortified with the knowledge that I had a bit more than a quarter tank of gas, the fortuitous alarm clock, the customary cookies, and some snowmelt for drinking, I calculated that the north wind from Wolf Point could be held at bay through the long Montana night. I would run the engine, heater, and radio, to hear weather reports and basketball games, for fifteen minutes each hour. I could then get some 45 minutes rest, confident that I would wake to the alarm clock set to ring each hour on the hour. I was quite sure the plan would work, even though the howling wind and the opaque whiteness of the snow from the northwest showed no sign of desisting and the road ahead was drifting a deeper white the few hundred feet the eye could see. I felt a peaceful confidence that I was to survive. But I was equally chagrinned at the distress I must be causing my family in Tucson and my family in Montana, who by this time, 4:30 in the afternoon, knew I was overdue. The thought was enough to give digging out before dark another try. Warmed by the heater and armed with my digging stick, I emerged ready to do battle with the ice man. He immediately won the round. The front end of the car and its drive shaft were impervious and immobile, frozen in compacted layers of ice. The front wheels had risen another half inch off the pavement. The slow, stalking darkness would soon descend over the drifting white dust of mid-day. The wind was howling colder now or was it the legendary wolves at Wolf Point on the Missouri River bank, fifty miles to the northwest? The later the hour got, the more sure I became that I would be considered a missing person, at least if anyone in Arizona knew that I had not reached my destination. Montanans, in contrast, have been in
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blizzards before. My father and I have seen 51 degrees below zero on our ranch south of Lambert. So, I was sure that I would see him and all my family again. But how could I let them know of this certitude, however misplaced? I had no way. Weve all heard the adage, the devils in the details, to denote the difficulty of carrying out a plan that seems so clearly correct in theory. Yet, in the midst of my predicament I felt Providence in these details. Somewhere, someone had been praying that my guardian angel would compel me to buy a clock I didnt need and carry an extra measure of supplies that would have been superfluous for such a four-day foray, even in February. Ten oclock. Lavina had just squeaked out a win over Ekalaka in Montana District 4 C. Basketball is over for the night. The news tells of more road closings and predicts minus twenty degrees in eastern Montana and western North Dakota; the blizzard will continue through the night. It is time to sleep until the 11 pm alarm, then until midnight, then 1 am, then At the two a.m. alarm, and again at the three, the fury of the wind drives sheets of snow across the windshield like a television station that had signed off for the night I wonder every hour, on the hour, whether indeed the storm will stop. I wonder if those I love are also awakening every hour with a start as my alarm rings or whether, indeed, they have slept at all. It is 5:00 a.m. I awaken in an eerie light. The fuel gauge now shows less than a quarter tank. It cant yet be dawn, in February, in Montana. I know it is not the sun, still two hours behind the invisible North Dakota horizon. Out of the south window I see the full moon. It is shining on the snow. The landscape is grotesquely sculptured but the sculptor is now silent. Snow-statue fence posts and drifted gargoyles are mute monuments to his icy evil anger, now spent. The whiteness of the moonlight stretches farther than I could have seen in yesterdays darkened daylight. The blizzard is over. The dawn will come. Seven-thirty a.m. February 25, 1994. The eastern sky, orange and pink, heralds the sunrise. The snow shadows are pale blue, reflecting the pristine sky. The storm is over with the dawn of this new day. Christopher Krogh, M.D., age 45 my friend is dead. Along with two other Indian Health Service doctors and their pilot, all perished when their plane crashed in
the same storm. The radio news identifies them. Their relatives have been notified. Hours before, I already knew. In the middle of the night, I knew. I pound my gloved fists on the dashboard of the prison that sustained me through my own small ordeal. I shout, God! How could this happen? I am spared in foolhardy pursuit of a game. Chris Krogh is killed in the line of duty, during his monthly winter rounds among the Native American Nations of North Dakota, who, like all of us Northerners, search for ways to prosper in the brief summer of the Plains. He is killed while working with their weakest, the women and the children, while helping them to steel themselves against the blinding snow and bitter cold winds that ultimately steal his own life. It is 8:08 a.m. In the splendid sun-bright snowy stillness, a snow plow snorts over the western horizon. In four minutes it will be here. I will crawl under the icebound car, attach the snow plows chain, break a bumper brace. But with ultimate ease the giant machine will free the Dodge from ices diabolical grip. Free at last. Free to retrace my route to Circle. Free to rejoice, rejoin, and reassure those who wait for me. Despite an indelible irony that I cannot erase but will not accept, a caprice that I will continue forever to rail against, I believe, and I believe that someday we will all believe, that Chris also is free at last.
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Cupid and Psyche and Skip

