in-Training

Latest Posts

Tales Behind the Terms: Newborn Skin Rashes

Medical Etymology: Tales Behind the Terms is a series of articles discussing the stories, origins, and meanings of words we use every day in medicine. The goal is to explore the history of the complex jargon we use with patients and learners. In doing so, I hope that we, as physicians-in-training, can deliver better healthcare that is understandable and memorable for all.

Newborn skin rashes are incredibly common, and while some may appear concerning, most are benign and self-resolving. The term “rash” has several possible origins: the Old French “rasser” (to scrape), the Latin “rasitare” (scraped), or the Middle English “rasch” (to scrape or scratch). It likely has etymological connections to the modern word “razor,” a tool used for shaving, which, if used improperly, can often lead to a rash. While babies are unlikely to suffer from razor burns, there are several distinct rashes that may arise during the newborn period.

The most common rash seen in newborns is Erythema Toxicum Neonatorum. It appears as small red bumps and flat spots that may evolve into raised pustules. These “pustules,” small inflammatory bumps filled with pus, are surrounded by a patch of redness. The exact cause is not entirely clear, but it may be due to the infant’s innate immune system responding to friendly microbes colonizing the skin for the first time. Given the benign etiology and natural resolution, the terms “erythema” (red) + “toxicum” (toxin) + “neonatorum” (of the newborn) should not seem so alarming; the term “toxicum” historically described the rash’s dramatic appearance, which was once thought to be harmful.

Transient Neonatal Pustular Melanosis is a rash with “vesicles” (from the Latin, “vesicula”, meaning “small bladder” or “little sac”) that rupture easily, leaving scales and pigmented spots that fade over several weeks. The term explains the description perfectly: “transient” (from Latin “transiens”, meaning “temporary”, something that can “go across”) + “neonatal” (from “neo-”, new, and “natus”, born) + “pustular” (blister, pimple) + “melanosis” (from Greek, “melas”, meaning “black” or “dark”). Knowing this, one can easily explain to a concerned parent that this is a rash in newborns consisting of small pimples that, when ruptured, temporarily leave dark or discolored patches on the skin.

Acne Neonatorum appears similar to the acne seen in adolescents and adults, with closed “comedones” on the forehead, nose, and cheeks, among other places. “Comedone” comes from the Latin “comedo”, meaning “glutton” or “eater,” because the material within these comedones was once thought to be parasitic worms or grubs that “ate” away at the skin⁶. The term “acne” comes from the Greek “akme”, meaning “highest point” or “peak,” referring to the “tips” of the skin eruptions. Thus, “acne neonatorum” is simply acne in the newborn, caused by stimulation of the oil glands by maternal or infant hormones. As the hormone system calms down after birth, so does the acne – at least until puberty, when the hormone system begins to roar yet again, and the “peaks” of this skin eruption may re-emerge.

Milia are very small white or yellow “papules” (bumps) that often appear on the forehead and nose. They are due to retained “keratin” (“horn” or “horny”), a substance found in hard, “horny” tissues such as hair, nails, and the outer layer of skin. The term “milia” comes from the Latin “milium”, a grain of the millet plant, which appears small and round. Another rash with a similar name but a different etiology is “miliaria”, caused by the retention of sweat due to partial closure of glandular structures. The appearance of “miliaria” is like that of milia, hence the similarity in name. If the sweat gland obstruction occurs at a deeper level, the rash may appear redder and is thus called “miliaria rubra” (“rubra” being Latin for “red”). More commonly, this is known as “heat rash.”

Seborrheic Dermatitis is a common condition in newborns that typically appears as red, scaly patches, often found on the scalp, face, or behind the ears. The term “seborrheic” comes from “sebum”, the oily substance produced by sebaceous glands, combined with “-rrhea”, meaning flow or discharge. “Dermatitis” derives from “dermis” (skin) and “-itis” (inflammation), reflecting the fact that the rash often occurs in areas of the skin where sebaceous glands are active. The condition is thought to be triggered by an overproduction of sebum or an inflammatory response to yeast naturally present on the skin. Although it may appear alarming due to its crusted, yellowish appearance, seborrheic dermatitis is generally harmless and tends to resolve on its own over time. The condition is sometimes referred to as “cradle cap” when it affects the scalp, as the patches of skin can become thickened and crusty, but it is not a serious skin disorder.

While the rashes described above are mostly benign and transient, one serious, though rare, neonatal skin disorder is Neonatal Pemphigus. This blistering condition appears as painful, fluid-filled blisters and erosions on the skin. The term “pemphigus” comes from the Greek word “pemphix”, meaning “bubble” or “blister,” which aptly describes the appearance of the blisters that form in this condition. Being an autoimmune disorder, neonatal pemphigus may require immunosuppressive therapy, along with topical treatments.

Though not technically skin rashes, two transient skin changes due to newborn vascular physiology are worth noting. “Cutis Marmorata” is the appearance of marbled or mottled skin¹, which can be understood as “cutis” (skin) + “marmorata” (from the Latin “marmor”, meaning marble). Thus, it translates to “marbled skin” and accurately describes the lace-like pattern caused by transient blood vessel constriction and dilation. “Harlequin Color Change” describes a pattern of redness, or erythema, that occurs when a newborn lies on their side, while the opposite side remains pale. This results in a sharp line of demarcation due to immature regulation of blood flow. The term “Harlequin” comes from the French “arlequin”, a character in comedic Italian art known for wearing a patchwork costume of contrasting colors. One can compare the patchwork-dressed character to the patchwork of redness and paleness in an infant with this condition. Both phenomena are transient and resolve as the baby’s body matures.

Newborns are beautiful, fascinating creatures, though they often present with one of the rashes described above. Thankfully, most of these are temporary and harmless, and having a thorough understanding of their names and clinical courses allows students and providers to accurately describe the condition to worried parents. The many different neonatal rashes provide great examples of how important it is not just to memorize a disease’s name, but to truly learn the tale behind the term.

Tales Behind the Terms: Measles

Published by Benjamin Popokh

Measles is an infection most likely derived from the Middle English “masel”, meaning “little spot”, which in turn comes from the Middle Dutch word for “blemish”. There may also be a connection to the Middle English “mesel”, describing a condition related to “leprosy”. This word itself comes from the Medieval Latin “misellus” (“a wretch”), a diminutive of the Latin “miser” (“unhappy, wretched, pitiable”). Altogether, these possible etymological origins suggest that measles is an infectious condition characterized by little spots or blemishes, causing significant unhappiness and distress to the sufferer. Understanding this, the common term “measly”, which originally referred to someone suffering from measles, can also be understood as slang for someone who is “meager, contemptible, or wretched”. Similarly, a “miser” is pitiable, living in a “miserable” state of “misery”.

