White Coat Reflections 2022 ◆ 1 a foreword I sat on the floor outside the door of one of the patient’s rooms in the inpatient psychiatry unit. The dust in the corner of the hallway was the only thing that made the cold gray floor and walls seem less sterile. I had finished the “face to face” documentation for my patient who had experienced emotional dysregulation and banged her head on the floor. Luckily, she was okay physically, but her sobs in the room showed how unwell she was emotionally. Review of her records illustrated a woman who had been through more trauma than anyone should ever endure. Her transfer notes painted a canvas full of behavioral “incidents” with streaks of medication changes that blended into the background of frustrated providers. The sign-out from the outside hospital reverberated in my mind – “She’s a difficult patient. No medications work. Therapy will not work. Good luck. Keep your seclusion room ready.” I remember the feeling of my stomach dropping when I heard this sign-out. The nausea and disgust were not because this patient was coming to my unit, but rather that anyone could talk about a person that way. Four weeks later, after too many seclusions, medication changes, fights, self-harm, and meetings with hospital administration, I realized we had not done anything different than the outside hospital to help her. My wandering mind was interrupted by the lyrics of Taylor Swift’s new song that the patient was singing between her quiet sobs. I pulled out my phone and started playing the song from YouTube. I opened the door that she previously had slammed shut and let the music play. As my patient and I hummed the same tune, I realized it was not medication, group therapy or talking to the team that was going to help her. It was human connection. From that day on, every time she would get upset, I would go sit down next to her and we would pick a song to listen to. During those moments, she told me what the lyrics meant to her, and she showed me her journal filled with sketches, lyrics of songs and poems. I learned that music was the only thing that helped her calm down and, in the previous months while hospitalized, she had no access to music due to her behavioral outbursts. I realized we, as a medical profession, had not been communicating with her the way she needed. Yes, everyone documented correctly, they educated the patient about medication changes and lab results and gave her textbook care from evidence-based practices and standard of care regulations. In her moments of need though, the interventions failed her in the most devastating of ways by taking away the one thing that she needed to self-soothe – her music. When I transitioned off-service, I made sure to highlight in my sign-out “Patient likes Taylor Swift and music is the best way to help her stay calm.” She had no more “behavioral incidents” the rest of her stay. The best patient care comes not only from mastery of medical knowledge, but often flows from creativity and flexibility. It is through arts and humanities that we learn how to channel that creativity into beautiful moments of connection with patients and honor what the patient needs. The arts allow us to interpret and express needs and ideas, sometimes without words. Arthur Ashe, a legendary professional tennis player, dedicated humanitarian, civil rights activist and advocate for equitable healthcare, said it best: “Start where you are. Use what you have. Do what you can.” Sometimes, in medicine, we can feel helpless when interventions do not work the way we wanted or expected. These are the moments to be creative, adaptable and flexible physicians. If there is one piece of advice I could give my younger self and trainees learning to become a physician, it would be to start where the patient is, use what you and they have and do what you can to be creative and flexible in their patient care. Do not abandon evidence-based interventions and standard of care regulations, but instead think beyond that to meet the patient where they are at. Only then do we truly learn there is no such thing as a hopeless situation. Only then do we learn that there is no such thing as a difficult patient. Only then do we open ourselves up to the beauty of human connection that can be as healing, if not more sometimes, than any of our medications prescribed. I hope the following works of creativity help you connect in ways you did not know were possible and inspire you to be the best physician for your future patients. Thank you to the Creative HeARTs team for producing this inspirational publication! Marissa Flaherty, MD “Start where you are. Use what you have. Do what you can.” ~ Arthur Ashe
2 White Coat Reflections 2022 ◆ the Creative HeArts team Bunmi Solano, MS2 I joined Creative HeArts, in order to experience the humanistic side of medicine, and help capture the myriad of emotions, stories, and breakthroughs that my classmates and I will accrue throughout our time here. Rose Pagano, MS2 I joined Creative HeArts because I believe it is important to promote artistic expression in medicine. Creating art is a beautiful way for us to reflect on our experiences in the medical field, and I am so proud of what my classmates and I have created and achieved so far. Michael Sikorski, GS4 During a personally eventful year, I found Creative HeArts and our journals to be points of personal pride and outlets of mindfulness as I got lost in the wonderful reflections of my classmates and peers. May you enjoy them too! Emilie Berman, MS2 Emilie enjoys looking at art and making art and has been honored to be apart of Creative HeARTS and getting to do these things with her peers. Toan Bui, MS2 To me, art is any method of expression wherein words alone fall short of capability. I decided to join Creative HeArts because it promotes a safe, inclusive space for the people of the UMSOM community to convey their creative voices. Equally important, the organization is a reminder that art and humanism are at the core of science and medicine.
