SPRING 2026
VOLUME 10
ISSUE 1
A
N
A
S
T
O
M
O
S
I
S
APHASIA
/A·nas·to·mosis/
n.
A connection between two normally
divergent structures. From the Greek
anastomoun, to provide with a mouth.
Letter from the Editors
Dear Readers,
At its most literal, aphasia is the loss or impairment of language: the sudden distance
between thought and speech, listening and understanding, knowing and being able
to say. Aphasia asks us to sit with a difcult truth: that not everything can be spoken,
and not everything that matters arrives in language.
There are moments when words fail because the body has interrupted them. There
are moments when grief makes language feel too small. There are moments when
pain, fear, love, illness, or memory resist expression altogether. In those spaces, com
-
munication does not disappear; it changes form. It becomes gesture, silence, image,
rhythm, touch, presence. It becomes the hand held at bedside, the pause before a
diagnosis, the look exchanged when there is nothing adequate to say.
As future physicians, artists, writers, and witnesses, we are often drawn to language
as a way of making meaning. Yet medicine continually brings us to the edge of ex
-
pression. Patients tell us stories that fracture mid-sentence. Families ask questions
for which no answer feels whole. Clinicians carry experiences that cannot always be
neatly named. Aphasia, then, becomes more than a neurologic condition. It becomes
a lens through which to examine the limits of language itself.
In this issue, our contributors explore what lives in the space between words: the
unsaid, the misheard, the mistranslated, the forgotten, the embodied. Their pieces
ask what it means to communicate when speech is altered or unavailable, and what
it means to listen when language is incomplete. They remind us that healing is not
always found in perfect articulation. Sometimes it begins with bearing witness to
silence.
We hope this collection invites you to slow down and attend to the forms of expres
-
sion we often overlook. We hope it asks you to consider what remains when words
fall away, and how much can still be conveyed in their absence.
With gratitude,
The Anastomosis Editorial Team
2
APHASIA
Wherever the art of Medicine is loved,
there is also a love of Humanity
– Hippocrates
Medicine sometimes snatches away
health, sometimes gives it.
– Ovid
MASTHEAD
Saumya Bharti
EDITOR-IN-CHIEF
Sarah Rockwood
EDITOR-IN-CHIEF
Brian Zhang
EDITOR
EDITOR
Tobin Stauffer
EDITOR
Molly Kalea Barron
EDITOR
Siwaar Abouhala
EDITOR
Elise Cai
EDITOR
Sheharbano Jafry
EDITOR
EDITOR
Jacqueline Yao
EDITOR
ART DIRECTION
4
Julia Li
Soa Gurgel
Nicholas Alfonso
IN THIS ISSUE
Tarushi Sharma
Night Shifts
7
Amanda Buster
Autumn
8
When Fluency Becomes a Liability
Sathiya Perkash K Velayutham
11
Samiha Reza
speak : : hear
12
The Missing Word
13
Lwam Zemikael Araya
Mid-sentence
Michael Johnson
15
Michael Johnson
Gesture
16
A Humble Abode
Baani Minhas
17
Within My Skin
Alaia Chen
18
A Fading Metropolis: Alzheimer’s
Through an Urban Lens
19
Ella Adeline Nettnin
Molly Kalea Barron
plastic grapes
21
Molly Kalea Barron
the human element
23
25
Art Portfolio (assorted)
Grace Jin
28
Brian Zhang
Birds**
Survival is maintenance.
Maintenance is invisible.**
Ianto Muir
31
Liam Little
36
A Single Clap*
Joyce Ker
37
Lesson on Etymology*
39
you do not have to
Tulsi Patel
Tulsi Patel
The Taste
41
Stitches
Madeleine Gayle Smith
42
PAUL KALANITHI WRITING AWARD
** WINNER * HONORABLE MENTION
5
Purpose
43
Madeleine Gayle Smith
My First Time Learning About a Jellysh
45
Bao (Le) Nguyen
First Morning After Funeral
45
Bao (Le) Nguyen
Elizabeth Ener
46
Slow Down
47
Slumber Party
Bao (Le) Nguyen
Path of the Unspoken
48
Niki D. Gallardo
cortical ribboning
49
Noor Suhaib Zanial
Dr. Tina
didn’t
couldn’t come in.
52
Kripa Philip
Kripa Philip
53
clinical vignette
Ellie Kim
Retina of Reection
54
Ellie Kim
55
Reach for Me
Luminous Strain
56
Ellie Kim
Joel Adu-Brimpong,
Sina Sadeghzadeh
The Silent Epidemic: Loneliness in
the Heart of Healthcare
57
Chloe Heath
59
Alphabet Soup
Chloe Heath
60
Locksmith
61
Surgeon Time
Judy Mizrachi
her name
Judy Mizrachi
63
Judy Mizrachi
Fig Trees
64
Elijah Suh
The Medical Student’s Liturgy
65
67
Elijah Suh
HYPE
Roya Brach Safaeinili
love-ethics
69
Starstruck
Jerry Shen
71
6
Home invasion, with
the entry sliced open; we
are here to rob her.
Inside glistens, sheen
of our broad lights exposing
all forms but shadow.
We bag our loot,
ruddy bowels, squishy from rot.
We are professionals,
creeping along her
walls, counting the rise and falls
of her chest, cautious,
lest she rise as witness
to her blood on our hands.
But our sins are sown
closed, and the dead cannot snitch.
We escape, sterile.
Night Shifts
Tarushi Sharma
7
“The sum of your days is the entirety of your life.”
I heard that once. Maybe in a book or maybe in one of those
movies where the main character gures out their entire life
in a day. Every day, as I tie the laces on my battered Ree
-
boks, I think about whether today is my life.
The door closed behind me and I heard the digital lock click
into place. I moved carefully down the stairs and wondered
if any of my neighbors were home.
Or if they hear me.
Most days I don’t hear them except for the occasional noise
from a television seeping out from under the door as I pass.
There’s a hum in my bathroom wall that tells me it’s shared,
but I never make out the words of the voices. The mail
comes for someone named Susan and it leaves the
mailroom just the same. I bring in her packages from the
front step and I tell people I know my neighbor, Susan.
There’s nothing on the steps for Susan today. I take a mo
-
ment to sift through my bag until I hear the rattle of the
plastic container. I empty the contents marked with the
letter “M” and swallow each without delay, step down to the
sidewalk, and throw on my denim jacket, squinting at the
sky to guess if I felt raindrops. I didn’t. But the sky in Octo
-
ber always kept me guessing. I could tell it was fall because
Autumn
Amanda Buster
8
in fall you can’t always see the sun but you know it’s there.
Sometimes you can also see the moon.
It feels like the night is always coming and the winter is
always a day away.
I waited at the end of the road for the cars to let me cross.
When the sedan approached, I saw the driver. I saw the
thermos in the cup holder and phone propped on the dash,
probably headed to work. I lifted my hand as I stepped out
to gesture “thank you”.
Down the street the leaves on the trees were changing color.
I let my eyes wander back to my shoes. I wonder if I should
replace them. I wonder if it’s obvious that the sole has mor
-
phed to the arch of my foot and I wonder if I should let it. I
could feel everything. I felt as I crushed the rst fallen leaf.
On a day like today, I wonder if I should take the long way,
around the pond where the geese stay. I wonder if they
leave when all the leaves are gone.
I want to see the last of the summer owers, I shouldn’t
rush.
Eventually my shoes bore me. I look up to each passerby
and decide where they’re going. I wonder if anyone does
the same to me.
Women in ats and wired earphones rush to the bus and to
the train and to the building by the bridge. Men in den
-
im enter the 7/11 and drop a coin in the cup of the door
holder. I don’t worry if their eyes meet mine, I don’t worry
if they know I’m watching.Around the corner came a man
with a bouquet. I make guesses about the occasion. A rst
day? A rst date? A last day? A funeral?
The breeze in the fall is a lot like the moon. It blows a warn
-
ing. To see the geese before they go.
The geese pay no mind to me. I walk past them and around
the pond. Runners moved around me on either side. I
should move more swiftly. Or get out of the way. But I take
my time. A tree by the pond has turned bright orange. The
kind of color that makes you wonder whether the fruit or
the name came rst. A gust of wind hit me with a chill that
made my eyes tear up.
I let it.
Across the pond I saw the faint gure of a mother and child,
perched on a green bench probably dedicated to someone
long gone.
I wished for another gust of wind.
Life will move so quickly past them, soon the child’s legs
won’t dangle from the seat, with any luck they’ll take her far
away.
Across the street, the students in the red brick college dorms
are studying for midterms. They’ll miss the orange tree in
their windows before it’s bare and they leave for Christmas.
My college dorm looked out to a cemetery. I remember nd
-
ing it ironic on the days where everything felt so important.
Some days I would look out to see new owers placed on
the graves and wonder how they got there. As they wilted,
they disappeared. I wondered whose job that was, to decide
when the ower no longer served its purpose.
I said goodbye to the geese, glad to know they’re headed
to somewhere warmer. Rounding the corner, the sound
of sirens in the ambulance bay broke through the wind. I
followed the sounds and moved into a crowd of blue scrubs,
stepping through the sliding glass doors. The clouded morn
-
ing light was replaced by uorescence and the cold smell of
sanitizer. I made my way through without any barrier, hear
-
ing even my shoes squeak on the polished tile. And feeling
every step.
Two young doctors rushed past with a patient on a gurney,
into exam room two. I moved with
them, quickly stepping into the room before the nurse
pulled a yellow curtain around us.