Another name for measles is “rubeola”, from the Latin “rubeus” (“red”) and the suffix “-ola”, indicating smallness. Interestingly, “rubella”, which is etymologically similar, refers to a different disease known as “German Measles”. While the similar names and meanings may be confusing, understanding the nuance helps: while both “-ola” and “-ella” imply smallness, the latter term suggests something gentler, subtler, and more refined. This makes sense, given that the rash in rubella is milder compared to the rash of rubeola (measles). Another term for measles, though less frequently used, is “morbilli”, derived from the Latin “morbus” (“disease, sickness”) and the diminutive “-illi” (“little” or “minor”). Historically, morbilli referred to the characteristic rash of measles. Just as the base word “miser” implies wretchedness and destitution, “morbus” can be linked to terms such as the Latin “mortalis”, (“subject to death”, or “mortal”), “morir” (Spanish for “to die”), or post“mortem” phenomena like “rigor mortis” (“stiffness of death”). Altogether, we can see that measles (rubeola or morbilli) is a serious infection with potentially dire consequences if left untreated.

To further understand this morbid condition, and to clearly explain the disease origins to patients, we must explore the pathophysiology. Measles is an extremely contagious viral infection that commonly affects children, though it is preventable by vaccination. The “virus” (from the Latin word for “poison”) belongs to the “Paramyxoviridae” family (para, “resembling”; myxo, “mucus”; viridae, a suffix to denote a family of viruses). This is a group of viruses “resembling mucus-associated viruses”, and it includes pathological relatives such as Mumps, RSV, and the Parainfluenza viruses. It is transmitted via person-to-person contact and airborne spread. Notably, it can remain airborne for a prolonged period, contributing to its high infectivity. Measles is an exclusively human disease, and it infects individuals by infiltrating and spreading in the “epithelial” cells (epi, “upon”; thel-, “nipple, teat”; the combination refers to the layer of tissue covering a surface) of the pharynx (“throat, gullet”) and lungs. While it is not essential for the patient or parents of a child to understand the more complex pathophysiology of glycoprotein and hemagglutinin binding, the simple imagery of a highly infectious “mucus-associated poison” which attaches to the “layer of tissue covering” the throat and lungs, may provide a clearer picture of how this virus originates.

The clinical course of measles can be divided into three stages: prodromal, eruptive, and convalescent. A common “mnemonic” (learning device, from the Greek goddess of memory, Mnemosyne) for the prodromal symptoms is the “4 C’s”: cough, coryza, conjunctivitis, and Koplik spots (some creative liberty taken with the last “C”). “Prodromal” symptoms are those that appear early in the disease, with “pro” meaning “before” and “dromal” referring to “a course”. “Cough” is an onomatopoeia, meant to mimic the sound of coughing. The Old English “cohhian” and Proto-Germanic “kuhhen” both evoke a throaty and cough-like sound. “Coryza” (“runny nose”), comes from the Greek “koryza”, based on the root “kory”, referring to the head or nasal area. “Conjunctivitis” refers to inflammation of the membrane covering the whites of the eye and inner eyelid, combining “con” (“together”), “jungere” (“to join”), and “-itis” (“inflammation”). Put together, “conjunctiva” is the membrane that “joins” the eyelid to the eyeball. Finally, “Koplik Spots”, small bluish-white lesions on the oral mucosa, are “eponymous”: they are named for Dr. Henry Koplik. His identification and description of these spots led to his name (“-onoma”) being put upon (“epi-”) the condition.

In the eruptive phase, a “maculopapular” rash begins at the head and spreads downward. “Maculopapular” means that the rash consists of both “macular” (“spot or stain”) and “papular” (“nodular”) lesions – both flat and raised. The final phase is “convalescence” (con, “with”; valescere, “to grow strong”), as the patient recovers and the rash, fever, and malaise subside. A rare complication of measles,“Subacute Sclerosing Panencephalitis”, may occur 5 – 15 years after infection. This term may seem daunting, but broken down, it means “sub” (under), “acute” (severe), “sclerosing” (hardening), “pan” (all), “encephal” (brain), “-itis” (inflammation). This term describes a slowly progressing, hardening, and widespread inflammation of the brain. The vivid imagery created by understanding the etymology of these signs and symptoms helps patients and caregivers grasp the progression of the disease – from the initial symptoms to the rare long-term complications.

Measles can be effectively prevented through routine “vaccination” (from the Latin “vacca”, meaning “cow”, as the first vaccine was created using the cowpox virus against smallpox). If infection occurs, the treatment is typically supportive, with “vitamin” A supplementation helping to maintain epithelial cells and support the immune system. Measles depletes Vitamin A stores, and because “vitamins” are essential for “vita-” (life), supplementation is critical.

This etymological exploration of measles illustrates that measles is a serious disease that begins with teary eyes, a runny nose, and a red rash, and may lead to brain tissue scarring as a rare complication. Ideally, it can be prevented with vaccination, a medical tool that has its origins in a classic farm animal. However, if the cells lining the throat and lungs are infected, patients should receive supportive care, along with vitamin A, a compound essential to life. The etymological journey of measles not only enriches our understanding of its historical and linguistic roots but also emphasizes the importance of vigilance, prevention, and education in combating this ancient and formidable disease.

Fentanyl

Published by Vartika Mishra

Being a junior resident (JR01) at our medical college, one of the busiest institutions in North India, is like walking a tightrope. Commission is constantly chosen over convenience. Among all the scut work a JR01 is expected to do, the worst is arranging drugs and supplies unavailable in government stock. In obstetrics, any drug could be demanded at any second without warning. The inability to produce the required drug immediately could result in a patient’s death—or sometimes even the resident’s.

Consequently, all the JR01s had a bag stuffed with anything and everything. This bag was the backbone of a JR01’s existence, their most prized possession. In the early morning hours when we marched into the hospital carrying our huge bags, we looked like a row of ants carrying crumbs of food much bigger than themselves. Every JR01 had metamorphosed into a walking, talking dispensary.