Skip Kriegel
Harmony
45
Stacy Nigliazz
Haven
0430 in the Emergency Department. Two hours after the bars have closed. One hour before evening pain stirs inside the first white slivers of daylight. Black coffee in the ambulance bay invites the retrieval of lost breath and strained lucidity. Only a moment to linger fealty in need, like suffering, observes no hour and grants no lasting reprieve.
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Lorena Borilla
Yellowtail
There was a notice outside her door and it read neutropenic precautions. I put on my mask and gloves and opened the door, hesitantly. This fragile, thin Caucasian woman with long arms was sitting at the edge of the bed. Her husband with grey, full hair and dark, black framed glasses was in near proximity with a computer on his lap. She sat there quietly eating vegetable soup and I stood there looking at her with great surprise as to where to begin my interview. Hi, I am going to be your doctor tonight and what is your name? is always a good start when you are suddenly dizzy and there is loss of words. I was jolted because I did not expect to find her looking so ill. How would I gain enough time to collect my own demeanor and slow my heart rate? She told me in a soft-spoken voice and before I got to gather her clinical history she told me that her grandchildren were drawing yellow people like her grandma. I have been eating too much yellow tail sushi she responded and smiled vigorously. I told her that maybe she had been eating too many bananas and we both laughed. She was indeed yellow skinned including her sclera. She is swimming underwater struggling to be set free and afloat. She sees no end and no light at the end. She feels powerless in her ability to release herself from the sick role. Countless conversations existing between her angels and demons lead her back to the initial start line of her dismal diagnosis. Sometimes she feels like a child playing a piata, with her eyes covered with a cloth and as her body is turned in circles, clueless where to aim and hit. She is dizzy and drunk, but not from chemical intoxication. She began to tell me how she wanted to be fully resuscitated in the event that she would be close to dying and wanted all of it to be done. She was only fifty-nine years of old and despite her stage IV colon cancer with liver metastatic lesions and peritoneal implants she was a fighter. This was her personal battle with the bodys cells that lost the power to die. Yet, that moment that I saw how she had come to peace with her cancer and that moment in the room was as if someone had held the clocks minute hand. She is the five year old child in a swing and as it pushes her higher and higher she would like to jump off and land on the floor to feel the ground. She imagines the earth beneath her feet. She wants to know that she exists for herself and not to lead this fight against it.
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Marilyn Halonen
Science Is a Pursuit and Pursuer