“Female, 83, post trafc collision, showing signs of brain
bleed.”
The dark-haired doctor shouted orders, requesting conr
-
mation of the patient’s condition. He didn’t need it. The
room moved around me with strategic chaos. A nurse
squeezed a bag to inate the lungs with the rhythm of a
breath. Breathing just the same as the geese, or the trees.
The dark-haired doctor wiped his brow and slowed the cha
-
os of the room, asking for a le on the patient.
“Next of kin?”
“There’s no contact here.”
9
“Well, is there a driver’s license?”
“Yes, it doesn’t say if she’s a donor though.”
“Well, let’s see if we can get a family in here.”
“I found a le here, hypertension, mild kidney disease, I’m
not sure what she’s good for.”
“I need to know if she has a family before I do anything,
they need to authorize.”
“No contact here. No directive either. Look-”
The nurse turned the screen around to show the doctor a
patient record on the computer. He
scrolled through notes.
A failing heart.
A fall.
No phone number to call. No directions.
The lungs rose and fell. Like waves meeting the sand with
perfect predictability.
Until they stopped.
Gently, the nurse lifted the mask and stepped back, turning
off the chirping monitor.
Outside the curtain, footsteps of passerbys moved with
quick pace. Doctors rushing to their page, visitors with tears
or fresh sets of clothing, or owers. Carts and gurneys rolled
through the hall and blew the bottom of the curtain inward.
But inside, it was quiet. For a minute or maybe an hour.
“I’m not really sure what to do with this,” the nurse said as
she placed a large Ziploc bag at the
foot of the bed.
Inside, only a denim jacket, and an old, battered, pair of
Reeboks.
10
When Fluency Becomes a Liability
Sathiya Perkash K Velayutham
The patient spoke uently. He answered every question in
full sentences, nodded at the appropriate moments, and
signed where he was told to sign. The language of medicine
moved smoothly through the room—diagnoses explained,
risks enumerated, plans outlined—without interruption.
Nothing in his speech suggested confusion or resistance.
And yet, when he left, it was clear that something essential
had not been communicated. Not because he lacked words,
but because the words that mattered had nowhere to land.
Aphasia is classically understood as a neurological condi
-
tion: a disruption of language following injury to the brain.
Words fracture. Grammar dissolves. Meaning slips out of
reach. In clinical contexts, aphasia is identied, classied,
rehabilitated. It is a decit to be named. But language can
be lost without injury, too. It can be rendered unusable by
structures that recognise only certain forms of speech as
legitimate. In such cases, the patient is not aphasic in the
neurological sense. They are uent. It is the system that
cannot hear.
Modern medicine is saturated with language. It relies on
precision, efciency, and standardisation. Symptoms are
translated into categories; experiences into codes. Speech
that ts these forms is rewarded with recognition. Speech
that does not—speech that is hesitant, emotional, circular,
or metaphorical—is gently redirected, corrected, or ignored.
Over time, patients learn what kinds of language are safe.
They learn how to speak in ways that will be heard. The
cost of this learning is rarely acknowledged.
Fluency, in this context, becomes a gatekeeper. To be articu
-
late is to be legible. To be legible is to receive care. Patients
who can narrate their pain in linear timelines, quantify their
symptoms, and respond crisply to closed questions are often
described as “good historians.” Their speech moves efcient
-
ly through the system. Others—those who pause, who con
-
tradict themselves, who struggle to condense suffering into
bullet points—are subtly marked as difcult. Their words
slow things down.
The irony is that the more uent medicine becomes, the
narrower its listening grows. Explanations are delivered
clearly, sometimes beautifully, but clarity is mistaken for
comprehension. Patients repeat what they have been told.
They nod. They assent. The ritual of informed consent is
completed. Language has done its job. Or so it appears.
But understanding is not a linguistic transaction. It is not
produced simply by exposure to information. Pain, fear,
fatigue, and power imbalance alter the conditions under
which language is received. A patient can repeat the risks
of a procedure without having integrated what those risks
mean for their own body, their own life. They can articulate
probabilities without being able to imagine outcomes. In
these moments, speech exists, but meaning does not follow.
This is not aphasia as absence of language, but aphasia as
disconnection between words and lived reality.
Silence often enters here—not as refusal, but as overow.
A pause that signals uncertainty is misread as agreement.
A lack of questions is taken as comprehension. The system
11
moves on, reassured by the presence of uent speech. What
remains unspoken is not empty. It is crowded with unarticu
-
lated fear, with questions that have no acceptable form.
There is a particular kind of patient who embodies this par
-
adox most clearly: the patient who can answer everything
except the question “How are you?” They can recount their
medical history in precise detail, list their medications, and
describe the trajectory of their illness. But when asked how
they are, language collapses. The answer would require a
different vocabulary—one that allows for grief, ambivalence,
exhaustion, contradiction. Medicine rarely lingers long
enough to hear such answers, even when they are offered.
This is a form of functional aphasia. Speech remains intact,
but it has lost its force. Words are exchanged, but they do
not alter the direction of care. They do not interrupt the
plan. They are acknowledged politely and then set aside.
The patient has spoken, but nothing has been said.
I am aware of my own position within this linguistic econ
-
omy. Fluency protects me. Comfort with technical language
grants access. The ability to translate between disciplines—
medicine, law, policy—confers authority. I can ask questions
in ways that will be answered. I can frame concerns in
acceptable terms. This uency feels like competence, even
benevolence. But it also risks complicity. When language
becomes a credential, those without it are rendered vulnera
-
ble. Their silence is not chosen; it is produced.
What does it mean, then, to listen ethically? It cannot mean
simply hearing words. It must involve attending to pauses,
to repetition, to the places where speech falters. It requires
recognising that silence is often informational, not empty.
That confusion may be masked by politeness. That assent
may coexist with fear. Listening, in this sense, is not passive.
It demands time, humility, and a willingness to be unsettled.
Healing has always involved more than speech. Before diag
-
nosis, before documentation, there was attention. The body
was read not only through language, but through gesture,
rhythm, and presence. Modern medicine has gained im
-
measurably from its linguistic precision. But something has
been lost along the way: the capacity to recognise forms of
communication that do not translate neatly into words.
Aphasia, reconsidered, is not only a pathology of the brain.
It is also a pathology of systems that mistake articulation for
understanding. When medicine listens only for uency, it
risks missing the very thing it seeks to heal.
The patient left the room as he had entered—composed, ar
-
ticulate, compliant. The form was led. The plan was set in
motion. Everything appeared to have been communicated.
And yet, somewhere between the questions asked and the
answers given, meaning had slipped away. Healing, perhaps,
begins not with nding better words, but with learning how
to hear what language cannot carry.
12
Previous Page: Illustration
speak :: hear
Samiha Reza
The Missing Word
Lwam Zemikael Araya
It is 2:00 a.m. in Davis, and my room is that soft gray
between
almost
and
not yet
.
I’m at Temple earlier with a coffee I shouldn’t buy,
telling myself I’m here to study
K-maps, ones and zeros, little boxes
where the truth is supposed to t.
But my real problem isn’t the homework.
It’s language.
There’s a sentence inside me that keeps reaching for day
-
light
and failing.
13
Not because I don’t know English.
Not because I don’t have words.
I have too many.
I can write whole worlds.
But this one sentence is different.
This one is the kind you say to a person
when you’re trying to be brave
and not dramatic
and not “too much.”
It’s simple.
It’s sweet.
It should be easy.
And still… it won’t come out right.
So I sit there, staring at my phone like it’s a patient monitor,
waiting for a pulse that doesn’t show.
I type. I delete.
I type again. I delete again.
Aphasia isn’t always a stroke story.
Sometimes it’s just the quiet moment
where your heart forgets the translation
for what it really needs.
I want to say:
I miss you.
But it turns into: “Hope you’re doing well.”
I want to hear back:
Please don’t disappear.
But it turns into: “Congrats.”
I want to say:
Can we x this?
But my thumbs freeze
like winter in a city I’ve never lived in
but somehow understand.
And the worst part is
I’m a scientist.
I love clear signals.
I love clean logic.
But people aren’t circuits.
You can’t force a connection
by pressing harder on the screen.
So I take a breath.
I put the phone down.
I look at my notes again.
AND, OR, NOT.
And I realize I’ve been living in OR for too long
Me OR peace.
Me OR dignity.
Me OR love.
Tonight, I want the AND.
Me AND my life.
Me AND my future.
Me AND a softness I don’t have to beg for.
I whisper the only word that always makes sense in my
mouth
“Temesgen”.
Thank you.
Not for the ache.
Just for the fact that I can still feel,
still hope,
still wake up in this gray room
and choose myself gently.
And maybe that’s the missing word.
Not the one I was trying to send.
The one I’m nally learning to say to me.
Stay.
14
Mid-sentence
Michael Johnson
15
Gesture
Michael Johnson
16
The twister had gone for the tongue.
Eyes thinly veiled dance over rubble,
salvaging words buried under
a foundation now splintered and cracked.
In the distance, scraps stolen by the wind
are gathered and polished off.
Sentences are mended.
Something isn’t missing or mourned
until one looks for it.
Like a passport or your identity.
Lips come up empty, reaching
for what is no longer there.
The door frame is now hammered over
the window and bedsheets make for a ceiling.
Wall paint is peeling, a light rose color
that forever slips the mind and is
always called green on rst attempt.