I remember one friend’s mother discovering a pack of condoms in her bag. Poor thing had to spend an entire evening explaining that the condoms were meant exclusively for transvaginal sonography. Her mother was finally convinced only when she realized that when one doesn’t have time to eat, bathe, or sleep, one certainly cannot afford time to fornicate. The bags were passed down the generations as priceless legacies when new batches of juniors arrived.

There was no right way of procuring these drugs. Beg, borrow, or steal—the drug had to be there when needed. Months of collecting had ensured that most drugs were in our bags except one drug that became every JR01’S worst nightmare.

Fentanyl was neither available in government supply nor in the market. Being a habit-forming drug, it wasn’t accessible to patients despite our well-written prescriptions. Anesthetists—well known for making life difficult for gynae JR01s—would just not give spinal anesthesia without Fentanyl (Fenta).

Very soon, Fentanyl was not merely a drug, it had become an emotion.

A JR01’s level of competence was measured by her ability to produce Fenta. Competence was inversely proportional to the time taken to fetch the drug.

A friend’s loyalty was assessed by her willingness to share her vial of Fenta in the hour of need.

If a person of the opposite gender offered you a vial of Fenta as a token of help, you could be sure they had some romantic interests at heart.

More fights had broken out over the custody of this exquisite drug than over any oil well across the world.

Once it was even utilized in solving a crime. A JR01’s precious bag of drugs was robbed in the hospital campus and a number of items went missing. After much speculation, it was concluded that no JR01 could be blamed for the robbery since a vial of Fenta was left untouched. A JR01 could not commit a crime so low and not be tempted to steal Fenta. Hence the incident was declared the work of some patient or domestic help.

Those were the days when a shiver ran down the JR01’s spine the moment people asked for Fenta in the operation theater. Whatever drug we had was used under careful supervision, like the last bottle of water in a drought. When that came to an end, all that was left was waiting for patients’ attendants to return empty-handed from medical stores while everyone in the OT waited anxiously for the JR01 to show up with the drug so surgery could start. The JR01 scurried in all directions like a frightened rat looking for a way out. The pressure was immense.

This reign of terror continued for a few months until one day a divine phone number appeared. All we had to do was dial it, ask for Fenta, and a God-sent angel would deliver it to the hospital gates.

It was only later that we discovered the “angel” was in fact an illegal drug dealer. Or a drug lord. I’m still not sure. None of us had ever seen him.

I always thought our angel was a pharmacist considerate enough to deliver drugs to our doorstep. I imagined a decent, well-groomed, tie-wearing man, hair combed down with water, clad in a well-ironed formal shirt as I exclaimed to my friends, “What a nice pharmacist we have found. Our days of the Fentanyl fiasco are finally over!” The other JR01s would invariably nod in agreement. Oblivious to the truth, for a while life had become a little less painful for us.

One fateful morning, Sakshi was preparing her patients for elective surgery. There were eleven of them, all dressed in white OT apparel. Once clad in the clean OT dress, patients are supposed to remain in the pre-operative ward. However Sakshi’s eleven pre-op patients were heading towards the gate in a single file. With Fenta unavailable in the government stock or the market, they were marching – still dressed in sterile OT whites – to buy the medicine from the angel at the hospital gate, the only way to ensure their surgeries could proceed.

What a nice guy, working so early for our convenience. So sincere!

Hardly had the march of the patients reached the gates when it was spotted by Dr. S, our resident in-charge. She was blessed with the ability to magically appear whenever and wherever something unlawful was being carried out by the residents. Almost like she had an inbuilt radar for detecting the ruckus created by her residents. There were only a couple of incidents that had gone past her unnoticed in about a decade. Needless to say, those incidents had gone down in history.

She was also the fastest and strongest link between the residents and the management. For minor breaches in protocol, she’d take our class herself and act as our shock absorber when the matter reached the HOD. But for something as huge as trafficking Fentanyl illegally into the department, she was going to ensure everyone involved was served the punishment they deserved.

So having spotted the march, she quietly followed the trail of pre-op patients right up to the hospital gates where the drug deal of the millennium was underway.

The angel was standing at the entrance. He was in his mid-twenties. His orange ombré-colored hair gelled into perfect spikes, like a vigilant porcupine. He wore a tight black T-shirt with short sleeves, his arms covered in neo-traditional tattoos from the wrist to the shoulder. It was abundantly clear he was anything but a pharmacist- more of a low-waist-ripped-jeans-wearing goon.

What followed this raid was intense. An active inquiry was immediately set up, and our degrees—which we had not yet obtained—hung in the balance. Sakshi had dug a grave for herself and dragged us all in with her.

Unaware of the sequence of events that had taken place in the elective OT downstairs, I was busy shifting my patient in the emergency OT on the first floor when Dr. S showed up.

She looked as calm and composed as ever. “Where do you people arrange Fentanyl from?” That question was aimed at me, in an attempt to gather more information about the angel. Overwhelmed by my desire to impress Dr. S, I perceived it as an opportunity to make a great impression on her. I deemed that if I told her I’d cracked a way of arranging Fentanyl from a “pharmacist,” I’d be declared a resident prodigy. I could almost see myself emerging from a blazing light with a vial of Fentanyl in my hands when it was most needed, while people all around me cheered in unison.

“Ma’am, there’s this pharmacist. We just have to ring him up and he delivers the drug,” I told her excitedly. I watched her closely, trying to find in her eyes the appreciation I deserved.

“Fine. Call him then and show me how you do it.”

Still ignorant of what was happening, I gladly took out my phone and gave the angel a ring. What could be more illustrative than a live demonstration itself!

“Will you put it on speaker mode?” she requested—but it wasn’t really a request, was it?

“Hello, can you please deliver a vial of Fentanyl to our Obstetrics dept?”

“I am never coming to that department again!” he yelled frantically. “I was caught by this madam. She asked me all sorts of questions. Please don’t call me again!”

I stood there mortified. Slowly, I raised my eyes to meet Dr S’s gaze. An expression of disapproval diluted with triumph was apparent on her face. This was the first time in months it had become perfectly clear to me that the angel had been nothing but a mistake.

Dr. S had always preferred sarcasm over screaming. So I stood there with my head hanging low while insults wrapped in clever puns were thrown at me at supersonic speeds. What came next was a fifteen-minute session where responsibility and awareness were taught to me so well, it’s possible some of my genes mutated permanently.

