voices aliterayjournal
voices about us
Voices is a literary magazine of the Duke University School of Medicine. We publish varied forms of creative expression from the medical community, and welcome submissions from patients, students, healthcare providers, employees, families, and friends. Our goal is to publish a range of unique voices in the healthcare system. We hope that as you read through the pieces published in this issue, you will be inspired to submit something as well. All submissions can be sent to voices@duke.edu. For more information, please see sites.duke.edu/voices/submissions.
letter from the editors
Transitions are hard, but they are inevitable. As organizations and individuals grow, we aspire to become better versions of ourselves as new leaders step in. For Voices, the time for change is here as we renew our commitment to sharing every perspective and to our community. Time marches on, and we have come so far since this endeavor’s humble beginnings–and since the pandemic began. We must make sense ofthisbravenewworld;wemustretectonwhowehavebeenandwhowehopeto become. In the face of obstacles, we conjured beauty and forged on with new connections, even ones spanning across miles of ocean waters. Sparks of wonder ignited with the next generation stepping into the hospital, into the freshly pressed white coats, into shoes that will be well-worn soon enough. We confronted our fears, and sometimes our fears confronted us. Sparring with the shapeshifting specter of the most famous disease to roam the Earth in decades, we learned to see its many faces and we strive harder to see our patients’ many faces. Turning to what is within, may we look for the light in the dark, see the dance in eachstep,hearthesongineveryword.Maywendstrengthineachother,andi the professionals too— because too often, we imagine that we can do everything on our own. May we be gracious towards those around us, and–perhaps most of all— may we extend that grace to ourselves. As always, we thank the Trent Center for Bioethics, Humanities & History of Medicine for their unwavering support while we welcome a new chapter and a new email to pair with it (voices@duke.edu). We hope you enjoy this issue and invite you to send us your thoughts and comments. Please reach out with your new submissions and inquire about joining the Voices editing team!
/AYO8T’(SI*N{*RAPHICS
ucL yZheng
Your co-Editors-in-Chief, Devon DiPalma, Emily Hatheway, Linda Li, Lindsey Chew, and Rui Dai
table of contents Letter from the Editors Devon DiPalma, Emily Hatheway, Linda Li, 2 Lindsey Chew, and Rui Dai Feel This Kassie Shannon 4 The First Time J. Trig Brown 5-6 One Size Does Not Fit All Simone Nabors 6-7 Chorea Magic Emily Hatheway 8 Living with Color Linda Li 9 Fractured Anonymous 10-12 ERA UN LAVORO SICURO Maurizio Portaluri 12-13 RetectiveChaos Jennifer Okunbor 14 Pieces Laura Mobley 15
associate editors Kate Daniel Nathan Luzum Lucy Zheng David Ryu
MS1 MS1 MS1 MS2
Mariam Ardehali MS2 Austin Ayer MS3 Seth Flynn MS3 Kira Panzer MS3
Megha Gupta MS4 Rosa Yang MS4 Federica Mosti GS2 S. Tammy Hsu, MD PGY2 Natalie Chou Undergraduate
faculty & staff editors | Trent Center Advisors Karen Jooste MD, MPH Sneha Mantri MD, MS Brian Quaranta MD
Jeffrey Baker MD, PhD Marjorie Miller MA Nikki Vangsnes
feel this “Feel this” the attending said as he grabbed my hand and placed it gently on the aorta of the beating heart. “You can feel the thrill of blood passing through the stenotic aortic valve.” Sure enough, with every heartbeat Icouldfeelasubtlevibrationbeneathmyngertips, the gentle thrum of blood being forced through an opening too small for its given task. “Can you feel that?” I answered with a quiet “yup” too caught off guard to come up with a reply that encapsulated my wonder at feeling a beating human heart forthersttime. I’d read about aortic stenosis. I’d heard the telltale murmur at the right upper sternal border. I’d seen the gradient across a stenotic valve on an echocardiogram. None of that could compare, however, to the experience of feeling pathology on the surface of a human heart. Kassie Shannon is a fourth year medical student at Duke University School of Medicine.