The kitchen table is down a leg —
it still holds under the weight of fragmented
conversations and heavy laughter.
Within this house, we make do.
A Humble Abode
Baani Minhas
17
Within My Skin
Alaia Chen
18
A Fading Metropolis: Alzheimer’s Through an Urban Lens
L
ooking around, I watch the city I love, the place that
makes me me, as it crumbles. I am sitting deep in the
city, where it all began, at the central library—the hip
-
pocampus. I almost smile as I think about how much I took
this place for granted. The archives, maps, names, and his
-
tories contained within the library were invaluable. A fact I
now cling to in anguish as I gaze at the gnarled fragments
of the building that remains. The library’s skeletal frame
-
work is warped by bulky, overgrown tangles, while dense
plaques clog the hallways and surrounding streets making it
nearly impossible to access the information inside.
How did it get to this point? At rst, the damage was so
minor that, I’m embarrassed to say, I hardly even noticed.
Small tangles sprouted between shelves, sometimes dam
-
aging a book or two. Really, they were only noticeable if
you were looking for them. Slowly, small details were lost
to me, names and memories just beyond my reach, items
misplaced more frequently, but I could get by. Without ac
-
cess to all my maps, I found myself getting lost on familiar
routes—coming home from the grocery store, for example.
It was frustrating, yes, but I made my way home eventually.
Steadily, though, the tangles grew more unruly. Whole aisles
of information were overcome. Shelves of material col
-
lapsed under the weight of the accumulating plaques. That’s
when the people around me started to notice. I was embar
-
rassed by how helpless I was without access to the library I
had come to implicitly rely on.
I went on like this for a while. So long, in fact, that I began
to adapt to a life without seamless entry to my library. But
the greedy tangles and bulky plaques did not stop there.
They crept their way downtown to the business district—the
center of thought and reason. It is here where plans are
developed, solutions to problems are proposed, and where
decisions are made. I look now toward the skyline that had
once stood so magnicently. I see skyscrapers that have
crumbled, with elevators that no longer work and ofces
that are all but abandoned. I remember when that skyline
dazzled. Lights twinkling as ideas sparked into existence,
diligent employees bustling from one ofce to the next as
problems arose and were promptly stamped out, the chatter
of commuters mulling over decisions amidst the organized
chaos that comprised this corner of the city. Now, the twin
-
kle of lights has dulled to an occasional icker. The bustle
has dwindled to a few burnt-out and disgruntled workers.
And the echo of the lively chatter is all that remains on the
empty streets. It was at this point that I was deemed “un
-
able to care for myself.”
I was so shocked by the blow to my once-thriving city center
that I hardly noticed when the destruction began to spread
to the surrounding residential neighborhoods. While the
city center kept things running, it was this constellation
of diverse neighborhoods that made the city a home to so
many. These neighborhoods are a patchwork of people from
various backgrounds, woven together from social connec
-
19
tions, communication, and personal histories. The block
parties, family dinners, deep conversations, and supercial
small talk dene day-to-day life here. This urry of activity
began to dull as mail started to be lost and phone lines went
down, overtaken by those same nefarious tangles. Without
these reliable lines of communication, conversations became
disjointed and social gatherings were impossible to coor
-
dinate. Faces of neighbors I had known for years began to
vanish, hidden behind walls of plaques building up around
houses. Things became eerily quiet and endlessly confus
-
ing without familiar faces to ground myself. This is when I
started to feel truly alone. After all, without communication
and the ability to socialize, how does one engage with the
world?
Last to fall was the part of the city that, quite literally, kept
things moving—the transportation hubs. The buses and
trains that allowed for motor skills and coordination. When
these shut down, movement throughout the city—to and
from work, between neighborhoods—became impossible. Of
course, as with the rest of the city, things didn’t shut down
all at once. A train line would stop running or a bus route
would be discontinued and, as it did so, my ability to con
-
trol movement faltered. As my options for mobility became
increasingly limited, my ability to complete basic tasks of
daily living was slowly extinguished.
And so, now I stand here looking out at my once beautiful
city. I know that it can’t function much longer. Even as I
watch, I can see the electricity ickering, streetlamps wink
-
ing out. The destruction came on so insidiously, it is only
now that I see how bad it has truly gotten. But this is not
how I want to remember my city, and this is not how I want
my city to remember me. I want to remember it as it was,
as I was. When the city was alive and ever-changing. When,
at its peak, the hum of voices and trafc and music that
dened it lled the air. When plazas of thought buzzed with
ideas being exchanged and expanded. When bridges and
roads were built and re-routed and changed every day as
new information ooded in, shaping the architecture itself.
When it was sleek and efcient, allowing me to tackle the
turmoil of daily life with ease. When every neighborhood
was alive and the network of connections between different
parts of the city was robust and purposeful. The radiant city
I once knew is crumbling — its sounds, its stories, its beauti
-
ful chaos reduced to fragments of what they once were.
Yet… I believe it will endure in the hearts of those who
loved it. Destruction may have overtaken this city that once
thrived, that once was me, but it cannot erase the lasting
imprint this fading metropolis leaves upon the neural land
-
scapes of others.
Ella Adeline Nettnin
20
plastic grapes
Molly Kalea Barron
21
you had raw beauty
beauty that was not cultured and cared for but simply
grew
parasitic and consuming
ripening on the vine until the farmer demanded your harvest
to be cut, with needle-nose shears
you lie on the operating table, cold steel up against your back
there are freckles scattered across your rouged cheeks
I can see how they have cycled, between blanched and sunkissed
in season from late summer through fall
their symmetry like grapes
but your skin isn’t thick like how our mother once wanted
cheeks are but crepe paper covering capillaries,
lightweight and uttering in anticipation
I watch from the eaves of the operative theater as
Venus, ever the exacting surgeon
picks at your sunburned nose and spotted skin
impassive but not impersonal, cruel judge that she is
she’s taken aback by how you burst with easy laughter and free owing tears
can’t see how the years will age your syrupy sentimentality into a mellow wine
instead she focuses on how your eyes crinkle in at the edges,
sending crows feet skittering across her drying canvas
cruel one
she sinks the scalpel singlemindedly
grabbing for your beauty like Tantalus
towards the fruit that’s already out of reach
as you lay with skin split open, sweet esh bruising under her knife
you ask her
will I be beautiful like when I was young?
she whispers
as fresh as you were on the vine
as the juices drip from your ngertips to the oor
I think about autumn, when leaves redden, turn golden, shrivel and dry
it is my favorite season
I know it once was yours
22
the human element
Molly Kalea Barron
23
on the day you died
we set the robot the task of coding out the most peaceful end to your time on earth
it spits out ones and zeros to manufacture cheer
it t h i n
k
s
From right here, I can simulate whole worlds for you to explore—
mountain ranges, deep oceans, and landscapes
limited only by computation
it cannot replicate how your lungs burned with exertion before these machines breathed for
you
climbing switchbacks to sit atop the ridges of the Sierra mountains
for no reason other than to summit, while watching water gush down from that devastating
height
the robot can calibrate your nutritional needs, and the tube in your nose provides them
but your stomach remembers more than slurry
it knows the juice of the cherries that stained your ngertips ruby red in the summer
the scrambled eggs you begged for at age one, nevermind the newborn allergy that gave you
hives
signing, more, more, ngertips pressed together before your mouth could form words
it turns you, gently, hour after hour
avoiding bedsores it knows are inevitable in your motionless form
it can’t fathom that you once twisted and dove,
naked and shrieking your way into the Mediterranean
to oat in the sea after sunset
it tells your family that
it is time
and I can’t disagree with the perfect, data-driven sympathy
but there is no thickness to its tinny voice
after the plug is pulled you have one last question
what does heaven look like?
it crunches your last words and t h i n
k
s
That depends on
who you ask
. I cannot if you’d like, I can answer this
from a
specic religious tradition
, a
near-death experience perspective
,
or even explore what heaven might look like to you.
but you have already moved on
24
Right: Satellite Baby Sutra, 2025. Oil,
ink, incense, joss, indigo and mulberry
paper on canvas. 60 in x 20 ft, 9-panel
folding screen
Left: Anatomy of
a Grotto Heaven
洞天解剖圖
,
2025. Ink and
Chinese medicine
herbs on xuan
paper. Hanging
scroll, 71 x 25”
25
Art Portfolio
Grace Jin
On this page: Inner Canon of the Yellow
Empress
《黄后內經》
, 2025.
Ink, iodine, salt, gardenia fruit and
safower on silk. 9 x 10 ft
26
PAUL KALANITHI WRITING AWARD
WINNING PIECES
Birds
Brian Zhang
Preston set his knitting needles down on the tray table and
leaned back.
“Wow,” he said. “That went by fast.”
I thought he meant the movie. It was his pick tonight —
Firebird, a 2021 lm about a Cold War love triangle. Friday
movie nights have been a tradition since our youngest,
Maya, had left for university and our place went quiet for
the rst time in twenty years. Preston and I had to learn
how to be comfortable with being just two people again,
and we had compared lists of things we liked to do. Spend
-
ing evenings indoors — snuggling in bed, gossiping about
ctional characters over a spread of good snacks — hap
-
pened to be one of the hobbies we had in common.
“What do you mean?” I asked.
He put an arm around me and picked at my wristband. “Do
-
ing this whole husband thing with you,” he said. “It went by
fast.”