A meeting was set up for the coming morning to find the main culprit and come up with a feasible solution. All the JR01s sat in front. Our seniors sat behind like uncomfortable parents at a parent-teacher meeting for failing students.

The feeling of anxiety and apprehension mixed with the anticipated loss of a fellow JR01 was surreal. On being asked who provided us with the dealer’s phone number, all the JR01s sheepishly blamed the next one till a full circle of blames was complete. A closed loop had formed, and without a reliable timeline, it was impossible to crack.

All of a sudden, we heard a voice, hesitant at first but growing more convincing by the minute. “The number was given to us by the anesthesia team. They were the ones who told us it was safe to order Fentanyl from him.” Pallavi, the smartest of us all, was frequently responsible for saving our skin.

Then I witnessed a strange phenomenon—a community-based telepathy at work, reviving all JR01s from a near persistent vegetative state to a state of vocal unison. I heard the following words come out of my mouth: “Yes, it was the anesthesia team.” And so did the others. Thus, the blame game came to an end with the full circle of blames being tangentially diverted to the team of anesthetists.

Fortunately, the management was finally successful in arranging for unlimited supply of Fentanyl. The amount of Fenta we now had at our disposal was Fentabulous (pardon me for the poor pun—couldn’t resist it). And that is how our era of agony, our Fenta festival, ended.

A few weeks later, Metrogyl was out of supply. The Metrogyl madness continued for a couple of months, but then it was taken care of.

And then Sensorcaine became unavailable. The Sensorcaine saga lasted for a few months, then it was taken care of too.

And so on and so forth. Life continued, and so did our residency.

Quince

Published by Medha Palnati

15.

Fifteen minutes before I was supposed to leave the hospital, April’s pager went off. That beep, beep, beep is now forever seared in my mind. She pulled up the imaging of the patient we were about to meet, barely looking up as the ICU physician, Dr. Wissman, whizzed by her.

“I accepted a crazy transfer,” he called out without stopping, “it’s from an urgent care.”

April’s green eyes darted up and down the computer screen in front of her.

“Already on it!” she responded.

Looking over her shoulder, I registered the extent of the impending chaos: the patient’s frontal lobe was full of blood.

April took a deep breath and stood up calmly.

“Another acomm aneurysm rupture,” she said.

I nodded, following her down to the Emergency Department.

14.

A crowd of people stood outside our patient’s room. Fourteen in total.

They had rushed him in, taken his vitals, transferred him from the stretcher to the bed, propped up his head, assessed him, confirmed the initial imaging, prepped and draped him, inserted IVs, and administered medications.

And now they watched with anticipation as April stood on a tall stepstool in sterile garb, screwing a drain into his skull to relieve the pressure rising inside his head.

April — a first-year neurosurgical resident — was focused and poised. I trusted her with my life.

I diverted my attention from her to the monitor reporting our patient’s vitals. His blood pressure was rising and his heart rate was dropping. He was in danger. His brain was at risk of herniation, compressing in on itself.

I closed my eyes and tried to imagine what his face might have looked like under those blue drapes.

13.

The sun had barely risen when his nurse hurried over to us.

“Please,” she said. “Room 13. They don’t speak English. They don’t understand what happened. Can someone please talk to them?”

Her voice carried a sense of urgency I recognized — one of care.

“I’m happy to help,” I said, “I speak Spanish.”

April followed me to his room. The lights were dim. I could make out his face now, framed with white bandages from the procedures he had undergone the night before.

The neurosurgeon, Dr. Platt, had placed dozens of tiny coils into the aneurysm that had ruptured to stop it from bleeding. But the blood vessel’s explosion had left a trail of carnage. The damage had already been done.

The patient’s family sat nearby: two sisters and a coworker.

His sisters had just flown in from Ohio — Alma and Angela. His coworker, Jake, had taken him to urgent care the day before. He was the last person who saw him before this happened.

Without uttering a single word, their eyes asked the same question on all of our minds: “Is he going to be okay?”

I desperately wanted the answer to be yes.

12.

He had been working in the States for twelve months now, his sisters told me. Just shy of a year. They had moved here shortly after him.

Before that, they all lived in Oaxaca, Mexico. Three generations under one colorful roof: two parents, four siblings and their spouses, five grandchildren.

Fifteen altogether.

Juan was their backbone.

That’s when I learned his name: Juan Gabriel.

But there stopped being enough work to go around. There stopped being enough money for his oldest daughter to go to school.

She was fifteen years old.

He wanted her to go to college, they told me. So he came here.

Even after he left to find work in the States, he was still the backbone of their family. He called every night. He sent home everything he could.

For twelve months, he owned only one pair of clothes.

That’s why they decided to come to the States. They wanted to help send money home so that he could buy himself new clothes.

11.

Eleven minutes before one, his vitals began to change.

His mean arterial pressure started to rise, and his nurse called Dr. Wissman to his bedside.

“Can you take his family outside to the waiting room?” April asked me. “I don’t have a good feeling about this.”

A lump formed in my gut as I guided them out of the room.

“Los doctores lo van a atender bien,” I reassured them. “He’s in good hands.”

The words were as much for me as they were for them.

Behind me, chaos began to unravel as a rapid response was called and a flurry of nurses rushed to his room. I kept my head facing forward.

10.

“Do you think it’s okay if some of the guys come visit?” Jake asked me in the waiting room.

“They’re real worried about him. We knew somethin’ was up when he didn’t come to work yesterday,” he said. “He never don’t come to work.”

Jake told me about how he drove over to Juan’s place the day before and found him throwing up with a terrible headache.

How he thought maybe it was just a bad case of the flu.

How this turned his world upside down.

How their whole squad was praying for him.

“There’s 10 of ‘em in total who’d wanna come visit,” he said. “We all work choppin’ wood in Vermont together. We love each other like family. If somethin’ happened to him, I don’t know what I’d–”

His eyes got teary.

“Aw hell.”

I noticed then that he had been holding the rough flannel overshirt we had bagged with Juan’s belongings the day before, hugging it tightly to his chest.

Of course they could come.

The nine minutes that Juan spent inside the CT scanner felt like a century.

When the images appeared on the computer screen in front of us, a heaviness settled over me.

Dr. Wissman closed his eyes and bowed his head.

He exhaled.

I didn’t need to hear the words to know it.

Juan wasn’t coming back.

He was just forty years old.