‹¢›‹.fi⁄.fifl¤¢‹
the first time
opportunistic infections. In 1991, there were few effective antiviral medications and the prognosis of advanced HIV/AIDS was grim. My surgical It was bound to happen sometime; I knew it would. Palliative Care consult request. colleague was correct; my patient was close to the end of his life even with a successful surgery. COVID-19 positive patient. Needs help with symptom management and goals of care. Criti- I accepted my colleague’s recommendation and we took the surgical option off the table. cal Care Unit Duke Regional Hospital. However, while logic eyed this clinical situaI am prepared, am I not? I have read the journals, waded through the guidelines, viewed and tion, my right brain sat stunned in disbelief that the surgeon would even voice a reluctance to reviewed the videos on donning and dofng. And I have seen the news, read the testimonials operate based on my patient’s HIV positivity, based on a potential risk to himself and his surof exhausted health care providers on the front lines, and watched as our hospital prepared for gical team. Was this an ethical stance? Slowthis surge with increasing anxiety. I am scared. ly and steadily, my right brain awakened to a Heart rate up, I feel my anxiety rising as I enter beautiful harmony of ethical principles: duty to treat, social contract, public trust, societal obliour Critical Care Unit. “Sarajane needs you in 12,” I hear as a nurse gation. Awash in a song of self-righteous indignation, I silently vowed in 1991 never to let the slaps a walkie-talkie into my left palm. Trying to risk of exposure prohibit ME from helping when appear calm and cool, I blow my cover fumbling with the device. Finally, forced to admit com- I believed I could. Trumpets sound in the backplete naiveté, I ask which button I press to speak. ground; the clouds part and I am ascending effortlessly in a golden chariot back to 2020. “Yes, I see Sarajane through the closed glass doors of his CCU room. “Are you coming in here? He’s Sarajane, I’m coming in.” The messenger who earlier gave me the walkin a panic,” she squawks clearly over the handset, loudly enough for all those gathered outside the ie-talkie and the tutorial of said device purposely and condently asks, lRegular or small si room to hear. To me, her question morphs into N95?” Then she leans closer so only I can hear, a test of character, my character, as suddenly it is “I’ll take care of you.” And she does. “Take off not 2020, Duke Regional Hospital, Critical Care Unit, but rather 1991, Durham Regional Hospi- your white coat, hang it here…put these booties over your shoes.” tal, Emergency Department. At this point, the federal prison guard sitting In my mind, I am standing by a stretcher. My patient, a young man with advanced HIV/AIDS, outside the patient’s room stands and offers me is writhing, a perforated viscus the likely expla- her chair. I think she notices that my hands are nation for the pain and the pneumo-peritoneum shaking. “Please sit here, it’s hard to put those seen on CT scan. The General Surgery attend- booties on while standing.” Our eyes meet. A ing, a respected colleague, is categorically ex- trained prison ofcial, I am sure she smells m plaining why he is not going to take him to the fear. Is that a conspiratorial wink of her eye? Booties now on, I am asked to stand. My paOR. “…Grim prognosis…poor wound healing… tron saint wonjt change his overall outcomevcanjt x continues the ritual, as I am gowned, gloved, masked, and shielded. I would not have this…don’t want to expose my surgical team to felt safer if she had wrapped me from head the risk of infection….” to toe in plastic wrap. In fact, I wonder if that Wait, did I hear that last statement correctly? Was he basing his decision not to operate on fear is what she did as storm clouds race across my once transparent shield. She aims me towards of infecting himself or his staff with HIV? My left the door and after what feels like several minbrain was processing the data: free-air on CT in utes of me pulling on the door handle, she genthe context of advanced HIV/AIDS complicated by pancytopenia, thrombocytopenia, and prior tly removes my hand and pushes the door open for me to enter.