I looked at him. The man beside me had white hair and
circular glasses perched low on his nose. His hands were
steady, the way they always were in my memory. I could
swear I’d only blinked. He had been twenty-seven only
yesterday, scrawny in an oversized blue sweater, fresh out
of Yale Law. He was slightly proud and enjoyed an evening
smoke, but had many redeeming qualities. He woke up
at eight-thirty every Sunday to go to the farmer’s market
to buy my favorite Vietnamese sandwiches from this one
stand. For our rst date, we met in the cafeteria of the New
York Presbyterian Hospital where I had been working as an
emergency medicine resident. He bantered so well with the
serving staff that they remembered his name better than
mine.
He found me at a time when I had found my footing in my
career (and was nally getting paid for it) but in shambles
about pretty much everything else. At twenty-ve, I worried
constantly that I was running out of time and wondered if
the fear of living and loving ordinarily would ever lift for
gay men. Before him, no one had bought me owers before.
Our room smelled faintly of disinfectant. I pulled the purple
blanket he had knitted for me one Christmas up to my
chin. Across from us, small desk-framed photographs of our
children caught the television’s glow. Maya with frosting on
her nose. Jackson at his rst swim meet. Natalie in a too-big
corsage, posing with a high school boyfriend.
“Did you move those?” I asked.
Preston followed my gaze. “They’re exactly where they
should be.”
“I don’t have dementia.” I said.
It came out like a question.
He reached for my hand and squeezed once. “No, honey.
You don’t.”
I let myself breathe.
“We did it,” I said. “We raised them.”
“We really did,” he said.
Somewhere down the hallway, a voice crackled over a
speaker. Lights out in ten minutes. A moment later, a man
28
and woman in scrubs appeared in the doorway.
“Mr. Zhang?” the man asked, glancing at the chart. “
Just
making sure you heard the announcement. If you need
anything overnight, press the blue button by your bed and
an aide will come.”
“I think I’ll be alright,” I said. “My husband’s here. He’s
staying.”
The nursing aides’ eyes icked around the room.
The man opened his mouth, about to say something, but the
woman interrupted him.
“It’s wonderful that your husband is visiting and here to
help,” she said. “Good night, Mr. Zhang.” They started to
close the door, then hesitated.
“And the blue call button,” the woman repeated, rmer now.
“If you need us. And let us know if your husband needs
anything too.”
Preston didn’t answer. He never does when they speak. I
watched the door close and felt, all at once, very tired.
He picked up his needles again, the soft click-click ground
-
ing me. After a moment he said, “We should go before we
miss it.”
I frowned. “Go where?”
He smiled. “You know. You remember.”
I closed my eyes.
—
After spending eight years doing undergrad and medical
school in the Bay, I had forgotten how unforgiving East
Coast winters were.
“You enjoy doing hard things,” Preston said, zipping his
puffer jacket all the way up to his chin.
“You chose emergency medicine.”
“I chose saving lives in a heated facility,” I corrected him.
“There’s a difference.”
We had just arrived at a campsite on the banks of the Long
Island Sound in West Haven, seventy-ve miles northeast
of the apartment we rented in Washington Heights. There
were families and groups of teenagers that had already set
up their tents. Preston said this was a good spot to see the
Geminids, a meteor shower that peaks every year in Decem
-
ber.
I didn’t tell my mother about the trip. We had argued the
night before over the usual things. She said I was stitching
myself together from the wrong parts and would eventual
-
ly come apart. She warned me, again, about the sickness,
about the consequences, about what happens to men like
me, citing statistics she had read from articles in her fellow
Asian immigrant WeChat circles.
She also called Preston poison. Someone who led her only
son astray, let alone accept him as another son.
Preston heard it all. He was folding our scarves at the kitch
-
en table, careful and unhurried. Over the years, the woman
I loved most in the world had grown increasingly creative
with her metaphors about gay people. She called again
while we were almost nished packing. I let it ring.
It wasn’t until I was inside the tent, wrestling my sleeping
bag into place, that it nally spilled out of me.
“I’m sorry about my mother,” I said. “You don’t deserve
that.”
Preston lay on his back, staring at the low nylon ceiling
where our breath fogged and faded.
“You don’t have to protect me from her,” he said. “I don’t
want that.”
He was quiet for a long time, then said, almost casually, “My
le was mostly adjectives.”
“That’s how they talked about me,” he continued. “Pleasant.
Well-tempered. Adapts well.
‘County staff love him.” He huffed a small laugh. “I think
they hoped families would read it and feel safe. Like I
wouldn’t cause any trouble if they decided to take a foster
child home.”
He picked at a loose thread on his sleeve. “For a long time, I
thought being liked was the safest thing you could be. Don’t
make trouble. Don’t ask for too much. Don’t say what you
actually want.”
The tent shifted as the wind picked up.
“I thought if I stayed agreeable long enough,” he said,
“someone would decide to keep me.”
He shook his head. “Turns out being easy to place isn’t the
same as being chosen.”
I didn’t know what to say. I just looked at him.
“So whenever you talk about giving up on your family,” he
said, still not looking at me, “I know this won’t be what you
want to hear. But your mother loves you. She’s wrong, and
it can get exhausting — but she’s still here. You have some
-
thing I don’t.”
He turned then, his voice softer. “Don’t walk away just be
-
29
cause it hurts. That would be selsh.
And you aren’t a selsh person, Matthew Zhang.”
Outside, a man shouted, “There! Another one!” A ripple of
excitement followed, voices overlapping.
He pushed the tent ap aside and cold air poured in, sharp
and clean, stealing my breath. The forest stretched out
beyond us - black trunks, frost-bright ground, clusters of
headlamps and ashlights bobbing as people looked up.
“Come on, Matt,” he said, holding out his hand.
I barely had time to protest before he crouched and lifted
me onto his shoulders, sudden and reckless. I yelped, grip
-
ping his hair as my legs locked instinctively around his neck.
“
Jesus,” I said.
I looked up.
The obsidian sky was a living thing. White lines tore
through the dark, quick and thin like chalk marks, like
Northern gannets plunging into the sea for prey. Other
streaks verged on shades of pink or green, aring wide and
lingering, ghostly, like a ock of mythical birds on some
mission.
The campers below gasped and counted under their breath.
An annual migration of rocks and dust burning themselves
out for our benet.
“They’re just space debris,” Preston said, steady beneath me.
“Leftovers from this parent asteroid called 3200 Phaethon.
Most days they go unnoticed. Then, for a few nights every
year, they hit the atmosphere just right.”
His hands tightened around my calves. “They refuse to be
ignored.”
“Romantic,” I said weakly.
“It is,” he said. “Make a wish.”
I hesitated. Another shooting star darted by above us.
“Do you think it ever gets better for the birds, Preston?” I
asked him. “Do you, uh — do you think all birds go on to
get married, have children, call their parents frequently, and
grow old?”
He paused. And then: “Yes. I really do think so.”
“Then I wish all those things for us.”
Preston huffed, his breath like powdered sugar in the 8°F
air. “I was going to wish for more upper-body strength. Now
I feel like an asshole.”
He set me back down, cupped my face, and he kissed me.
Every pair of eyes on the campsite were on us. In English,
we don’t have a word for being mortied, proud, and stu
-
pidly in love all at the same time, but that was what I felt.
That night, I overowed with an audacity to reach for some
-
thing greater than myself, even though I had no idea how to
hold it. I reached for Preston, and then for my mother.
—
When I open my eyes, the stars are gone.
The ceiling above me is white. The room is quiet. The chair
beside my bed is empty. Idle waves of color roll around in
the TV screen sitting in front of me. I had probably for
-
gotten to turn it off last night. Through the cracks in the
window blinds, I could see the daylight outside. Preston is
not here. I know, without knowing how, that it’s going to be
okay. He will return.
I am quite hungry. This morning, I decide that I would like
to break routine and have breakfast with Mrs. Mary Pope
and Mr. Kevin Marino, two of the other senior citizens I met
since coming to the facility.
When Preston was diagnosed with end stage liver cancer on
his sixty-sixth birthday, I asked if he was scared. He joked
and said not really, except he added that he was scared of
leaving behind an introverted old man like me to make
friends and talk to strangers by myself. I vowed to prove
him wrong.
I know I have to press one of the buttons by my bed to
call for a nursing aide to help me change and brush my
teeth, but I can’t remember which. So I try all the colors.
In the meantime, I reach for my phone to dial my mother’s
number. I have an unexpected surgery that the attending
had asked me to scrub into tonight, so I will have to put a
raincheck on our dinner plans, but I’d like to meet her for
dim sum tomorrow.
I will also bring her lilies from the local orist.
Lilies are my mother’s favorite owers.
30
Survival is maintenance.
Maintenance is invisible.
Survival is maintenance.
Ianto Muir
31
Maintenance is invisible.
From the outside, nothing looks differ
-
ent. People tell me I seem better. They
told me that then, too. I learned early
how to look ne: steady voice, careful
answers, tension distributed just right
so no one asks follow-up questions.
Progress doesn’t announce itself. It qui
-
etly replaces performance with labor.
History of Present Illness
After a fteen-minute consult, a new
psychiatrist handed me an intake form.
It was neat. Orderly. Hospitalizations.
Medications. Procedures. Then:
Have you ever attempted suicide?
☐ Yes ☐ No
The box was too small. It couldn’t
hold the why, the how, or the choice to
climb out of the river. It couldn’t hold
the silence that followed.
I felt the urge to check “no.”
Instead, I drew a backwards check
-
mark in “yes,” crooked and defensive,
and moved on.