Eight years of neurosurgical training — seven years of residency and one year of fellowship — could not prepare Dr. Platt for the conversation he was about to have.

He shook his head as we entered the room.

He never sat down.

“When the brain bleeds,” he said with a soft voice, “sometimes the other vessels in the brain spasm. They clamp down and stop giving oxygen to the other parts of the brain.”

I translated each word carefully, slowly, mimicking his tone as best I could.

“That’s what happened to Juan,” he said. “It’s like he had a very, very large stroke, and there’s nothing that we can offer surgically to make him better.”

“What does that mean?” his sisters asked.

“It means that the tissue in his brain is unfortunately not salvageable.”

I translated again. Word for word, just as I had been trained.

“I don’t understand,” one sister said again.

“Is it okay if I try to explain?” I asked Dr. Platt.

He nodded.

I sat down. I held both of their hands.

I looked them in the eyes.

“It means that the Juan Gabriel you told me about — the one who loves you, the one who is the backbone of your family — he’s not coming back.”

I said it plainly, tears welling in my eyes.

I let silence fill the room.

They already knew.

Then the wails started.

“Will he ever walk again? Talk again? Smile again? Hug his family again?”

Their questions turned into screams.

Dr. Platt shook his head. “I’m sorry,” he said.

He left the room.

I stayed behind.

Seven o’clock approached.

Juan’s sisters asked us to help relay the information to his parents, wife, and daughter over the phone. I translated again, this time for Dr. Wissman.

“Can he still hear us? Can he still feel pain? Can he understand us?”

We sat there and cried together.

“No los quería decir,” Angela said into the phone.

I didn’t want to tell you.

We filled out paperwork with the Mexican embassy so that his wife and children could come visit him at his bedside.

That evening, Juan’s coworkers came to see him.

They formed a circle around his bed, holding hands.

Jake led them in prayer.

The next morning, they performed brain-death studies.

For brain-dead patients whose families choose not to donate their loved one’s organs, the hospital allows them six hours to remain on life support before officially withdrawing all medical interventions.

Six hours.

This is the timeline we put on their grief.

Six hours for his wife and children to arrive at his bedside.

Juan’s nurse fought with administration over the phone.

“Yes, I understand that he doesn’t need an ICU bed to die in, but can you at least have some empathy for his wife and children who are trying their hardest to make it here to see him!?”

Her voice was angry.

It was no use.

Six hours.

We told his wife and daughter over FaceTime as they waited in line to cross the Juárez–El Paso border.

His wife, Carmen, had mascara running down both cheeks.

Behind her, I could see the bridge I recognized well. I had crossed it dozens of times when I lived in Juárez. I had waited in that line for hours before.

What were the odds they would make it?

Five minutes before his wife and children landed in Albany, New York, Juan’s heart stopped beating.

“It’s almost like he knew,” his sister said through tears. “Like he didn’t want his children to see him like this.”

We met Carmen and Juan’s children in the ICU waiting room.

That’s where we told them he was officially gone.

His daughter screamed:

“No me podía esperar, Papá?”

Dad, you couldn’t wait for me?

Juan’s son was four years old.

He painted his father’s hands and feet with a paint brush the Child Life specialists had brought, pressing two yellow handprints and two yellow footprints onto his shirt so he could remember his dad.

Three thousand dollars was what it would cost to ship Juan’s body to his home in Oaxaca so the proper rituals could take place.

His boss, who came to express condolences to the family, paid every cent in cash.

None of the tools medicine had to offer could save Juan.

But I had two ears, and with them I listened.

I had two arms, and with them I embraced.

I had tears, too.

So with them, I cried.

Juan’s daughter, Millie, stroked her father’s face and told me she had only one wish.

A few months earlier, she had planned her quinceañera, her quince.

Her father saved extra money to send home for the party. He got her the dress she wanted, the food she wanted, and the venue she wanted.

But what she wanted most was for her father to come home – to be there on her special day.

When he told her that he couldn’t come, she delayed her quince for a whole month.

But he still couldn’t make it.

She kept wishing he would come.

But he didn’t.

She was upset with him.

She didn’t speak to him for weeks.

Now she wished she could take that back.

She wished she had talked to him every day.

She wished she could have thanked him for fifteen sweet years together.

Music in Medicine, Music as Medicine

Published by Sarah Kim

I walk into my patient’s room as he is receiving a blood transfusion with a guitar strapped across my back and sheet music in hand. He is used to seeing me in the early mornings when the surgical team rounds. He has been in the hospital for a week now, recovering from a liver cancer resection. He had joked with me in the operating room before he went under anesthesia, and I had looked forward to checking in on him the subsequent days. Yet each morning afterward, I watched him retreat. He ate less. He spoke less. Though he met his postoperative milestones, it was clear to me that he was losing heart each day he continued to be hospitalized, and was perhaps in need of something that we had not provided him yet.

As part of my school’s “Music in Medicine” service organization, I ask whether he would like me to sing and play guitar for him. I confess that I only know Christian worship songs. I am unsure of his own beliefs, but I know he is close with his son, a pastor, and I hope the music might offer him some small semblance of home.

He looks uncomfortable, his heart rate hovering in the 120s as he receives a blood transfusion. After a moment, he gives a slight nod. I take it as permission.

I begin to play “What a Friend We Have in Jesus.” A few verses in, his breathing deepens. He falls asleep with a faint snore, and I notice on the monitor that his heart rate has drifted down to the 80s. The nurse rushes in, concerned about a possible transfusion reaction. When he stirs and appears stable, we watch as his heart rate climbs back into the 120s. Puzzled, she decides the drop was likely an unusual blip and steps out.

I start my second song, “It is Well.” Once again, he falls asleep, and once again, his heart rate settles into the 80s. When I pause between songs, it rises abruptly to the 120s – even though he remains asleep. As I finish a final hymn, I see the now-familiar pattern: his heart rate easing downward as the music continues. I leave quietly, careful not to disturb his rest.

For many days afterward, I wonder what truly underlay those fluctuations. Was it increased parasympathetic tone as the music lulled him to sleep? A physiologic response to improving volume status from the transfusion? Or was it something less easily measured – the comfort of melody, the familiarity of hymns, the subtle easing of a homesick spirit?

My team ultimately attributes the fluctuations to his restoring volume status. And perhaps they are right. The blood replenished what his body lacked. But I cannot shake the sense that the music replenished something else – something the transfusion could not supply.