White Coat Reflections 2022 ◆ 3 Nicole Tugarinov, MS2 I joined Creative HeARTs because it is a great way to connect with the more humanistic and creative parts of medicine and of myself. Being in medical school has shown me how important it is to make room for art, expression, and selfreflection. Sanyukta Deshmukh, MS2 Sanyukta joined Creative HeArts to rekindle her own connection to the arts and humanities. She considers all forms of art to be a universal language, and loves how much she is able to learn about her peers at UMSOM through their reflective pieces. Shirin Parsa, MS2 I am so grateful for having Creative HeArts as my artistic outlet throughout my medical school journey. The creation of this WCR edition has been a wonderful experience, and I hope everyone enjoys the art that can be found in medicine and all around us. Cassandra Seifert, MS2 It has been a tremendous privilege to produce this iteration of White Coat Reflections. To the Class of 2026 – thank you for sharing your reflections with our community and for your commitment to the indispensable role of art in medicine; you have reminded us all that expression and connection are inseparable parts of being. Mitali Sakar, MS2 Medicine and art are so intertwined, it’s impossible to have one without the other. I joined Creative HeArts to better explore that connection and express myself through writing. I’m so grateful to be on this team and help join so many wonderful works of art into a journal.
4 White Coat Reflections 2022 ◆ Foreword Dr. Marissa Flaherty............................................................................. 1 The Creative HeArts Team..................................................................................... 2 Table of Contents..................................................................................................... 4 Beginning Again Jason Zhou, MS1..................................................................... 6 The Touch Toan Bui, MS1.................................................................................... 7 Untitled Aprill Park, MS1................................................................................... 8 Andante Cantabile Han Dewan, MS1 ................................................................ 9 “The Dog-ter will see you now” Melissa Sierra, MS1..................................... 10 Class I Oclussion Taylor Kolosky, MS1............................................................. 11 Good Company Vishie Betapudi, MS1 ............................................................ 12 The Heart Behind the White Coat Fatima Nycole Hidalgo, MS1................. 13 Matter Dowon Kim, MS1 ................................................................................... 14 Table of Contents
White Coat Reflections 2022 ◆ 5 Jane Doe, 87 y.o. F Taylor Kolosky, MS1........................................................... 15 Holding My Breath Leena Khoury, MS1......................................................16 The Thinker Bunmi Solano, MS1..................................................................17 The Inner and Outer Selves Helen Nguyen, MS1........................................18 A Noble and Worthy Fate Anonymous........................................................19 Post-Exam Relaxation Bruce Chen, MS1.....................................................20 5,212 meters of yarn Katharine Zhu, MS1...................................................21 Harrison’s Bread Recipe Harrison Mayo, MS1............................................22 Renaissance Student Bunmi Solano, MS1....................................................24 Sometimes my Sunday looks like: Bella Horton, MS1 ...............................25 24 Hours Claire Asenso, MS1 ........................................................................26 ! It’s time to BeReal ! in medical school Fatima Nycole Hidalgo, MS1...27
6 White Coat Reflections 2022 ◆ Jason Zhou, MS1 Beginning Again Digital Art
White Coat Reflections 2022 ◆ 7 The Touch Toan Bui, MS1 Acrylic Paint
8 White Coat Reflections 2022 ◆ Untitled April Park, MS1 This is a drawing of a photo found online, however, I decided to change the people of the drawing to be representative of minorities in medicine. Online - Procreate
White Coat Reflections 2022 ◆ 9 As the murmurations of starlings condense onto the roofs of rowhomes and the sun nestles into the skyline, the strings swell into the kitchen. You pull me into your arms as the horn melody croons, burnishing a reminder on my heart of the gift of a moment with a sunset, Tchaikovsky, and you. Andante Cantabile Han Dewan, MS1
10 White Coat Reflections 2022 ◆ “The Dog-ter will see you now” Melissa Sierra, MS1 This is my dog Baya! I know the picture is silly but she has supported me through grad school and now again for med school :) I wanted her to have an honorary spot in our class since she has been there for me every day so far! She’s a senior dog so unfortunately she might not get to be with me for all of the journey, but I’m glad she’s joined me so far.