The form didn’t ask for more.
Past Psychiatric History
I didn’t hate admitting I had tried to
die.
I hated admitting I had failed.
Failure was choosing a bridge too
short. A river too deep. Failure wasn’t
regret or revelation. It was the thought
of a breath full of water when I’d
planned to die on impact.
I didn’t survive because I was brave.
I survived because I panicked.
There was no nobility in it.
From 2016 to 2025, I told no one. Not
my therapist. Not my doctors. Not my
friends. Secrecy felt like control, and
I rationed the truth carefully. Over
time, control became isolation. Control
narrowed my world until no one else
t inside it.
Chief Complaint
“How are you doing now?”
A mineeld.
“Doin’ my best.”
“Livin’ the dream.”
“Eh…”
The third is dangerous—too close to
honesty.
The second ends the conversation. It
signals distress while making it clear
I’m not available for questions.
My shoulders tense before I answer.
I scan their face for how much truth
they can tolerate.
32
Too honest sounds unstable.
Too light sounds evasive.
I aim for something survivable.
Medication Compliance
I resisted medication for years.
I hunted side effects like evidence. Any
discomfort was an excuse to stop. I
told myself I was cautious. In reality, I
was looking for exits.
Now I take the meds. Not because I
like them; because stopping costs more
than continuing.
It’s not devotion.
It’s maintenance.
Nutrition / Activities of Daily Living
(ADLs)
Starving myself was my favorite form
of self-harm: socially acceptable, easily
hidden, often praised.
Calling it survival feels humiliating.
It feels like being congratulated for
breathing.
I eat anyway.
Affect / Appearance
I look calm.
The anxiety is gone, but quiet still
requires effort. People don’t see what’s
missing, only what remains. They don’t
see the rehearsals I no longer run, the
threats I no longer scan for, the emo
-
tional prepayments I no longer make.
The work is what doesn’t happen
anymore.
Progress Notes
Progress isn’t looking better.
It’s letting bad days exist without
apology.
That distinction didn’t make sense to
me until inpatient care.
My rst exposure to group work was
sitting in rooms where people said
symptoms out loud. No one competed.
No one performed recovery.
After a childhood built on self-reliance,
being held felt foreign. Being listened
to was worse. My experiences were no
longer unchallenged, and I didn’t have
the strength to defend them.
I want others to feel the lightness I feel
now.
But my path isn’t transferable.
My partner doesn’t scan rooms for
threats anymore. She doesn’t preempt
my emotions. And now that I can sur
-
vive what used to break me, even her
protection can feel like a cage.
Next Steps/Monitoring
It’s easy to lie.
My phone asks how I’m doing ve
times a day.
33
Energy (1–5). Mood (1–5). Symptoms.
7am. 11am. 3pm. 7pm. 8pm.
I used to tap through it: fast answers,
clean data. Then I started going back.
Deleting. Re-entering.
I felt before I answered.
The point wasn’t accuracy.
It was honesty.
If only with myself.
Now they’ve asked me to be an ambas
-
sador.
To act as proof that help works.
I said yes, then panicked; not because
I doubted the program, but because I
doubted my right to represent it. My
chest tightened with the old instinct to
perform stability before anyone could
question it.
Visibility is complicated. There’s an old
fear that if people really see me, they’ll
know I’m not okay. There’s a newer
fear that if I look okay, I’ll be lying
again: rehearsing stability, producing
the version of myself that professionals
reward.
Approved. Stable. Alone.
What if I fail the people who saved
me?
What if pretending to be better be
-
comes the job?
So I make a plan. Small. Private.
Non-negotiable.
“I’ll do this tomorrow” means:
Take the meds.
Answer the app.
Eat.
Notice.
This isn’t hope.
It’s work you have to do quietly, every
day, with no witnesses.
Because survival is maintenance and
maintenance is invisible.
34
PAUL KALANITHI WRITING AWARD
HONORABLE MENTIONS
A Single Clap
Liam Little
I remember that room of isolation,
The sound of the singular clap,
The clap that was my own,
A steady beat to keep my belief.
I remember when it was just me.
When all that kept me going,
Was the sound of that clap,
the rhythm of my belief.
I remember how it felt in the dark shadows of
Uncertainty.
So in that room of isolation, I will join you.
And now there will be the two of us clapping.
Now, the two of us believe,
in the dream
and in
You.
36
Lesson on Etymology
Joyce Ker
For Li-gang, my father
37
In Greek karkíkonos, Latin cancer, a growth, lump,
what lurks like a crab, growing—by which I mean
omnis cellula e cellula, “each cell stems from another cell.”
Incision in your chest-cavity to remove a lobe,
a lump of cells. Call it obscene, Latin obscaenus,
“ill-omened, abominable, repugnant to the senses”—
chemical warfare of Cisplatin and Docetaxel,
your watery stool and scaly skin, pungent
celery juice and bone broth protein powder,
repugnant to your senses, extracted from marrow,
the essence of life. Or do you need to exorcize
your unmet desires, your anger, or, in youth,
were you a smoker, in which case I have nothing
to say. The night before your surgery, you asked
if this were all foretold by the stars—
Cancer, constellation of a crab in the heavens,
inhabiting the shore of your body,
Al Tarf its brightest star, from Arabic for “the end.”
You do not believe in desire or spirits or fate.
You hate me, hate your body,
hate the Kaplan-Meier survival curve.
In the beginning a blood-cough, knot in your rib-cage.
Two centimeters in diameter, smooth-edged
like a clenched st, not spiked like a crab-claw.
In Chinese you say cancer, ái, which sounds
too much like ài, meaning love. Which is to say:
You must still love life. Or have you forgotten it—
your life, your childhood in Wenzhou, the mountains
white with snow, xuě. Carrying timber on your back,
not afraid of god or fortune, crying when you fell
and saw your own blood, xuè. The mountains’ topography
carrying a history, an identity. Your history: gone gone gone.
All of it: Li-gang with cancer. Metastasis, Latin meta
and stasis, “beyond stillness,” the body’s geography
unmoored. What cruel topography, your blood an ocean
that breathes and breaks, lurking still.
38
you do not have to
Tulsi Patel
Inspired by Mary Oliver’s Wild Geese:
“You do not have to be good.
You do not have to walk on your knees
for a hundred miles through the desert repenting.
You only have to let the soft animal of your body
love what it loves.”
39
To the Resident
You do not have to carry it alone.
You do not have to hold
every sigh, every alarm,
every family’s question
as if it belonged to you.
You only have to walk the corridor,
press your stethoscope to the chest,
listen for breath where it is faint,
for silence where it should not be.
Meanwhile outside the window
the sycamores lean into morning,
a line of geese cuts the sky open,
the earth keeps turning
though here the clocks stand still.
And you—
you are not only witness to near endings,
not only bearer of charts and codes,
but a body among bodies,
living in the chorus of the world,
allowed to look up,
to belong.
To the Patient
You do not have to be grateful.
You do not have to nod
when someone says “at least…”
or swallow your fury
when the pain will not let you sleep.
You only have to live inside this body,
with its scars and bruises,
its sudden betrayals,
its stubborn pulse that carries you
hour by hour.
Meanwhile the world continues—
the sparrows scatter seed,
the rain slides down the glass,
the earth keeps loosening
and blooming again.
And you—
you are not only a patient,
not only a vessel of suffering.
You are a story still unfolding,
though some days it feels like an undoing,
a name still spoken with love,
a person whose purpose
is repurposed daily,
amongst the chorus of the world.
40
Cisplatin leaves
a metal tang.
He says it feels
like sucking on nickels,
like a spoon left too long in the mouth.
No mint will chase it,
no water will wash it down.
Every swallow is iron,
every breath
a forge in his throat.
Later,
I watch him push away dinner,
the chicken untouched,
the cake half-eaten.
Cancer robs appetite,
but chemo
robs avor itself.
Food becomes memory—
a sweetness you can recall
but not touch.
The Taste
Tulsi Patel
41
Sitches
Madeleine Gayle Smith
When I was 7 years old, my Nana taught me how to sew.
My rst project was a simple apron to tie around my waist,
which I learned how to stitch by hand. My Nana’s time
in my life was short, but whenever I get out my sewing
machine, I think of her. Over time I added to my sewing rep
-
ertoire: a patchwork quilt for my childhood doll, a friend’s
slacks, Halloween costumes, and my high school prom
dress. I discovered that my favorite sewing projects are not
the ones that begin with an uncut bolt of fabric, but the
projects that require repairing or repurposing something to
bring it a new life. There is such joy in taking an old jacket
with torn pockets and making it useful again or sewing up
my little sister’s stuffed animal.
When I was 13 years old, I discovered the best sewing
project ever. Sitting in a medical exam room, I listened
as my cardiologist explained to my parents why I needed
open-heart surgery to correct the cleft in my mitral valve. I
had so many questions: What’s wrong with my heart? What
is open-heart surgery? I wanted to know every detail about
it all. I found a video of a surgeon performing open-heart
surgery online, and I watched it from start to nish. It was
astonishing to see how the surgeon’s hands, stitch by stitch,
were able to make a malfunctioning heart into a healthy
one. I was transxed. What if those hands were mine and
that heart belonged to another teenage girl like me?