one size does not fit all
Our patient lies with mouth agape. Beads of moisture coat his furrowed brow. His head apI have always had a physically large head. pearsslightlyaskewasif thenoisyhigh - towox While tests and visits to specialists as an infant ygen is blasting his head backward and to his showed that I was in perfect health, the size of right. Lips, bluish. Nails, dusky. He looks so my head was not something that could be easily small, so fragile, so alone as his hospital bed forgotten. The most common reminder comes dwarfs his wasted limbs. His eyes x on Sara every time that I try on a lone-size-ts-allm h jane. The truth is that no matter how hard I try or how Sarajane leans close to our patient, tilting her much effort I put into squeezing that hat on my ear towards his mouth. “It’s so hard to hear in this head,itjustwouldnott.Icanpersonallyat suit, can you repeat that for me and the doctor?” that lone-size-ts-allm does not work-for he The volume and the vitality of his voice surprises wear, so why was I so willing to accept the same me. “I just want to get right with my Lord…and model for the way we practice medicine? my family…children and grandchildren; I just The way I, and many others, have experienced miss them so much…” He goes on to answer the healthcare system is relatively one-dimenmy question, “If time is short, what is important? sional. When you have a problem, you go to the I’ve got to get straight with my God…there have doctor, explain your symptoms in the most cutbeen things…too many things, bad things…” His and-dry fashion possible, and receive treatment eyes leave Sarajane and dart around his room as based on what appears to be your top concern. if looking for his confessor. After a moment of siWe have been conditioned to separate ourlence, he adds, “And I don’t want to suffer…never selves into neat boxes of symptoms that can be on a ventilator…” Finally, he concludes, “Chapexamined and treated uniformly. Separate treatlain? Why, yes, I would love to have prayer…” ments for separate symptoms. The problem is Sarajane moves closer to his bed. She arches that these boxes have been constructed by the protectively over him like a palm tree on a warm majority and for the majority which exacerbates sunny beach. Of course, she too is wrapped health inequities across racial and socioecohead to toe in PPE. On her, though, the PPE nomic divides. This is an issue that spans our does not hinder her care. She remains therahealthcare system as a whole and is particularly peutic. Calming. Loving. A healing balm. One notable in women’s health. of her gloved hands rests on his forehead while When I arrived at Duke and began studying the other lightly touches his arm. Her eyes esthe history and current implications of these cape her shield easily and clearly; they speak disparities, I began to question everything I reassuringly to his. As his anxiety wanes, his rehad previously known about women’s health. I spiratory rate slows, what were sobs cease, and learned that the pain of Black women is often an he blinks the tears from his eyes. In one motion, afterthought cemented in the fallacy that we can Sarajane’s left hand deftly releases his, grabs two handle more pain than our White counterparts. I tissues, and gently dabs his cheeks until dry. As listened to stories from women of low socioecobedside nurses have done through every pannomic status who did not have the resources to demic, she heals this man’s suffering with her seek care. I researched the barriers to care that presence, her words, her touch, and her caring. disproportionately affect the LGBTQ+ communiShe has this, I say to myself. Panic evaporates, ty.Idedicatedmytimetondingthevoicestha his and mine. had long been silenced. The effort that I put into J. Trig Brown, MD, MPH, teaches and practices Palliative these studies led me to examine my own expeMedicine at Duke Regional and Duke University Hospitals. riences within the healthcare system. Have my concerns been brushed aside because I was a woman? Has my queerness negatively impact-