Visions foggily cloaked in memorys mystique enter at will and bring to mind all those hours in the classroom and play and labor of love at the bench. We were sure then science was absorbed passively, was our plaything, was simply a tool, our tool to lay a foundation for future career and that was that. Soon, though, seeping in, curling around the facts and the tests and test tubes we began to have an inkling of being invaded by a living thing with a beating heart...
(continued on the next page)
Antelope Canyon
Kyle Sinclair
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(continued)
...We were and remain still without defense, still owned, still used by the invader to spew out here and there bits and pieces of itself,
Antelope Canyon
Kyle Sinclair
Joining a community of others so invaded we send forth these hot coals that in their dissemination have enlivened and will utterly transform life on this planet.
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Denis Pivniouk
Summer In Russia
I step onto the jet bridge. The cool wind tears through the narrow gap between bridge and plane, bringing with it equally chilling drops of rain. It is the middle of July. The bridge ends and as the door swings shut behind me, I glance through the wall sized window on my left. The sky is gray. It has obviously never heard of the word blue, and is proclaiming this fact defiantly to the world. Raindrops thump against the window and squeak down, leaving dirty gray streaks behind them. The flow of people behind me picks up and carries me down the hallway to where there is no more window. There are, however, stairs, which lead into a lamplightbathed lower level. The room is crammed full of people and inundated in noise. The human river propels me through the throng and then slams into the mile long line stretching from the booth marked Passport Control. I let my eyelids droop and wait. The escalator slides slowly down into the depths of the Earth. It is one of the few in the city that take longer than two minutes to carry a rider to his destination. Large advertisements plastering the sides of the giant tube crawl slowly past me, inundating me with calls to purchase tickets to Spain, shiny new shoes, and cutting-edge cell phone cases. There is a steady hum of voices resonating all around, as well as the dull roar of the subway trains screaming past below. The distant platform is still just barely visible in the distance. Time has slowed in this tunnel, withered away to nothing. There is nothing but noise and people in this place. A man on the step above me shifts and loses his balance; he is forced to step on my foot to keep from tumbling down the steps. A businessman practically flies past me, skipping over three steps at a time, his black suit open and his crimson tie flapping behind him. Several people stare after him. Most, however, are lost in their thoughts and are turning their heads absentmindedly back and forth, their eyes following the stream of advertisements up to the surface. I too succumb to the hypnotic colors and shapes of the posters, nearly forgetting where I am as the steps begin to disappear into a dark slit in the ground. With a slight hop I keep my balance, but quickly lose it as the mass of people behind me forces me into the wall of backs trying to squeeze into a much smaller tunnel leading to the platforms. The swift current of shoving bodies propels me onto the platform and dissipates ever so slightly. The ornate chandeliers throughout this cavern make it much brighter than the preceding tunnel. The shadows are forced to the edges of the platform to lurk amongst the pillars which curve away into the ceiling. They are riddled with bronze designs and each is adorned by a large painting on one side. A brief glance at a sign hanging from the ceiling tells me to join the shadows on the right side of the platform. From here, brass plaques with the word Kievskaya can be seen hanging over the rails. The pressure of moving bodies is constant here. More people are streaming in from the opposite end of the cavern, where another escalator is just visible. The two crowds meet in the middle of the cavernous area and merge together. Further confusion is added by those transferring from the neighboring station by means of a staircase that deposits them squarely at the point where the two main masses of people become one. Suddenly, there is a screeching roar, and a train bursts from the dark opening to the right of the far entrance. It streams into the station and screams to a halt. As I am rushed inside, I see that people are even more tightly packed in here. There are no vacant seats, but neither is there a need to grab ahold of something, as there are no areas where one can fall without first pushing aside someone else. The doors squeak together, and the platform retreats behind the train. It isnt quite pitch black inside the compartment. It is simply filled with that sort of grayness that makes you long to shut your eyes and dive into the relaxing darkness behind your eyelids. My glasses are partly dangling off of some netting pretending to be a shelf on the wall to my left so the grayness is blurred further by my vision. It is as if an Impressionist painting has been drained of both color and contrast, leaving only ghosts of the original image behind on the canvas. I stretch my arm out at the ceiling and stare at my hand, slowly bringing it closer and watching it gradually swim into focus until it covers my eyes and blocks out the gray.
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Somehow the darkness demands silence, and so I feel as though Im being smothered by it. But something squeaks and the spell is broken. In a moment the monotonous ba-du ba-du of the wheels on the track bursts forth and fills my world. I suddenly realize that there is an earbud whining quietly in my ear. The sound is partially drowned out by the train, but I can barely make out the screeching guitars of a song that stubbornly refuses to fit my setting and mood. I stab at my iPods controls with my finger, switching it off abruptly. Dropping my hand into the space to my right, I find the second earbud dangling forlornly above an empty cup of tea. It is yanked up and, together with its technological partners-in-crime, is shoved next to my glasses. I squirm and turn over without slipping and plummeting off of the bunk. The window is curiously covered only in the bottom half, leaving a slice of the world outside easily