If my experiences with medicine are a patchwork quilt I
continue to stitch together; the fabric of my early high
school years is pastel pink. My rst solo drive at 16 years
old was to the hospital for my weekly volunteer shift in the
cardiology unit. Over the course of my time volunteering,
it was humbling to meet patients from diverse backgrounds
and listen to their surgical experiences. In my time in the
cardiology unit, I was inspired by patients’ stories of re
-
silience and the lessons they learned from life that they
chose to impart to me. There was an elderly woman I met
post-operatively. We shared a love of dance. She expressed
regret over not continuing to dance for fun as she got older.
Having gone through open-heart surgery, she felt like it was
time to return to dance and quipped that with her newly
xed heart she’d call it “transcen-dance.”
My time as a young adult is the deep navy blue fabric in my
quilt of medical experiences. Shortly after my 18th birth
-
day, I found myself in a different area of the hospital than
my typical haunt with the heart patients. My parents had
recently divorced, my dad was out of the picture, and my
42
mom lost the ability to move the right
side of her body. An MRI showed a
rim-enhanced lesion in her brain, and
the doctors did not initially have a de
-
nitive diagnosis. It was the rst time I
had to confront uncertainty in medi
-
cine. My mom went through a spinal
tap, physical therapy, and months of a
PICC line and steroids. Imaging contin
-
ued to show an undiminished lesion.
Months after her initial hospital stay,
we decided to proceed with a brain
biopsy. The procedure reduced the size
of the lesion and conrmed that it was
an abscess, but postoperative swelling
resulted in my mom losing the gains
she had made with her mobility. Until
this moment, I had a belief in the abili
-
ty of medicine to x any problem, that
it was as simple as mending a hole in
the sleeve of a sweater.
The sky blue fabric stitched into my
patchwork of medical experiences de
-
picts my rst job in a medical practice.
I was 23 years old working as a scribe
in an orthopedic clinic, when I met
a patient who illustrated to me how
medicine can be uncertain and imper
-
fect, but beautiful. She was my own
age and had been in a horric car acci
-
dent—sustaining multiple comminuted
fractures to her upper limbs. Medicine,
however wonderful it is, however able
it is to improve and repair, cannot
reverse the damage her arms and
hands endured. Each time I saw her
for a post-operative appointment, I
marveled at the human body’s remark
-
able resilience. She progressed from
early appointments, when she quietly
spoke with her hands unnaturally still
on the exam table, to later clinic visits
when she excitedly gesticulated as she
recounted stories. It was not just the
43
surgeon’s skill in the operating room,
or her body’s gradual pathway towards
healing, that captivated me. It was also
the way the surgeon, hand therapist,
and patient worked together toward
reaching recovery goals. Through mul
-
tiple surgeries and countless therapy
sessions, she continued to celebrate
each advance she made in her recov
-
ery, even knowing that she would
never be able to play piano the same
way again.
Although my Nana is no longer alive,
her presence is the golden thread
stitched throughout my quilt of experi
-
ences.Her greatest legacy was not just
teaching me how to sew, but showing
me how to repair, restore, and bring
new life. I imagine the words of com
-
fort she would have shared with me
during my open-heart surgery and the
wisdom she might have given as we
navigated my mom’s medical journey
together. Perhaps most of all, I think
she would be excited to know that her
gentle instruction with a needle and
thread when I was a little girl instilled
in me a passion to encourage and
restore others as an adult. I continue
to carefully sew my quilt of experi
-
ence and my time in medical school is
adding squares of verdant green fabric
to the patchwork. At this liminal stage
in my educational journey, I continue
to dream of one day transforming lives
through the medium of medicine the
way my Nana’s gentle presence and en
-
couragement changed mine.
Left: “Purpose,” is a photograph of a 60 × 80–inch quilt
Madeleine sewed as a nal goodbye to the medical
practice where she worked as an orthopedic scribe. The
quilt is composed of 17 surgical towels and one pair of
worn-out scrubs. Once a surgical pack has been opened,
the surgical towels are no longer considered sterile. Made
-
leine hoped to repurpose the retired scrubs and banished
surgical towels into a quilt that would hold memories of a
formative chapter of her life.
44
My First Time Learning
About a Jellysh
First Morning
After Funeral
Bao (Le) Nguyen
Bao (Le) Nguyen
named the Turritopsis dohrnii is when
I’m standing in front of a sign that says
“immortal jellysh.” It is the one
and only creature in nature that has
the ability to regenerate
its cells when it becomes sick or too old,
and restart its life cycle. Just like that,
it goes back to square zero with the push
of a button. I think of my mother,
her pale, thinning body resting calmly
on the rosy oral-patterned bedsheet
in my bedroom, too tired to make a sound.
What good is regeneration now when
her cells can’t unlearn their impatience?
In the kitchen, the rst light of dawn storms
through the windows and lls the apartment
with re. I can’t shake off the feeling
that I’m passing this golden time alone
with my father who seems to take pleasure
in nothing, other than his freshly brewed
tea from a porcelain cup that glistens
on the table, while the pianist plays
inside the tin music box by the doors.
I tell him about what I wrote last night
in my diary: how two people would still
see each other even though one was dead,
how they could speak to the other in dreams.
And the seat across from me seats no one.
Slow Down
Elizabeth Ener
45
46
Slumber Party
Bao (Le) Nguyen
We tell ghost stories to scare each other.
They keep us alert to things in the dark.
Our ghosts are keepers of things in the dark:
The words for the fact of their missing esh.
There are missing words for their factual esh,
For we choose to seal them in a cofn.
I seal my mother’s last words in a cofn
Wide enough to conceal her thin body.
She couldn’t conceal her thinning body,
Her bruised kidneys, her heart in swift failure.
My heart bruised quickly over her failure,
Thudding like thunder in hot July rain.
In a July thunder-thudding hot rain,
We tell ghost stories to scare each other.
Path of the Unspoken
Niki D. Gallardo
47
48
cortical ribboning
cortical ribboning
“Soa
Jose
Camila
Daniela
Juan
Luis
Natalia
Antonio….
Her ngers slowed down in their count as her memory
trailed off.
Her eyes stared off into the distance beyond the walls of the
ED, attempting to grasp at
what memories she had remaining to recount the beloved.
In the mere seconds it once took her to recount the twelve
siblings who had given her life
and love, their faces and names began to fade into the
oblivion.
“And what are the names of your four other siblings Elena?”
“I am not sure. I am trying to remember.”
Her eyes began to well up once more in frustration.
“I know their names, I do.
They are my siblings. I grew up with them.”
“Honey, remember there’s Carolina, Emilia, and Mateo and
Manuel who passed away.”
Her husband calmly grasped her trembling hands to steady
her mind and placate the
frustration bubbling over,
as he gently guided the tendrils of her memory to wisp
into a recognizable form that could keep her alive.
“Oh yes! Carolina, Emilia, and Mateo and Manuel!”
Relief washed over her face, a momentary halt to the panic
that had consumed her in the
last few hours.
49
“We walked to school together when we lived in Colombia.
Now we all live close to each
other.”
“My favorite subject was math. I liked math a lot.”
She smiled– a triumph in the battle for her memory.
This is a win. She still remembers aspects of her childhood.
His eyes locked on Elena, simmering with pain and tears.
He discreetly wiped them away before they could escape
and make a scene.
She did not take notice,
perhaps lost to the moments in Colombia that she held onto
lest they leave too.
Her husband
glanced at me
momentarily and the pain in his
eyes spoke the words he was
too scared to utter –
I know something is very wrong with my wife.
Her neurological exam was perfect.
The model of a standardized patient in an informational
video to teach medical students
how to conduct a neurological exam.
Evidence was gathered - she
is
okay - ignoring the looming
shadow of her rapidly waning
memory.
“What’s wrong with me? I was not like this before.”
The momentary respite had ended,
fear and confusion haunted her once more.
“I will speak to my attending and we will review your imag
-
ing.”
_____
“You should look up an image of cortical ribboning. It’s
pathognomonic for Creutzfeldt-Jakob.”
Neurology said.
“How long will she have?”
Unfortunately not long, only 6-12 months. They rapidly
decline.”
Sympathy tinged their voice and eyes
as they witnessed the horror dawn on my face
gathering what small shreds of kindness they had left in an
exhausting day
to ll the deep chasm of silence that ensued between us.
“We know, it’s very sad. ”
_____
it weaved a beautiful pattern out of her cortex
bright signals to showcase the intricate creation of God
concealing the relentless destruction it wrought on her,
as it insidiously siphoned o? the essence of who she is.
Noor Suhaib Zanial
50
She could no longer drive to her usual grocery store to grab
her favorite snacks,
could not remember why she had called her sister,
gave her son a towel instead of water because she forgot
why she went to the kitchen for
him
And as time would pass,
she would no longer
say
I love you
to her husband,
her sons,
and her Soa, Jose, Camila, Daniela, Juan, Natalia, Antonio,
Carolina, Emilia
or pray for Manual and Mateo.
as she fades away,
as her cortices shrink,
as her eyes dim,
their cries grow louder
attempting to drown out the silence
enveloping her
and we bow our heads in shame
for we have failed her, them
we do not know everything,
we are not powerful against everything,
we can not give what we do not have,we can not say what
we do not know.
and when it has taken her
and the pain nally washes over them,
their voices will exhaust and sputter,
silence will be her nal abode.
51
Dr. Tina
didn’t
couldn’t come in.
Kripa Philip
It was raining in Kerala.
Not soft. Not poetic.
Just rain,
the way it always is there,
loud,
honest.
My grandmother
lay beneath
a white embroidered sheet.
I sat front row,
watched her disappear
in centimeters.