ed my care? Have I been treated based on a clusive, because the issue is not that our one racial stereotype? Has the system failed me? size is too small or too exclusive. The issue is In considering these factors, I realized that the thatwearetryingtoteveryoneintothes system has not failed me—at least not in a way box, regardless of its size. If there is any hope that was obvious enough for me to notice. I have of closing the racial and socioeconomic dibeen fortunate enough to t the mold of what vides in women’s health, we must move away the healthcare system indicates I “should be.” I from the idea that treatment requires patients realized that I do not have any memorable exto t an agreed upon mold. Rather than - be periences of healthcare professionals taking the ing separated into conveniently manageable time to understand me as a person before treatboxes, each patient must be treated as an ining me, but then again, I have not needed them dividual—not a mere collection of symptoms. to. The standard treatments worked for me. I was The reality is that one size does not t toldtotmyselfintoboxeslabeledlone-size-and ts- that should not be our goal. The boxes allmwheninreality,theywerelone-size-ts-most. that m we are taught to squeeze into are not broBut because I fell into that “most,” it was easy to ken; they function exactly as intended. What is convince myself that “all” was a fair label. broken? Recognizing my complacency in this situation The idea that we should squeeze into these seemed like something that should have come boxesintherstplace. easily to me. After all, I had tried to explain to my Simone Nabors is an undergraduate Robertson fair share of friends, family members, and store Scholar at Duke University. workersthatalone-size-ts-allmhatsimplywould not t on my head. It has never failed that their trust in the validity of a tag was unwavering until they watched me attempt to put the hat on. They had no reason to question a system until they sawforthemselvesthatitdidnott. Thejumpfromlone-size-ts-me(andeveryone thatIcansee)mtolone-size-ts-allmisconvenient, but we should not need to personally witness or experience the taws of a system to understand that it is failing. If I tried to squeeze myself into a hat that clearly wasnjt tting,it would be easy to tell myself that the hat is the wrong size and that I needed to get a different one that was better catered to my head shape. I know that when it comes to hats, lone-size-ts-allmisafalsesentiment.This knowl edge gives me the power to stay away from these labels and hope that one day we will move away from them altogether. There is a pervasive and parallel obstacle in women’s health: we do not even always recognize the disingenuity of “onesize-ts-allm. It is much easier to convince our selves that the problem lies within us, rather than thelone-size-ts-allmlabel. The solution is not as simple as stretching the borders of lone-size-ts-allm to make it-more in ‹'«¢§fl¤¥. , ¢‹‹fi ,
chorea magic When she found herself dancing? It felt off. She was too old, she said, she needed to shift Tosomethingthatlledherwithlessemptiness That gave her a true outlet… of hope When everything felt uncertain Between her and her niece’s campers. In the same lot rested two campers, It did not feel right to default to dance With her niece now watching this uncertainty Acted out. Just because her body chose to shift Her brain separate, without hope Without her consent. As if her body were empty— Althoughtherecontainedtwohabitants,theofceroomfeltempty To an onlooker, but in her life, two campers Mind and body, hoped For answers, with each crinkle of the paper. Dancing As the doorway opened, arm shifted And relaxed overhead, the doctor’s eyes uncertain. When asked, lowering her mask with a seated plié, a certain dark emptiness parted between her shiny dentures with a shift in her smile. “Campers!” She sang, arms encircling the air in dance Eyes focused on the doctor. Hope. And with another hopeful Nod by her, a “We do not know why” —certain. She felt no need to dance Then, niece’s eyes summoned to a new emptiness Etched with the exhaustion of moving a camper To watch her dear great aunt shift. But in the room the provider shifted From patient to screen, searching, hoping To create a trail for these two campers Although the path uncertain It could not be empty As this is a partnered dance. Years she spent in a universe uncertain Desiring a day of normalcy. For herself. For her niece. A happy emptiness— The goal for this important dance. Emily Hatheway is a third-year medical student who hopes to pursue a career in pathology and medical education. ‹¢›‹.fi⁄.fifl¤¢‹
living with color Linda Li is a second-year medical student at Duke University School of Medicine, with interests in psychiatry, narrative medicine, and the medical humanities. This piece incorporates a multitude of colors to demonstrate this patient’s optimism despite living with a chronic medical condition.