The day before his discharge, I walk into my patient’s room to find him sitting up in bed, digging into a large bowl of yogurt. I pull out an incentive spirometer, and he chuckles – the first laugh I have heard from him since his operation. He tells me he prefers the Acapella device because he likes the sound it makes; he pretends it is a saxophone. When I am urgently called away from the room, he calls after me in a steady voice: “I’ll remember you when I play”.

I do not get to see him again. But I no longer worry about his spirit. I had watched it return.

Whatever the true explanation for his heart rate fluctuations, I know this: long after he forgets the units of blood transfused or the numbers on the monitor, he will remember the music – the music that met him in a way medicine alone could not. And in that memory, perhaps, is a different kind of healing.

Hope, the Natural Armament

Published by Kenneth Pham

In high school, I learned about humanity’s darkest corners far too early. I came across videos online of people telling stories of unthinkable violence, suffering and cruelty that left me profoundly shaken. I learned about snuff films that glorified murder, stories written by women who experienced sexual violence, and serial killers with sadistic rituals. “How could anyone even fathom committing those acts?” I wondered. “Where is the light I’m supposed to look for in ten people, knowing that if just one of them were capable of such darkness, I would never be able to trust again?” Although these thoughts often weighed me down, I realize now that they were also the catalyst for my professional goals. How could I, someone who wants to help the most at-risk, just spend my days fixing hip joints and sitting in an office?

Then, in college, I worked in an Emergency Department, where I saw the worst of the worst in a hospital. I witnessed a pregnant woman coming in after being assaulted by her partner, children under fifteen years old for gunshot wounds and several patients being rolled in after a mass shooting. I told myself that the “light at the end of the tunnel” was not observing these events, but learning from them. Just then, just maybe, the memories of those victims would not go in vain, as I would become a physician who tries to make sure no one else has to suffer the same fate. However, I knew this dream was overly idealistic and a facade to make sense of the tragedies I witnessed. Like a child who covers their eyes when counting for hide and seek, just to be able to peek through the cracks of their fingers and see everybody as they run away. Deep down, I knew I was only one person, and the job to fix these complex social issues required a culture shift. I did not think the beliefs and efforts of an individual could make a difference. My old acquaintance of overwhelming dread poked its head through yet again.

During medical school, I wanted to properly explore the idea of mortality and what motivated the loved ones of the deceased to keep living. On this journey, I came across John Green’s book Everything is Tuberculosis. The crux of the public health argument presented in the book is that TB is an easily curable disease, yet it remains the leading cause of death outside of the wealthiest countries. Green highlights the irony: the wealthiest countries have access to all of the cures for TB, yet possess a minority of the cases. In contrast, poorer countries have all of the cases, yet are forced to suffer without the cures due to corporate greed and lack of international cooperation. In other words, people do not die from Mycobacterium tuberculosis—they die from poverty and the genetic lottery that determined where they lived.

Although I could go on about how Green makes TB such a fascinating bacterium to study, what stands out most to me is the passion behind it all. It is muted, yet apparent, how furious Green is about the inequity in treatment. He befriends a TB patient named Henry, the same name as his son, whose condition worsens over time and carries a poor prognosis, yet he still finds hope and faith in his cure. How does he do it? When asked why he goes to such great lengths for just one patient, Henry’s primary doctor responds: “Yes, I know, it’s just one patient. There are so many patients, and Henry is just one. Why should we move mountains to save one patient? Because he is one person. A person, you understand?”

Although I did not formally recognize it then, Dr. Girum Tefera’s words were ultimately what motivated me toward my vocation during those dark years. In healthcare, it is easy to extrapolate your horrifying experiences to the outside world. The more gruesome cases you see, the less you feel like a shepherd who keeps their sheep in a herd so that they do not become privy to the horrors of the real world. Instead, you become more like one of the sheep themselves, playing your role in a never-ending cycle that has gone on for decades. However, this sense of powerlessness in an endless cycle is not the whole truth. Improving the life of even just one patient makes the job worth it – even if the system follows suit.

In a later interview with NPR to promote his book, Green shared a perspective that fundamentally changed how I see progress:

“I keep in my wallet a little note that says, ‘The year you graduated from high school, 12 million children died under the age of 5. Last year, fewer than 5 million did.’That progress was not natural. It did not happen because it was always going to happen. It happened because millions and millions of people, hundreds of millions of people, maybe billions of people, came together to make it happen, to make the world safer for children.” (Green, NPR, 2024).

Although the patients I saw in the Emergency Department came in for truly gruesome injuries and in overwhelming quantities, they were not representative of life outside of the hospital. Just because I witnessed senseless deaths due to gang violence, that did not mean there have not been activists fighting to make their neighborhood more peaceful and succeeding. Although there are people in this world who prey on children, there are also those who teach them and make their eyes light up once they discover what they are passionate about. There are partners whose loved ones suffer cardiac arrest on Thanksgiving day, yet who put whatever they had half-cooked in the oven into the freezer, since they could not imagine a life in which their loved one did not get to hear how thankful they are for them over delicious food.

The answer I have come to realize in facing the horrors of this world—although my younger self would be furious that I came to what seems like an overly simplistic conclusion—is hope. Hope, in my view, is not about seeking lofty goals and setting unreachable expectations, but about assuming that if others support me, laugh with me, and care like me, then there is hope that the world can change for the better. What motivates me now, after seeing an overwhelming number of gunshot wounds, is no longer the reverie of becoming a hero, but the few isolated interactions I had with other patients. Although I may witness atrocious traumas at work, they do not always follow me home, and I can still be a compassionate doctor: one who sees the worst in humanity and the beauty that can arise from its darkness.

I have recently begun applying this philosophy of assuming the best in people in my everyday life. I pay for my friends when they need it because I hope they will do the same for me. I give leftovers from school events to the unhoused people on my way home because I hope they would do the same for me. I offer food or water to a wife who has been sitting with her injured husband in the ER for eight hours without any, because I hope that someone would offer me the same kindness if I were in her position. Although acting as an optimist while seeing myself as an innate cynic has not always yielded the results I had hoped—friends not paying back, others doing deeds for resume building, and hospital staff treating patients rudely—I still find relief in this practice. In a world where I see the evils as overwhelming, carrying out these actions feels like the only weapon I have in fighting back.