We waited
for Dr. Tina.
The chemo doctor.
Her presence
felt like a guarantee,
as if seeing her
meant a few more years
had already been secured.
But she did not come in.
She stood outside,
beneath a cracked umbrella,
looking
but not crossing.
There was nothing left
language could authorize.
I understood something
about grief,
and doctors,
and thresholds.
She did not need
to see the body.
She already knew the loss.
And I wanted to be
that kind of knowing.
That kind of near.
52
clinical vignette
Kripa Philip
patient is a 20-year-old
with attened affect,
rumination,
feelings of emptiness.
answer choice:
refer to psychiatry STAT.
but the chart never says
what to do
when the patient
is you.
53
Retina of Reection
Ellie Kim
54
Reach for Me
Ellie Kim
55
Luminous Strain
Ellie Kim
56
The Silent Epidemic: Loneliness in the
Heart of Healthcare
Joel Adu-Brimpong & Sina Sadeghzadeh
“All the lonely people
Where do they all come from?
All the lonely people
Where do they all belong?
Ah, look at all the lonely people.”
- Eleanor Rigby, The Beatles, 1966
In the hushed corridors of hospitals, where the hum of
uorescent lights mingles with the beeping of machines, a
silent epidemic thrives. Loneliness, a word rarely spoken
on medical rounds, has become one of the most pervasive
ailments we encounter as third-year medical students. Amid
dazzling technological advances and ever-expanding clinical
checklists, it is the quiet ache of isolation that resounds the
loudest.
As members of the care team, we spend hours with patients,
navigating diagnoses, medications and discharge plans. Yet
in the rush to collect data and move efciently from room to
room, it is often the unspoken that lingers longest. Patients
with ailments such as heart failure, dementia and renal dis
-
ease frequently nd their greatest relief not in new prescrip
-
tions but seemingly in the chance to be heard. Their stories
spill out in the pauses between clinical nuggets, lab results
and imaging reports; they share stories of family lost, activ
-
ities no longer able to participate in, careers left behind and
of days marked by silence and deprived of human touch.
The truth is unsettling: no matter how much time we spend
at the bedside, it never feels like enough. Hospitalized
patients, conned by illness and routine, crave more than
medical attention. They yearn for connection. In those mo
-
ments, our role subtly shifts. We are no longer just medical
students; we become witnesses, companions and sometimes
the only consistent human presence in their day.
This experience is not anecdotal. U.S. Surgeon General Dr.
Vivek Murthy has warned that loneliness is a public health
epidemic, a call echoed by the World Health Organization,
which now recognizes it as a global health priority. The
data is stark. Loneliness is associated with increased risks
of heart disease, stroke, dementia, respiratory illness and
premature death. A report from the National Academies of
Sciences, Engineering, and Medicine found that social isola
-
tion and loneliness are linked to roughly 30% increased risk
of heart disease and stroke. Among patients with heart fail
-
ure, loneliness is associated with nearly a fourfold increase
in mortality, a 68% higher risk of hospitalization and a 57%
increase in emergency department visits.
The consequences extend well beyond physical disease.
Loneliness weaves itself into mental health, fueling depres
-
57
sion, anxiety, and, tragically, suicide. The economic toll is
substantial as well, with estimates suggesting that loneli
-
ness contributes more than $6 billion annually in excess
Medicare spending. These are not marginal effects; they are
signals of a systemic blind spot.
And yet, our healthcare institutions remain poorly equipped
to address this need. Hospitals are meticulously designed to
treat pathology, optimize workows and control infection.
In the process, they often become environments that inad
-
vertently amplify isolation. Shortened visits, documentation
burdens and rotating care teams fracture continuity. Ef
-
ciency, while essential, can quietly crowd out presence.
This tension is only intensifying. We are entering an era
dened by articial intelligence, virtual reality and increas
-
ingly sophisticated digital tools. These innovations promise
earlier diagnoses and more personalized treatments, but
they also risk further distancing clinicians from patients. A
virtual reality headset may transport someone to a simulat
-
ed beach but it cannot replace the comfort of sustained eye
contact or the reassurance of being truly seen. No algorithm
can replicate the healing power of shared silence or a hand
held at the bedside.
Perhaps most concerning is that loneliness is no longer
conned to older adults. Rates among young people now
rival, and in some cases surpass, those of prior generations.
If we fail to address loneliness within healthcare today, we
risk building a system that treats disease efciently while
leaving an entire generation emotionally underserved as
they age into it.
In an age of unprecedented medical capability, our greatest
challenge may not be mastering AI or quantum computing
but remembering what medicine is. Healing has always
required more than technical excellence. It requires pres
-
ence. It requires recognizing that behind every diagnosis is a
person whose suffering may be eased not only by treatment
but by connection.
Healthcare leaders, clinicians and trainees alike must learn
to treat human connection not as a luxury or an inefciency
but as a core component of care. This means designing sys
-
tems that protect time at the bedside, training clinicians to
listen as deliberately as they diagnose, and valuing presence
as a clinical skill rather than an optional virtue.
If we fail to do so, we will continue to cure disease while
neglecting something just as vital -- healing. And our pa
-
tients will keep asking, quietly and persistently, the same
question posed decades ago: where do all the lonely people
belong?
58
It’s like a can of alphabet soup was emptied into his
brain. Beige letters dispersed in broth. One by one, his
mind wrangles and aligns each letter to form a word.
At least, that’s the intention. Instead, retrieved letters
mingle with Qs and Es and Ls, forming an unintelligi
-
ble mosaic of consonants and vowels. Meanwhile, the
chatter of the world marches on.
Alphabet Soup
Chloe Heath
59
I mute the television and move across the couch, right next
to my dad.
“Start from the top. Okay, rst word.”
He begins spelling, each letter slowly bubbling to the sur
-
face.
“T. H. E…”
“The”, I say.
He gives me a thumbs down. A hoarse mumble escapes, but
I don’t understand. Again, from the top.
“T. H. E…Y.”
“Ahhh, ‘they’”, I say. He gives me a thumbs up. Onwards.
“L.O.S.T.”
“They lost…”, I say. Thumbs up.
“T.O.”
“They lost to…”
“D.U.K.E.”
They lost to Duke. I sit there, confused for a moment. And
then I recall, a moment ago, ESPN ashed the record of
Michigan State’s basketball team. Their then-perfect record
of 8-0 had been tarnished, but I wasn’t sure by whom. Of
course, my dad knew. A dedicated follower of his alma
mater, he knows everything about the Spartans. The words,
‘They lost to Duke’, boomerang in his head before he can
nally integrate these thoughts into speech. By the time he
nds his words (or rather, dictates the letters), ESPN has
moved on from college basketball.
These days, my dad doesn’t speak much, and most attempts
sound more like grunts. Aphasia gradually closes the door
between the inner workings of his mind and the world, and
eventually, the key will turn and the door will lock.
But right now, he perseveres. Every syllable he utters is like
wedging a foot between the door and the doorframe. Every
letter I ask him to repeat, or mumble I try to decipher, is
my attempt at jiggling the door handle, to keep the portal
between his mind and the outside world ajar for just a little
bit longer. Our broken conversations are a joint ght against
the insurmountable beast of neurodegeneration.
Locksmith
Chloe Heath
60
surgeon time
Judy Mizrachi
61
Yesterday i watched a man get lungs
he had no lungs
we gave him lungs
or rather the surgeon
gave him lungs
a brilliant man
with thready thumbs
that work on as the ECMO hums
and vitals steady sum.
Held the scalpel as a paintbrush
deftly
gently
ease
and care
and his instruments his paintbrush
as if no one else was there.
Never seen man
use his pinky
used to stabilize the blade
guess I’d not seen dedication
never seen a man afraid.
And yet despite his fear was condence
was pride of pallid prayer
as he marched on to the morrow
for the patient lying there.
‘Hey, lets focus on the patient’
‘time spent is
made up
somewhere else’
And i felt bad for the fellow
jaw was twitching
conscious self
He was nice and he was bright and
he was gifted
to be sure
For I had watched him suture
watched his talent just before
But talent isn’t vital
in the trenches
on the oor
No your talent leaves you naked
in the battlements of war
And I felt worse for the patient
and I felt the surgeon’s right
even then as fellow trembled
fellow tailored through the night
And the surgeon made him stronger
harder
readied him to ght
And the fellow he was armored
scared and shitting far from sight.
‘Don’t waste time!
Think of the patient!
My record’s 60 minutes’ time!”
“Time’s a ticking
just get on with it!”
Minutes life-
times on the line
And yet on the clock was ticking
and yet the patient, he survived
survived to breathe again tomorrow
breathe and beat and think in time.
He will breathe again tomorrow
genius bore him
air in rhyme.
And he’s breathing
And his life breath
Surgeon sutures.
Close him
Time.
62
her name
Judy Mizrachi
There was once a woman
And I didn’t know her name
She was lying on the table
And I didn’t know her name
She’d been sick maybe a while
And I didn’t know her name
Or maybe she’d been ne
Again
I didn’t know her name
But I saw her on the table
And I saw her open chest
And I saw it when they took out
Took the heart beneath her breast
And I saw her laying there
Just saw her laying there to rest
And I saw the surgeon doing
Surgeon do his very best
Surgeon knows her name and family
Surgeon knows her awfully well
Awfully well to be inside her
In this raging pit of hell
He was frantic scared and livid
His own trauma burning too
No he could not lose this patient
Could not lose this girl he knew
But me? Me, I didn’t know her
I knew nothing after all
Couldn’t know that when I left her
Deft sir reaper came to call
Didn’t know she had a family
Parents, people real to love
Didn’t know her nal prayer
Her nal moments from above
But still I saw her nal heartbeat
Fore her heart forever still
And I realize im a monster
And I realize this is real
And I realize oh how dare I?