fractured
ities—the late and no-show policies, the details surrounding my insurance. When the paperwork was nished, she asked me, lWhy are you here My rst therapist was named Annette. She today?” had an ofce on the second story of a charm I looked back at her stunned. Wasn’t she suping craftsman-style house in northeast Portland. posed to be the one to tell me that? There wasn’t a lot of rhyme or reason for my choosing herhthe ofce was a few blocks fromMy voice shook as I tried to form an answer to her seemingly simple question. I kept chokmy apartment, and she took my insurance. I was ing on the words, unable to spit them out. The sold. hurt that had been resting in my chest started I didn’t want to go to therapy. I was 19 and in to slowly rip open and fall into the room. Then, my mind, a highly functioning adult. My boywithout warning, I came undone. I struggled to friend at the time, Jeff, felt differently. He had breathe through my heavy sobs. Although I knew pleadedwithmetonallymakeanappointment my pain was a passive but constant presence in after one too many nights spent sobbing on the mykill life, I didn’t understand it. It felt familiar, but it bathroomtoor,screamingthatIwouldreally wasn’t something that I could name. Somehow, I myself this time. I was one breakdown away from realize how much baggage I was carrying rock bottom but I thought that I was ne. In didn’t my around until I found myself sitting in that chair mind, this was just normal stuff that all people across from Annette. go through. Yet, I obliged, because of the signifNow, the dam was broken. I was broken. And I icant strain my outbursts were causing our relawas starting to see that this was not just normal tionship. stuff. So, on a chilly spring morning, I walked into *** that craftsman-style house, climbed the narrow Over the coming weeks, Annette and I fell staircase, and sat in the waiting area. It was welinto a predictable routine. We talked, I cried, coming but drafty, and as the seconds passed, I and then time was up. During our sessions, started to panic. “I could still leave,” I told myself. I explained how I would get so angry at Jeff. I I could tell Jeff that I went and instead spend an would scream and tell him that I hated him behour at the coffee shop around the corner. fore throwing gravel at his car as he tried to drive Just as I had decided to walk back down those away. I told her how afterward, I would cry and stairs, Annette opened her door and invited me beg him to stay. These outbursts were like out of into her ofce. She was an older woman with body experiences; I knew what I was doing was thin, straw-colored hair and weathered eyes. wrong, but I couldn’t stop myself. It was like an She looked kind and trustworthy, and that was addiction, I needed the emotional release and I good enough for me. wasdesperatetondawaytoexorcisemypain. Her ofce was simple. The ceiling was trian I admitted to Annette that when things got espegular and slanted in a way that felt comforting ciallydark,Icouldonlyndrelieffromslamming instead of claustrophobic. The room only had a my head into the wall. few pieces of furniture—a coffee table, a low-sitAs Annette dug deeper, she used all of my stoting sofa, and a cozy armchair. As I followed her ries to formulate a differential, trying to underin, Annette informed me that I could sit wherstand how I became the person sitting in front ever I felt most comfortable. I was surprised. I of her. assumed that I would take the couch and she During one appointment, I decided to sit on would take the chair because that’s what hapthe sofa. It was colder than usual for spring and pens in the movies. a space heater sat between us, gently warming Like the contrarian that I am, I took a seat in theroom.Forthersttime,sheaskedme-ques the armchair, unaware of what was to unfold tions about my childhood. She had been slowly over the next hour. We started with the formalcollecting information, saving the biggest piece ‹¢›‹.fi⁄.fifl¤¢‹