To hope is not a sign of weakness—it is the most human thing we can do. To hope is risky. It is to know that circumstances are not in your favor, and yet still push on. It is, in fact, one of the most powerful things we can do: to acknowledge the evils in this world and still choose to fight them. Hope is an act of defiance. It is to take arms against whatever powers that be and say that, despite the unjust circumstances they force us to live in, we still fight to shape them into the image of our likeness. To hope is to not to be overwhelmed by the wickedness that precedes and awaits us; it is to see the beauty of life and be reassured that things have gotten better, and will continue to get better, now that we too are part of the fight for progress.

orange sun

Published by Audrey Lyu

wake up, orange sunshine fills my eyes.
feed my bunny, sweet smell of coriander.
i miss home.
change into scrubs, head for the bus.
i wonder what my sister is doing right now.
it’s cold here, i text my lover.
walk to class, today we dissect.
grandma is dying.
open the abdominal cavity.
peel back the layers of fascia.
i miss my parents.
listen to my professors.
peristalsis, achalasia, portal vein.
this is what i prayed for, isn’t it?
but my dog is dying.
my childhood room is collecting dust.
i miss my friends.
i miss my love.
grandma is dying.
read my textbook,
anxiety fills my chest.
i miss my home.
study. move.
move.
i move. i work until the sun goes down,
until i see the sunshine reflect off the skyscrapers in front of me,
filling my eyes with orange once more.

Poetry Thursdays is an initiative that highlights poems by medical students. If you are interested in contributing or would like to learn more, please contact our editors.

nourish

Published by Audrey Lyu

when i die,
donate my body to science.
for perhaps i may be dissected,
by childlike hands and fresh minds,
whose shoes I once stood in.

open my body,
peel back the layers of fascia and adipose,
swallowed with that in which I lived for.

when they open my abdominal cavity,
may they learn my favorite foods,
the myeokguk i ate every birthday,
and my love for candies,
that painted my stomach red.

and in my spine,
they will see my uneven curved vertebrae.
count, T1, T2, T3.
number my past,
feel the tears i shed at 14,
pain i carried at 24.

when they see my tongue,
will they see my motherland?
the muscle of language atrophied, unused, dormant.
search for its memory,
deep under the epithelium of assimilation.

and when they open my heart,
all they will see is you, my love.
written in my myocardium is your name.
the trabeculae that hold your sweet words and sweeter memories.
their noses will be filled with nothing but peonies and green.

after, lay my body to rest in the earth.
so that as my flesh decays,
and becomes one with the soil,
i seep into the foods they eat,
water they drink,
air they breath.
so that my memories,
your love,
is passed on.
when i die,
let us nourish them.

Poetry Thursdays is an initiative that highlights poems by medical students. If you are interested in contributing or would like to learn more, please contact our editors.

Restraints

Published by Kimaya Gazula

“Call security. We need restraints.”

The nurse yelled out into the hallway while he gently held down the patient’s strong right arm that vigorously wrestled in all directions to escape. I, a relatively new Patient Care Associate on the floor, was on the other arm. His screams echoed throughout the room, bouncing off the walls and into the hallway, prompting glances from other staff members.

I had walked in a few minutes earlier with his breakfast, ready to feed him. Simultaneously, his nurse was administering his morning medications. It wasn’t long before the patient punched into the air, demanding that he wanted to leave. He didn’t want breakfast. He didn’t want medication.

He swung his legs over the bed, attempting to get up. We knew he wasn’t strong enough to walk on his own; he was a fall risk. Cautiously, we tried to help him back into bed. It only got worse. My head was reeling as he tried forcing himself out of our grasp. Tension heightened in my stomach and my brain scattered everywhere. What was I supposed to do?

How badly I wanted to squeeze his hand and tell him that everything would be okay. But I couldn’t. Nothing I said or did in the moment seemed to reach him. My presence in the room felt pointless. Why wasn’t he listening to me?

Police arrived and secured the patient to the bed. I was at a loss for words. The patient didn’t commit a crime, so why did we have to do this?

Shortly thereafter, I attended a training session about caring for agitated patients. I was tasked with listening to an example audio that represented what patients with an altered mental status may hear throughout the day. The instructor told us to order a coffee while playing the audio with earbuds. At first, it seemed silly. It would be just like listening to music, right? Easy peasy. No different.

Little did I know, I was so wrong. After asking the barista to repeat what she said three whole times, I was hit with a jolting realization. All sorts of tones barked into my ears telling me to look up or down and listen to them. I wanted to shut out all the voices. But I couldn’t.

It felt like somebody else was inside of my head, controlling every single thing I did.

Patients with an altered mental status present a difficult, yet intriguing, challenge. Upon starting my job as a Patient Care Associate, I never envisioned using restraints was part of the job description. When the patient got put in handcuffs, I felt like a bad caretaker. I felt like I wasn’t doing enough for the patient.

To be completely honest, I still don’t feel as though we did enough for the patient. Were there no other options? Did we really have to tether him to the bed rails, preventing even the slightest movement?

The moment the police entered; I exited. I could no longer be there for the patient. Not by choice, but by hospital protocol.

I will never know exactly what my patient’s internal experience of that hospital room was that day, but I do know that it was likely out of his control.

This patient introduced a lingering question to my understanding of hospital safety. How can we implement alternative measures to de-escalate similar emergencies?

At first, I figured restraints were the only option. They shouldn’t be.

Moving Beyond Knowledge

Published by Patrick Hamann

The ability to empathize and to wonder is fundamental to being human. These aspects of thought allow us to expand our knowledge and deepen our connections with others. Before starting medical training, I believed I would maintain my own sense of wonder, perhaps even expand it through new experiences. Yet after three years of medical school, I have found this more difficult than expected. Although medical education has certainly broadened my mind and offered remarkable opportunities, I have begun to recognize an inherent tension between its structure and the humanistic practice we are encouraged, as physicians-in-training, to embody.

Systematic thinking dominates medical training, teaching us to view problems primarily through a cause-and-effect lens. This approach often leads to a limited, action-oriented perspective that can hinder our ability to understand patients holistically. In promoting this cause-and-effect habit of thought, systematic thinking undermines the principles of humanistic medicine. Humanistic medicine strives to move beyond thinking that is limited to identifying the next best step. Instead, it intentionally attempts to see the patient and their life as a whole, emphasizing their lived experience. If put into practice, humanistic medicine allows us to connect deeply with patients and to navigate uncertainty with meaning. Unfortunately, it is often only briefly addressed in medical education, even though learning to practice it, like any other skill, requires dedication and sustained effort. Like many others, I feel this tension increasingly throughout my training, but my unconventional path into medicine makes it feel particularly acute.