White Coat Reflections 2022 ◆ 11 Class I Occlusion Taylor Kolosky, MS1
12 White Coat Reflections 2022 ◆ Good Company Vishie Betapudi, MS1 I’m very lucky. I heard that it can be hard to sustain relationships during school. And it is. But I’m very lucky. That’s because I have two buddies who I see every day. Every morning they remind me to chug some water – it’s very important to stay hydrated. It’s awfully scary for me to ask people how they’re doing. But my friends give me a little pep talk. “Of course it’s scary,” they say, “but we think you’re a really great guy, and those other people probably will, too.” Each time I step off the scale at the doctor’s office and hear about “lifestyle adjustments,” they encourage me to feel gratitude towards my body for sustaining me. When I charge on home down South Charles Street to make it to the virtual info session that I won’t pay attention to, they tap me on the shoulder. “Look at the trees – aren’t they gorgeous? And the weather is just divine! Why don’t we take a stroll?” I heard that it is very important to keep good company. I’m very lucky because I do. I actually heard that I probably shouldn’t talk about them here. I don’t think that’s fair, though. They’re as important as anyone else in my life. Every beaming smile, every bombed joke, every long-winded question, every suggestion and answer, right or wrong or neither, every “how are you?” -- that’s them, too. I think they should get their time to shine, so here goes. I’ve got two friends I want to tell you about. Their names are Fluoxetine HCl 20 mg capsule 3x/day and Bupropion HCl XL 150 mg tablet 1x/day.
White Coat Reflections 2022 ◆ 13 The Heart Behind the White Coat Fatima Nycole Hidalgo, MS1
14 White Coat Reflections 2022 ◆ Matter Dowon Kim, MS1 We used to swagger through suburbia on our bikes with pegs and crates that held our hearts We loved to break ourselves open like cracked eggs on steep hills that our homes leaned on. Scrapes of us still lay there on the side of the curb, being digested and re-digested by desperate organic matter trying to survive. I want to be valued like nature values my chemistry.
White Coat Reflections 2022 ◆ 15 Jane Doe, 87 y.o. F Taylor Kolosky, MS1
16 White Coat Reflections 2022 ◆ Holding My Breath Leena Khoury, MS1 I both feel like my life has culminated to this moment And that my life has only just begun At this intersection, I find myself afraid to fail But longing to soar Oh how lucky we are How brave and bold How lucky we are I now know that the beautiful feeling of wind on my face Comes from V1 to VPM to cortex processing And somehow it is more beautiful than the feeling itself My sun-soaked cheeks in mid-August as we laughed and sweat and walked to class together I better understand as the production of vitamin D and potential damage to my DNA from UV rays And in so many ways I find those days more special than ever How lucky we are To understand the beauty of life so intimately How lucky we are To restore the human body to a state of health How lucky we are To know and learn as much as we do in a world where learning is not a human right How lucky we are To wear a white coat
White Coat Reflections 2022 ◆ 17 The Thinker Bunmi Solano, MS1 Procreate
18 White Coat Reflections 2022 ◆ As we learned about the facial structures in the anatomy lab, I thought about the patients that underwent face transplants. I came across the story of Katie Stubblefield, who received a face transplant after a self-inflicted gunshot. At the age of 18, Katie lost part of her forehead, nose and sinuses, mouth, and much of her mandible and maxilla. Our face dictates how others perceive us. The visible self represents a part of our identity. I cannot imagine the pain and emotional hurdles Katie and her family went through. The face transplantation gave her a second chance at life. Yet, she’s still going through years of physical and speech therapies to regain her functionality. Katie shared her story to raise awareness about the lasting harms of suicide and the precious value of life. I admire Katie and her family for their love and steadiness. Her story reminds me of the importance of caring for our inner selves. The Inner and Outer Selves Helen Nguyen, MS1 iPad Sketch
White Coat Reflections 2022 ◆ 19 A Noble and Worthy Fate Anonymous Being a med student, oh what a thrill Learning about the human body and its skill Working hard, burning the midnight oil Dedication and determination, the ultimate foil The challenges may seem endless, the workload immense But the reward of helping others, makes it all make sense The late nights and early mornings, the never-ending studying All worth it, when you see a patient recovering and thriving The road to becoming a doctor, a long and winding path But the journey is worth it, with each new lesson and math The knowledge and skills learned, invaluable to the end The satisfaction of saving a life, a feeling to defend So embrace the journey, dear med student of mine Embrace the challenges, they will only make you shine For in the end, the reward is great To be a doctor, a noble and worthy fate