for last. Now, she was ready to start exploring my 19 years. But my repetitive self-repression had roots. grown a monster inside of me. I was starting to As I listened to her questions, I watched the suffocate. And so, I told Annette that I would try. rain drip slowly down the single-pane windows Try, being the operative word. These were ofherofce.Inanattempttohidefromher-inter not the kind of conversations that I had with my rogation, I sank deeper into the cushions, resist- mother. We hadn’t always gotten along in the ing her advances into my psyche. She was un- way that we should have. I was argumentative, deterred by my obvious discomfort, now asking stubborn as an ox, and impossibly determined directly about my parents’ marriage. as a teenager. While I was smart and I stayed out “Their relationship was tumultuous,” I ex- of trouble, I was not an easy girl to raise and I plained. Saying the words aloud caused my en- struggled with any semblance of authority. We tire body to tense with stress. I shifted in my seat had always loved each other very much, but we to try and relieve the pressure, but it only settled had not always been close. further into my chest. I went on to tell her about Those days that I went home to Washington nights that devolved into endless ghting, were dreary but and overcast, like most days in the I couldnjt pinpoint anything specic.Somehow, Pacic Northwest. On one particularly gloomy my memories were so clouded, it was like trying afternoon, my mother asked me to go to Costto remember a dream that had already been lost co with her. I hated Costco. The stress of grocery to the morning light. shopping in a crowded warehouse lled with Annette wasnjt satised, lKeep digging,mthings she that I didn’t need was not appealing to would say. She pushed for more details, but I me. But I had nothing better to do, so I tagged couldn’t give her what she wanted. I was dumb- along. On the way there, I tipped through the founded. I couldn’t tell her anything else because radio stations incessantly, even though I knew it I didn’t remember. The strangest part was that I wouldbotherher.Shenallygotsoirritated didn’t recognize the lapses in my memories until me that she turned the music off entirely. We sat that very moment. The realization washed over in silence for the rest of the car ride. me, leaving me neck-deep in water struggling to A few minutes passed before we pulled into stayatoat. the chaotic parking lot and stumbled upon a Finally, before our session was over, Annette spot that was reasonably close to the entrance. asked if my parentsj ghts were ever violent. My mother lI pulled the car in slowly and I realdon’t know,” I answered honestly. ized that this was my moment. I wasn’t ready. *** My stomach was in knots. I looked down at my At the end of our session, Annette encour- hands and saw that they were shaking. I took a aged me to speak with my mother about my deep breath, swallowing my fear. I nally asked childhood. She explained that it would be easier her the question that had been pulling at me for for us to get the root of my issues if I had a bet- weeks. ter understanding of my own story. I knew she “What was your relationship with Dad like?” wasright,butIfeltterried.IdidnjtknowThe what words I fell out of my mouth more quickly would nd on the other side of these questions than I had intended. They felt sloppy and inadeand I was afraid to ask. quate, but they were all I had. I struggled to remember anything notable She was surprised, pausing for a moment beabout my childhood. The feelings were there, fore saying, “Well, don’t you remember?” but they weren’t connected to images or memI was more careful this time before answering. ories that I could make sense of. When I looked “No, not as much as I would like to.” Hesitation back everything appeared so abstract and it left still lingered in my voice. me completely unhinged. What I did know is Then, in the parking lot of Costco, one of my that the feelings that I had were dark. I wanted least favorite places, she told me. She told me to turn away from them like I had been doing for ‹'«¢§fl¤¥. , ¢‹‹fi ,
about the knock-down,drag-out ghts.About My mother was ne. And while this moment the bruises and the neighbors who tried to help. served as the epilogue of her story, it was the She explained that my grandmother worried prelude to mine. A fracture had formed at the constantly about my father killing her incenter a t ofof my universe, and it would never be rage. She begged my mother for years to leave the same again. him. She talked about the stress and the screamAnonymous ing and the constant indelity. As she told me her story, she didnjt tinch. And then she said I was there. That I saw everything. That this wasn’t her story, it was our story. She looked over at me before asking me again incredulously, “You don’t remember?” Era un lavoro sicuro I tried to hold back my tears but I was giving They told me it was a safe job myself away. I didn’t remember. She described la mia fabbrica correva these experiences, moment by moment, exin my factory, all running mi piaceva tener duro plaining how we were sitting right there at the I enjoyed hanging out there table. But I didn’t remember. I could not look at le famiglie manteneva. her. I knew that