Dare I not
Not know her name
And how on Earth now do I ration
O’-lies and idolize this pain
What on Earth this woman’s dying
She gave no permission to be here
Be here in her open body
Be here at all
It’s wrong
I’m sorry.
And I won’t do it again.
This I promise you
39 year old woman
Who I don’t know
Whose name I don’t know
Whom I’ve never seen alive
With her own heart in her chest
I’m sorry.
I promise you
I will never again look inside a person
Without at least knowing their name
63
Fig Trees
Judy Mizrachi
My mentor would hate this poem
He doesn’t like this sort of thing you see
Keep your head down. Do the surgery.
Go home. Live a life. Leave.
“Every man shall sit under his own vine and g tree. And no one shall make him afraid.”
My mentor has a g tree. Wisdom it’s called, I think.
Wisdom I don’t have, but wish I did. Wisdom perhaps I will acquire some day
If I’m not a fool. If I learn from him. If I pay attention and stop needing attention all the time if
If I’m brave enough to just cut and sew lines and save lives and
help and give and not need everybody to know
Wisdom.
He - my mentor - is the greatest surgeon of our time. His hands. Don’t. Move.
It’s Magic to watch him
But if you haven’t watched him in the OR you would never know
Wisdom.
My mentor is the greatest surgeon of our time. Certainly of our generation.
Not ashy. Steady. Intentional in his life. In his research due-ly diligent. Dualy. In his OR efcient
And he takes time. Precious, life-saving time
For me.
Invests in his students. Invests in me.
So we must be important. Like his research. Like his surgery.
He thinks we’ll save lives perhaps someday and gain
Wisdom.
He’s planting g trees.
So he
at least
thinks
there’s
hope
for us
after all
64
The Medical Student’s Liturgy
Our Father, who art in Heaven, Hal
-
lowed be Thy name.
I thank Thee for the high privilege of
attending medical school—a sacred
calling to heal the sick, help the lame
to walk, and the blind to see. But
mostly, Lord, I thank Thee that I attend
a prestigious institution like Stan
-
ford Med. May this anchor my Hinge
prole, let it also allow my parents to
nally win the passive-aggressive brag
-
ging war against my less successful
extended family.
Grant me, O God, the endurance to run
the good race as I go into research and
prepare for STEP
. Clothe me in humil
-
ity, but let it be a loud humility, one
that adorns me to be the rst to post
“Humbled and honored to announce...”
on LinkedIn.
As for my rivals applying to the same
specialty: smite them. Let them be
cast into the darkness of SOAP
, where
there is much weeping and gnashing
of teeth.
I submit unto Thee my Clerkship Eval
-
uations: Help me to be seen as a “team
player,” but also, simultaneously, “head
and shoulders above everyone else
on his team.” If Thou cannot give me
better than my peers, I ask that Thou
simply makes everyone else worse—
Thy will be done.
Regarding POM, sanctify mine feed
-
back. Let the only note in “Keep/Start/
Stop” be: “Keep being perfect; Stop
nothing.” Let it be known across Thine
Kingdom that I am doing way better
than the other members of my E4C,
like Adam Nelson.
Shepherd my career path. Lead me
beside still waters and green pastures,
65
such as Ophthalmology at Stanford or
Dermatology at Harvard. Lead me not
into the valley of the shadow of death,
which is General Surgery at Yale or
Emergency Medicine at Johns Hopkins.
In Thy holy word, Thou commanded
us to love our neighbors as ourselves.
Help me, therefore, not to compare
myself to my peers, but to celebrate
their accomplishments. I note, how
-
ever, that this commandment would
be signicantly less burdensome if
my publication list was stronger than
theirs’. I offer this merely as a sugges
-
tion for Thy divine strategy.
Give us this day our daily bread. Move
the hearts of the Ofce of Medical
Student Wellness to bring back Bagel
Wednesdays, while also expanding it to
include Tuesdays and Thursdays. This,
I pray.
Forgive us our debts. I pray for a
collapse in federal interest rates or
a signicant pay raise for my father
and mother, that they might cover my
living expenses.
But ultimately, Lord, beneath the
grumbling and the crippling impostor
syndrome, I remain awestruck by this
privilege. To hold a human heart, to
catch a new life, to sit with the dying,
these are holy terrors and honors
beyond PWD. Grant me the grace to
grow into the physician my parents
already tell their friends I am. Help
me to be worthy of the trust placed in
my hands.
For Thine is the kingdom, and the
power, and the glory, forever and ever.
Amen.
Elijah Suh
66
HYPE
Elijah Suh
“Through me you go into a city of weeping; through
me you go into eternal pain; through me you go
amongst the lost people...
Abandon all hope, ye who
enter here.” — Dante Alighieri, Inferno, Canto III
“The horror! The horror!” — Joseph Conrad, Heart of
Darkness
“And now Samos, sacred to Juno, lay ahead to the left...
when the boy began to delight in his daring ight, and abandoning
his guide, drawn by desire for the heavens, soared higher...
The unhappy father, now no longer a father, shouted ‘Icarus, Icarus
where are you? Which way should I be looking, to see you?’ ‘Icarus’ he called again. Then he caught sight of the feathers on the
waves, and cursed his inventions.” — Ovid, Metamorphoses
67
I, like Icarus, ew too close to the sun.
When Stanford Medicine Hot Yoga and Pilates Enthusiasts
(HYPE) announced a free hot yoga class, I thought it would
be easy; I assumed those who had gone before were ove
-
rhyping the difculty, the rigor, the odor. But the tragedy
of Icarus was not in that he fell, it was the condence with
which he set about his adventure. My ight began at 07:30
hours at the Town and Country Core Power Studio. Weary
pilgrims shufed inside, tossing towels and water bottles
aside, not knowing they discarded the possessions of the
damned. Our instructor entered, smiling, and closed the
door behind her. I didn’t know it at the time, but that door’s
click was the death knell of my happiness.
We began with alternating downward and upward dog, then
chair pose, then we threw it back a little. The instructor
interjected her orders with a slow, rhythmic count: “Breathe
in, partial stretch… 4… 3… 2… 1.” I tried to complain, for
the break between each number was not measured in sec
-
onds, nor Mississippis. I did the math, and I found I could t
all 50 states and many of the US territories between her “2”
and her “1.” At some point, she started counting backwards,
and my mind succumbed to insanity.
The room continued to grow toxic. Oxygen was replaced en
-
tirely by the hot CO2 of our breaths. We alternated between
Warrior I and Warrior II for what felt like weeks. With no
clock to mark the era, I took to scratching days into the
drywall with a ngernail. I had counted Day 27 just as the
instructor chirped out the “30-minute mark.” Impossible, I
thought, as we transitioned to Warrior III and IV
.
To compound my suffering, I had acted the fool. I grabbed
the 5lb and 8lb weights, ignoring the clerk who recom
-
mended the 3s. As I panted, unable to lift a single hammer
curl, I felt the stinging hubris of Icarus. But imagine if Icarus
survived the fall, swam to shore, put his wax wings back on,
and immediately ew back into the sun. That is the deni
-
tion of my stupidity.
At one point I looked at the wall-length mirror to check my
form. The man staring back was not me; he was a melted
candle of a human.
Over time, I watched the entirety of the water cycle play
out on my mat: precipitation from my pores, evaporation
leaving diamonds of salt, and a tiny raincloud forming near
my head that condensed and rained back onto my brow.
Intermittently, as a break, I stood up and drank from my
water bottle, though it had been empty for fteen minutes. I
found that sipping at air was less embarrassing than weep
-
ing openly.
At the nadir of my spirit, a classmate, Amit, who was next to
me, saw me slump forward. “Get up, soldier,” he whispered.
“This is no place to die.” I tried to turn over, praying for the
sweet release of death. Alas, it did not come. I believe Amit
may have administered CPR on me as we did tricep kick
-
backs, but, alas, my memory is hazy.
When the lights nally went dark, I was happy for I as
-
sumed I had nally died. But the instructor was simply tell
-
ing us to nish our session by assuming our “natural body
positions.” Some inhabited Downward Dog; others evoked
the Lotus. I assumed the position of a trauma patient in
shock: arm at a right angle, leg bent to ensure the airway
remains clear.
We got acai bowls after tho, which was a nice little pick-me-
up.
68
love-ethics
Roya Brach Safaeinili
69
Like cherry blossoms in the spring
The years turn over in their parallel nature
Memory of warmth budding from a past life
Love was in form before I ever knew its denition
From the smells of
khoresh
to the melody of
Farsi
I grew up dancing in the spaces between words
Cut between cultures, a ridgeline of beauty
Drawn from fear, counted in steps and seconds
This sharp new life softened for me
By the ones who came before
Showering early years in sunshine
It is basked in an eternal light
Those years hold me now
When I cling to silence and only feel
What cannot be expressed
And only lives in dreams
The resolve to hold it all
To remember even in pain
To honor the brevity of experience
Does not end; it carries us
I hold the dew of spring,
With weight, watering the soil
It is all I could wish for
Nurturing what comes next
dostet daram
, I love you
70
Starstruck
Jerry Shen
71
72