20 White Coat Reflections 2022 ◆ Post-Exam Relaxation Bruce Chen, MS1 We love our crab fries!
White Coat Reflections 2022 ◆ 21 5,212 meters of yarn Katharine Zhu, MS1 Every piece I’ve knitted in my first semester of medical school. Merino wool, mohair, acrylic yarn
22 White Coat Reflections 2022 ◆ Harrison’s Bread Recipe Harrison Mayo, MS1 This recipe is very simple and requires no baking skills or specialized equipment. The basic recipe can be adapted into many variations, some of which are listed at the end. Prep time: 20 minutes (+ 8-24hrs proof time) • Cook time: 45 minutes (+ ~1hr cool time) BRING OUT: • Large bowl • Plastic wrap • Measuring cup • 9x5 baking pan • Measuring spoons (0.5tsp needed only) • Cooking spray • Large spoon • Sharp knife/Razor blade • Cutting board • Bread knife • Tin/aluminum foil Ingredients (makes one loaf): • All-purpose flour – 3 cups (380g) • Water (slightly warm) – ~1.5 cups (360g) • Active dry yeast – 0.5tsp • Salt – 1tsp • Rosemary (optional) – 0.25tsp (just a dash) RECIPE: 1. In a large bowl, add 3 cups of all-purpose flour, breaking up any clumps 2. Add 1tsp of salt to one side of the flour Fine salt works best for this recipe, but coarse salt works too 3. Add 0.5tsp of active dry yeast to the other side of the flour 4. Mix the flour and salt on one side, and then mix the flour and yeast on the other side, and then combine the two sides and mix thoroughly This is to prevent direct salt-yeast contact as that can kill the yeast and affect the proof You can optionally add a dash of rosemary here for some extra aromatics 5. Once the dry ingredients are thoroughly combined, add most of the 1.5 cups of water to the bowl, leaving some still in the measuring cup (around 0.25 cups) The water should be around 90°f, but it does not have to be precise. Just don’t make it too hot 6. Mix the ingredients together, trying to form a shaggy dough mass. Try to make sure there aren’t any clumps of dry flour at the bottom of the bowl. Don’t be too rough 7. If there is still some dry flour in the bowl that cannot be incorporated into the dough mass, keep adding the remaining water until it all has been incorporated into the dough Super wet dough is hard to work with in later steps, so add in small increments. I usually end up using most of the 1.5 cups of water, but it all depends on humidity, type of flour, and precision of measurements 8. At this point, the dough should look very messy and shaggy 9. Cover the bowl with plastic wrap and leave on a counter out of direct sunlight for 8-24hrs I prefer my dough to rise for 24hrs, but this can be shortened to even as little as 4hrs, but it will not be as good You may need to poke holes in the plastic wrap if you see it bulging from the produced CO2 10. Once the dough has risen, generously flour a cutting board/work surface
White Coat Reflections 2022 ◆ 23 11. Use a spoon to scrape out your dough onto the floured cutting board and coat your hands with flour 12. Depending on how moist your dough is, you may need to add a little bit of flour to it while you work 13. Your goal now is to shape the loaf as best as possible. I like to take my dough, flatten it and coat it with flour, and then start to work it into a loaf shape, adding flour if it is too sticky. During this, I am “pseudo-kneading” it while I work, pushing my knuckles into it to flatten it out and tucking the underside up into the dough. Again, you main goal here is to just get it smooth looking, not sticky, and roughly the shape of the loaf pan. This is definitely the hardest step, so it will take a few times to get this right 14. Once your loaf is shaped, leave on a floured cutting board for 30 minutes for the final proof 15. Meanwhile, place your 9x5 loaf pan (or equivalent) into your oven, and preheat to 450of If you notice your loaf getting burned on the bottom or sides, you can reduce this number to 400-425of and slightly increase cooking time 16. Once the oven has been preheated and the loaf has risen for 30 minutes, remove the loaf pan, spray lightly with cooking spray, and gently place your loaf into the pan 17. Once