if I caught her gaze I would break Families, sustained we were. apart into a million pieces. So, like a coward, I stared at my feet. Tenevamo alla salute, Her stories were dizzying. How was it that none We worried about our health, of these memories felt like mine? It was too il terrore del tumore much to process. And in the midst of it all, I was frightened by the cancer dalle cause sconosciute; completely overwhelmed by a sense of grief whose origin remained in stealth; for my mother and what she had experienced. che per colpa di un untore She had birthed me and given up her world for Most likely plague-spreader me. She was my mother. I felt so angry for her. I non pensavo avrei perdute My entire life robbed thought about the way in which I had idolized sia le gioie che l’amore. my father after the divorce before I realized how of joy, love and pleasure. much easier it was to be the weekend parent. I felt completely ashamed of myself. Molti cadono ogni giorno Underneath the shame, I could feel my pain Workers fall every day throbbing. These stories still didn’t feel like per cosí tante ragioni mine, but they resonated with the heaviness that for so many reasons had been living in my chest. They resonated with sulla strada del ritorno, returning on the path home my pain. quanti in lontane nazioni, Inallylookedupatherwithtearsinmyeyes. migrants from distant countries, “I’m so sorry,” was all that I could muster. I knew ma vederli tutti insieme that the words were not enough. But seeing them all together sàturi enormi stanzoni She glanced back at me and laughed. She crowding the once enormous wards laughed with her whole belly as she grabbed my al potere non conviene hand. “It was so long ago,” she answered with because of leaders—absent, misguided a smile. Her response only made me cry more. dare al popolo visioni, promoting unrealistic visions “It’s okay,” she said, “It’s over now. Everything is ne.mAndforher,itwas.Theseexperiencesand le tivù non siano piene whileTVsllwithimagesofdeath memories were nestled away, safely buried in di decessi sui cartoni. the depths of her consciousness. inwarehouseslled,notwithcardboard.
ERA UN LAVORO SICURO IT WAS A SAFE JOB
‹¢›‹.fi⁄.fifl¤¢‹
Smog è stato, non fa niente, It was the Smog, it doesn’t matter, ma portavi a casa il pane but you brought bread to the table e se puzza c’è fetente and if it smells, there’s something rotten le ragioni sono arcane, the reasons are mysterious, non da torcia certamente. certainly not from the torch. Lavorato dodici ore Worked for twelve hours contro un albero schiantato smashed against a tree non sentivo più torpore I could only feel numbness volevo essere abbracciato I wanted to be hugged fatalità, fu malore destiny, it was a sudden illness non fatica m’ha stroncato. not exertion that wore me out. Morti a mo’ di stillicidio Dead, dropping like dominoes troveran parola giusta the right words, elusive pluricausa, no omicidio cause of death—many, save homicide per la vedova una busta. only an envelope for the widow. Ma col virus è altra cosa But with the virus it’s another story è caduto chi ha subìto those who suffered fell la ragione ben vistosa the reason was transparent omissione, s’è chiarito neglect, it was clear dal potente viene ascosa the powerful keeping secrets, so apparent tutti l’hanno ben capito. Everyone understood that well. Sempre c’è parola ultima There is always a last word la velina per giornali newspapers instead of paper tissues mai parola della vittima: never the word of the victim: solo casi accidentali only accidents, per the government era fuori ma illegittima. no illegitimacy to condemn.
Morti d’altre malattie Dead, from other diseases vecchi di nessun valore the elderly, now worthless giornalistiche facezie: journalism turned into a joke, chi produce giammai muore. only value in productivity doomed to push on like Sisyphus. Morti pure i produttori Dead, even the worker bees per assenti mascherine from the absence of masks contagiati operatori, infections rampant ma bugie tanto meschine petty lies abundant han trovato i decisori. just continue, even menial tasks. Molte cose sapevamo, Many things we knew chi comanda mai sincero, insincerity of those who govern ma gran cosa imparavamo: revelations, we continue to learn quel che abbiamo non è vero. what we trusted simply was not true. Rinunciare potevamo. Give up, we could have Torneremo sì al sicuro when it is safe, we can return se la fabbrica che apriamo if the factory ever reopens produrrà equo futuro. perhaps then equity will be born. Maurizio Portaluri is the radiotherapy director at A. Perrino Hospital in Brindisi, Italy.