visible. I peer intently into the darkness, but there is currently a solid wall of trees passing us by. While the stars cast a weak, gray light over the land and succeed in partially illuminating the interior of our compartment, the wall of trees is too much of an obstacle for them, and at the edge of the forest, pure darkness begins, sucking me closer to the window to gaze at things that are impossible to see under the veil of night and shade. As the train clears a bend in the track, a sudden spot of light whizzes by. Then another. The diluted yellow lights sitting at the top of the lampposts briefly illuminate the section of wall above the top bunks before rushing off into the distance. They feebly slap at the face of the darkness, pressing at it and forcing it to huddle in narrow slivers between the circles of light around posts. Suddenly, the train begins to slow, and its monotonous rumble starts to fade away. As I stare intently out, a platform slides into view, and starts to run alongside the train. A sign perched atop the platform floats lazily past, but the letters run together in the darkness and escape me. I stand upon the gray stones of the Red Square, staring up at the structure before me. Its main body extends
upward for no more than five stories, yet it appears to dwarf all that is around it. Placed conveniently at the main entrance to the square, it provides a sharp contrast to the miniscule figures of tourists swarming about it. The building itself is a mass of architectural activity. Windows dance about its face, changing scales with every floor, but never shrinking below the height of a grown man. Turrets of various shapes bustle among the windows, covered by intricate molding. The great red facade is further accentuated by the overcast sky behind it, further dominating the area. Shreds of exclamations and words in many languages float past, but slowly slow and dissipate. The structure and its contents overpower everything, in a way that cannot be conveyed by the ridiculous bronze plaque by the entrance proclaiming: State History Museum. The unwavering wall before me presses at me with the full force of the millennia it protects. The footfalls about me are those of merchants, of warriors, of statesmen long gone. The history behind this scene smothers me from hundreds of years before Columbus had even dreamt of the sea. It overwhelms my mind and pulls me in, and in I go, succumbing to the pressure of ages. A sense of urgency grips me and forces me to sit straight up. I slide myself to the foot of the bunk and slip off, landing silently on top of my sneakers. Jamming my feet into them, crumpling the back of one, I carefully slide the door open. A sudden beam of light stabs at me from the outside hall, blinding me and drenching the compartment behind me. I dart outside and shut the door as fast as I can. Weaving slightly, I hobble to one end of the car, still trying to work my foot into the shoe. Quite unexpectedly, the train finishes its deceleration, and I nearly tumble forward onto the floor. The conductor slinks from his own private room and gives me a look. Then he proceeds slowly to the door and swings it open, letting a burst of cool, night air to rush to meet me as I stumble outside.
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I stand on the platform slowly taking in the view and fighting an unbearable urge to lean coolly against the train. The air is cold, and the slight breeze rips through my T-shirt and chills me as though it is the freezing wind of Siberia. A shiver runs unstoppably down my spine and I clasp my arms tightly around me, daring the night wind to force me to retreat to the cover of the trains interior. Several insomniacs are shivering near the train, and bits of conversation drift over from people wandering near the neighboring cars. The conductor is the image of impatience, lounging casually by the steps up into the car, arms crossed and eyes glaring disapprovingly at the sleepless few gathered by him. Three men huddle off to one side, lighting up cigarettes with a lone lighter. Another passenger stands to my right gazing upward. My eyes follow his gaze, but meet only a gray sky, with occasional gloomy clouds crawling across the sliver of moon that can be seen above the train. My sight sinks slowly down at the station itself. It is an odd place to make a half hour stop. There are certainly no new passengers bustling up to the train; the only silhouettes around me are those of other nighttime wanderers. The station building itself is impressive for a tiny place near the border. Our car has pulled exactly up to the main building, and now I stare at the dark hulk. The weak light around me is unable to penetrate the shroud of darkness draping over it, but two short wings and a church-like steeple can be seen contrasted against the sky beyond them. The looming building beckons me forth, so I take three steps forward. I then conscientiously glance around me to see if anyone has noticed my advance. I am rewarded by another glare from the conductor, who then looks meaningfully down at his watch and peers at me from the darkness thrown over his face by his cap. Letting a single quiet sigh loose into the night, I stop and turn back to the station. To my surprise, my slight approach to the building and the adjustment of my eyes to the darkness have suddenly allowed me to make out the station much more clearly. I can now make out the dark outlines of the dirty red bricks that its built from. The windows seem to be gaping wounds in its sides, leading into a