placed, use a sharp knife to make a small cut down the center of the loaf, no more than a couple millimeters deep 18. Cover the pan with foil and place on the middle rack for 30 minutes 19. After 30 minutes, remove the foil covering and leave for another 10-15 minutes 20. Remove once browned to desired level If you want to be sure the bread has been cooked thoroughly, you can use a meat thermometer to test the loaf. It should be at least 190of degrees before removing and letting rest 21. Remove from loaf pan and let rest for at least 30min-1hr before cutting and serving If you cut it too soon, the crumb structure will be a mess 22. Serve with butter, olive oil and salt, or slice and add butter, garlic, parsley, salt, and bake to make a fantastic garlic bread VARIATIONS: So that was the basic recipe I use. However, there are tons of variations you can do to it to make many different types of loaves. Here are some of my favorites: Rosemary Salted Bread ~ Add some rosemary to the dry ingredients before mixing. Once the loaf has been shaped and placed into the greased loaf pan, lightly spray the top of the loaf with cooking spray and sprinkle a mix of dried rosemary and coarse salt onto the loaf. Make slit, and bake as normal Cheesy Italian ~ Add some oregano to the dry ingredients before mixing. After you dump the dough onto the cutting board to shape, flatten out the dough as best as possible while coating it with flour. Sprinkle a mix of cheese (any type/mix of types besides parmesan) and Italian herbs (either a pre-made one, or a mix of oregano, rosemary, basil, marjoram, and thyme) in a thin layer across the dough. Roll up the dough and tuck in all the corners to prevent too much spillage. Repeat this process of flattening, adding, and rolling/folding until you cannot add any more mix. Place loaf into the greased loaf pan, spray a tiny bit with cooking spray, and sprinkle a touch of the mix onto the top of the loaf, make slit, cover (try to make it slightly tented to prevent the cheese on top from sticking to the foil), and bake as normal Spicy Garlic ~ Add some red chili flakes to the dry ingredients before mixing. Once the loaf has been shaped and placed into the greased loaf pan, lightly spray the top of the loaf with cooking spray and then add a mix minced garlic, chili flakes, and cayenne pepper. Make slit, and bake as normal. The garlic often has a tendency to burn when uncovered, so consider baking for slightly longer covered, and then not too long uncovered Please reach out to me with any questions you have! Happy Baking!
24 White Coat Reflections 2022 ◆ Renaissance Student Bunmi Solano, MS1 Procreate
White Coat Reflections 2022 ◆ 25 Sometimes my Sunday looks like: Bella Horton, MS1
26 White Coat Reflections 2022 ◆ 24 Hours Claire Asenso, MS1 4:33 AM Light filters into my vision, and my hands, in a drunken stupor, find the lamp to switch it off before sleep regains control of my body and I collapse in bed. 6:54 AM My face is glowing from the screen resting on my knees while the words of today’s lecture go in and out of focus— 8:37 AM My eyelids have been replaced with bags of sand, constantly spilling into my limbs until my body is sinking and I kiss gravity. 12:19 PM Time is an illusion. You only live once, I tell myself as I laugh with my friends. 3:42 PM I pay rent to my mind. Sometimes I get crowded out by the information it lets in, shoved into a corner and forgotten. Other times, I climb out from underneath and take my place on my throne of mastered material, an An-queen. 8:01 PM I look over my shoulder and realize the sun left unannounced again. Another day I am held hostage by my own comprehension. 12:14 AM I let the day fade like a dying flame that I have exhausted myself stoking, and fuse with my bed until further notice.
White Coat Reflections 2022 ◆ 27 It’s time to BeReal in medical school Fatima Nycole Hidalgo, MS1 ! !
28 White Coat Reflections 2022 ◆ The Creative HeArts team invites you to visit the online “bookcase” to view the White Coat Reflections books from previous classes of The University of Maryland School of Medicine. SCAN ME!