reflective chaos
Jennifer Okunbor is a second year medical student at Duke University School of Medicine, and she contin ues to explore careers in obstetrics/ gynecology and anesthesia. -
This piece was inspired by my community partner for SCOPES, a creative arts pro gram that pairs members of the community with chronic health conditions with medical students. My community partner has HIV, and he uses meditation to cope with the chronic pain he experiences with his HIV. I wanted to represent the mix of emotions my community partner experiences when he meditates and experiences his pain.
pieces
set, I noticed that as the sun fell behind the shoreline, areas in the picture became shadowed, turning parts of the iridescent orange to a It wasn’t until the last two years that I learned to dark hazel. The shadows had fooled me, but the love jigsaw puzzles. COVID-19 and quarantine piece had been there all along, just not in the only strengthened that love. It has been a great way I expected it. As I proudly appreciated the way to dissociate from the challenges of the day small photo, I noticed that it was the shadows while keeping my mind working. Plus, there is that gave the photo its depth and multiplied the something so satisfying in hooking those little ocean’s beauty. pieces together, but then ever-so-frustrating to For many people, including myself, 2020 was not be able to nd the one piece youjve been shadowed by loss, loneliness, confusion, and searching for for hours. But the satisfaction that fear. In this seemingly universal struggle, could hits you when you nally nd that elusive piece there be any pieces of beauty to be found has no better feeling! shrouded in this darkness? The shadows someLast week as I was staring at my partially comtimes fool us into believing that it is impossible. pleted “Places of the World” puzzle, I was huntDifferent pieces of our journey in life can be ing for this piece that should have been obvious and easy to nd. The section I was working ondark and foreboding. 2020 and all that has occurred may not be what you thought you wantwas a small Polaroid-like photograph of the Baed or at all what you were expecting, but dark linese Sea at sunset with the gradual fading of moments remain a fact of this life. The bright the orange sun retecting off the water. There and colorful sections are easy to love and unwere only so many orange colored pieces and derstand as they are lled with happiness I’d been very thorough in my search looking at light. But it is the combination of color, light, every piece on the table at least four times. I reand shadow that gives a masterpiece its beauty sorted to searching under the table, under my and depth. Avoiding the dark and pretending it bed, in my cat’s hiding spots, the vacuum cleandoes not exist does nothing but leave your puzer, and just about every nook and cranny of my zle with missing pieces that are fundamental to apartment. No luck. your journey. The color isn’t gone just because I gave up the hunt after two hours and sulked it is harder to see. Besides, it is in the shadows on the couch thinking about the missing piece where we gain courage and learn about faith. and how it would be disappointing if my puzzle Andwhoknows?Youmayevenndthatyouare ended up incomplete. If I called the puzzle comthe light in the darkness. pany to complain, would they send me the one piece or would I have to hunt through the entire Laura Mobley is a Pediatric Physician Assistant at Duke new puzzle to nd it? I gured Ijd try again the University Hospital. next day with fresh eyes before resorting to that tactic. After a few minutes, I laughed at myself for getting so upset about a puzzle. This piece had stolen my peace! The next morning as I sat down at the table with my coffee, I noticed a clustering of dark brown pieces I had sectioned together. One had a tiny, almost indiscernible orange teck of color on the edge of it. I jumped up excitedly and placed the piece in the hole cut perfectly for its shape. Phew!Relieftoodedoverme. Why had I missed it so many times? As I looked closer to the now completed picture of the sun-
voices join VOICES sites.duke.edu/voices voices@duke.edu
front cover artwork: NoLuiswithoutJane ayleBr eGriselisasecond-yearmedicalstudeetDukna UniversitySchoolof Medicinewithastor nginteer stinmedicalhumanitiesandmedicalethics. uiL sJunead diedwithienthr eweeksofoneanotheorf VID-19andOmC incompleteisoltia onheT . irlovedones,includingtheir andughter r(andthetiar sts’ friend)strugledtocoorditena theircaer andeventualfnealsr whiledealingwithisheavyemotionaltohiT l. s piecehonorstheirmemory:thebiuid—Lr sandhisloveof bitcdwar hitheng, sewingeedle—Juneandherbeautifulemobr ide. ry