I attended a small liberal arts college where every student followed the same curriculum, built entirely around discussion of primary texts. We began with the ancient Greeks and read our way through to the twentieth century. After completing the program, we all graduated with a bachelor’s degree in liberal arts. I valued this approach deeply because it was both highly individualized and inherently collaborative. We learned to engage in meaningful discussion and to solve problems together. Our grades were based solely on our spoken and written words. Classes began with an “opening question,” which we explored within the context of the work we were reading, seeking to understand it more clearly by teasing out ideas and discussing themes of the text as a whole. Inevitably, more questions would arise, and we would work together to make sense of them. Often, we did not arrive at satisfying answers, but that was not the point. Listening to one another, exchanging perspectives, and learning to sit with uncertainty: that was the point.

Medical education is structured differently. It relies on a systematic framework prioritizing sequencing and retention over open-ended inquiry. In recent years, there has been growing recognition of the importance of humanistic education within medicine. Yet this shift has produced little change in the underlying structure of training, which remains inherently systematic, a matter of logical sequencing, and encourages similarly systematic habits of thought. Within this paradigm, information is presented as the culmination of principles, reinforcing a cause-and-effect mode of reasoning. This structure has many strengths. It provides a shared framework for communication among practitioners and allows us to organize vast amounts of complex information efficiently. Problems arise, however, when the methods we use to learn medicine begin to shape how we practice it. The priorities of care become altered and we fail to integrate the information from our patients into a holistic understanding of them and their lives. It is a pattern that I have noticed frequently over the course of my clinical rotations.

During a pediatric hematology/oncology rotation, one conversation in particular illustrates this pattern well. The patient was a five-year-old admitted for unexplained bleeding. His family had no idea what was wrong; days earlier he seemed perfectly healthy. The physician entered the room, named the diagnosis, and explained that the cancer was treatable, outlining treatment options, risks, and the likelihood of recurrence. There was clarity in his words and confidence in the statistics he cited, but all the family heard was cancer. After the conversation, they were left to reconcile the weight of that word with the sight of their child, still seemingly healthy and playful. We speak fluently in our own medical language among ourselves, but at the bedside, the transition to empathetic communication is often overlooked. Pressures of clinic efficiency, high acuity, and entrenched habit all play a role in widening this gap and represent real barriers to humanistic care. In response to these pressures, most efforts focus on improving communication by eliminating medical jargon. While important, on its own it is not sufficient. Practicing humanistic medicine requires a focus not just on explanation, but on the relationship between patient and provider. Yet medical education rarely teaches this skill with the same rigor it applies to diagnostic reasoning. This absence reflects a deeper structural problem, one in which empathy is treated as secondary rather than essential to good clinical care.

This way of teaching medicine has real clinical consequences. One experience shared by a close colleague during a primary care rotation illustrates these consequences and shows how humanistic medicine can begin to address them. Their patient was following up after hospitalization for being struck by a car. The student conducted a routine history and presented the case to the attending. When they returned to the room together, the attending’s first question was not scripted or determined by an acronym. It was simply, “How did you get hit by a car?” That question opened a conversation that had not occurred up to that point; the patient revealed that he had attempted suicide by intentionally stepping in front of the car. This information had gone undiscovered until that moment—not because it was unknowable, but because no one had thought to ask. The question was simple, but it was asked with intention. It invited the patient into a difficult conversation and showed a willingness from the physician to meet him on an equal, more human level. Unfortunately, students’ exposure to this humanistic approach is limited and often depends on the individual mentors. Without explicit education in humanistic care, we risk losing—or never fully developing—the ability to engage meaningfully with our patients.

Prioritizing the systematic aspects of an inherently human pursuit like medicine is a short sighted and self-limiting habit. It not only weakens our connection to patients, but it also drastically restricts our critical thinking skills, cutting out natural curiosity. When our interactions are based primarily on demonstrating knowledge and an “understanding of the facts,” the first thing to disappear is the ability to ask meaningful questions. This is not because of increased ignorance; rather, it reflects a diminished capacity to work through uncertainty. When people are encouraged to think broadly and are given space to explore uncertainty for themselves, the practice of this kind of thinking strengthens critical thought. Problem-solving then becomes grounded in a deeper understanding of the problem itself. Growing these skills allows us to remain present and reflective with patients, even in the midst of uncertainty. But these skills must be intentionally nurtured and explicitly taught otherwise they fade—like any habit—in favor of the ever-present “I know the answer” attitude.

We undeniably need the efficiency of systematic thinking to learn and apply medical knowledge, but we must also deliberately cultivate the human side of medicine. This begins by naming the limitations of our current system and learning to recognize when structured reasoning is essential, and when it is more important to return to what makes us human: our capacity to empathize, to connect, and to feel. Doing so not only allows us to care for patients in a more humane, person-centered way, but also sustains us as caregivers in a profession that too often forgets what makes us human.

The Dichotomy

Published by Meghan Acheson

Witnessing the first breath of life, the last before death,

“You are cancer free!”, “The cancer has returned,”

“Congratulations, you are pregnant!,” “I am so sorry, but there is no longer a heartbeat,”

The scream of a mother echoing down the hallway as she brings new life into the world, the scream as she watches her child depart it,

Tears of joy in one patient’s room as their scan was clear, tears of sorrow in the next as their scan shows new metastasis.

The dichotomy of medicine – the best and the worst in life,

What a privilege and honor it is to walk with people on the best and worst days of their lives.

Poetry Thursdays is an initiative that highlights poems by medical students. If you are interested in contributing or would like to learn more, please contact our editors.

Foreign Bodies (Berries)

Published by Veronica Gibbons

Foreign Bodies (Berries)

Veronica Gibbons (2026)
acrylic on paper

This painting reminds us that beneath every incision is a unique individual, shaped by experiences that cannot be standardized. Medicine is inherently unpredictable, and while training emphasizes mastery of uniform knowledge, that focus can shift attention toward efficiency, performance, and personal progress. The unexpected blueberries disrupt this mindset, highlighting that while anatomy may be shared, each patient is different. The piece underscores the responsibility to stay adaptable and attentive—not just to the procedure, but to the person—recognizing that caring for patients requires presence and flexibility as much as technical skill.