seemingly empty interior. Even from here I can see that the glass doors leading inside have been scratched and worn to the point that you can barely see through them. Even the drying ivy on the right wing seems to be hanging rather lazily, unwilling to even bother trying to take over the wall. I he builamg appears hollow behma its dark windows; the space enclosed by the walls is filled only with darkness. I step back, and at that moment, the trains whistle blows, shattering the buildings grip on me, and I pile aboard along with the others. I walk slowly along the sidewalk to my grandparents apartment building. It is swiftly getting darker, but the mix of pollution, clouds, and tall buildings keeps me from being able to see any stars. I pass through a row of street vendors. The longest line has formed by a small kiosk selling various meats, but the neighboring bread salesman is having a busy evening as well. Not as many people are attracted to the stand of fruit, which has been open all day and has had ample time to soak up the exhaust fumes of passing cars. I quicken my pace as the daylight starts to fade at an accelerated velocity. The vendors start closing down, and their customers dissipate. Nobody seems to be going my way though. A small beacon of bright light swims past on my right as I pass a tiny shooting gallery. It is still apparently open, and illuminated quite well, but the doors are closed, and I see no people around it. The gallery marks the end of the vendors, and the street plunges into darkness and silence. I focus on a point of light visible in the distance: the supermarket that marks my left turn. The bright lights of the gallery have left my vision wounded and struggling to come to grips with the darkness. As they finally adjust to the lack of light, a group of stray dogs appears to one side of me. They slink smoothly down the side of the street, like wolves prowling through a forest. Their gaunt, ragged bodies heave visibly with every breath. Most of the pack ignores me, not sparing me so much as a glance. One of the smaller ones, however, swivels its head to glare at me through small, evilly glinting eyes. It lets out a low growl, pushing me involuntarily to the
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other side of the street. I quicken my step once more, but this stray has got its eye on me. It breaks with its mates, who spare it no attention and continue in the opposite direction. The street is now empty besides me and my gray companion. I try to keep my eyes on the street in front of me, ignoring the menacing presence at my side, but it is no use. The dog utters a sudden yelp and plunges at me from the shadows. It streaks to my sandaled feet, and closes its teeth around one of them, luckily striking only the band of the sandal. It is unnaturally thin, and all of its ribs stand out eerily through its fur. The fur itself is matted and dirty, and one of the dogs ears is torn. I swiftly bring about my right arm, which is holding a heavy bag with two bottles of milk. The bag strikes the dogs head, tossing it away from me. It yelps and springs back into the darkness. The mans face lacks malice; lacks any sort of emotion really. His eyes stare blankly at the documents as his fingers dance nimbly over his keyboard, inputting the magical formula that will open the way for me into the country. The man on my left with the large suitcase and the little girl at his side taps his foot, glancing up at the clock. My fingers drum idly on the top of the border patrolmans podium. He snatches up a stamp and jams it violently into my passport. His eyes remain glued to the screen, half closed, but his fingers gather up my passport, my other documents and press them smoothly into my hands. The din in the room suddenly strikes me with its full force as I step past him into the baggage claim area.
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Backyard Morning
Htay L. Hla
Moon is Out
Jessica Serrano
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Thank You
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Written Work
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SUBMISSION GUIDELINES
Harmony, a literary journal of essays, short stories, poetry, visual art, and photography is a publication of Arizonas College of Medicine Program in Medical Humanities. Students, faculty, and staff of the Colleges of Medicine, Nursing, Pharmacy, and Mel and Enid Zuckerman Public Health are encouraged to submit original, unpublished work to our journal, however, anyone may submit work. Work on all themes and topics will be considered, especially those related to the world of medical humanities. Failure to adhere to the following guidelines may result in the piece not being considered: All written submissions should be no more that 5,000 words with spelling & grammer checked Work must be titled, double-spaced, 12 point font, and with the title and page number as headers on each page. Previously published work will not be considered. Submissions are accepted only via email. Submissions should include on a separate cover letter the authors name, mailing address, email address, and phone number. 7. The preferred file form for documents is Microsoft Word.
Visual Work
1. Artwork submitted electronically is preferable in a CMYK 300 dpi TIF file. 2. All work must be titled. 3. Submissions should include on a separate cover letter the authors name, mailing address, email address, and phone number. Each published contributor will receive two copies of the journal. Thank you for your interest and submission to Harmony
SUBMISSION DEADLINE April 1, 2011

Send submissions to:
harmonymagazine@gmail.com All works are eligible for: Mathiasen Written Art Prize ~ $500 Kenneth J. Ryan Visual Arts Prize ~ $500 There are two prizes awarded in each category and one is for students only!
Please direct any questions to The Editors at: harmonymagazine@gmail.com. Thank you.
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Frost
David Van Gelder

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I hope you enjoy this years issue.

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Mathiasen Prose Award Winners

Kenneth Ryan Visual Arts Award Winners

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How to produce a bad patient.

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Final Words in the ICU

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Passion and Privilege

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Blue Moon Over Madera Canyon

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Ana Marie Lopez

THE SOUNDS OF VIOLENCE

Homeward Bound at Sunset

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Ana Marie Lopez

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Lost and Found

Movement IAllegro Maestoso

Movement IIAllegro Appassionato

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Old Doctor Tales

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Mark Joseph DiNubile

A Portrait of a Doctor as an Old Man An Inevitable Trilogy

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Big Sky Country

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The Skinning of a First Year Medical Student

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When Summer Hits

and screams of her unborn child.

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