mmassirer

Written By: Nancy Falco Chedid, M.D.

Note: This work is closely based on real events and is autobiographical. Except for my own first name, all identifying information has been withheld or changed to the best of my ability. 

The afternoon began pleasantly enough. Mind-numbing lectures behind me, I stepped outside and imbibed the balmy air of a beautiful day. The sole purpose of my life, at that moment, was to put distance between myself and anything remotely related to the study of medicine.  

    But then there was Catherine. My effervescent classmate was approaching at a healthy trot, indomitably as a cavalry charge. In the past, I had evaded invitations to join her in all manner of do-gooding; this time I was captive to her relentless sweetness and sincerity.  

    “Nancy,” she said, “I’m driving out to Syllford Clinic. Why don’t you come with me?” The apparition I had summoned, of iced tea and a plate of calamari at a harborside café, receded intooblivion.                                                                                                                      

    I heard myself say, “Sure, Cathy, I think I can manage that.” She flashed a smile with a shade of triumph.    

    I knew that Catherine’s older brother, Andrew, was rounding out his surgical training at Syllford. On most Friday afternoons, like this one, the two siblings’ labyrinthine schedules aligned and they were able to get together for coffee.Catherine’s enthusiasm for the visits was understandable, even admirable. But I wasn’t quite sure about this clinic; for me it held (and still holds) an air of mystery – which may well have been by design. 

    Syllford could be found, by those in the know, deep within a gorgeous, hilly, wooded area that was otherwise residential. The place screamed — tastefully, of course — “blue blood” and “old money”. The building’s entry hall retainedtrappings of its original incarnation as an expansive Victorian house, with darkly paneled walls, gilt chandeliers, and the rest. There was no hint of the modern surgical facility that stood beyond the erstwhile parlor doors.  

    Today, two facelifts were on the schedule – which was typical, as I learned. VIPs seeking a veneer of perfection flocked to this place. While some other cosmetic clinics had private back doors so that patients in unsightly bandages could exit discreetly, here the entire surroundings were secluded. The very rich and very famous could be cloistered, from the time of arrival through the moment they were whisked away behind blackened limousine windows.  

    According to Catherine, occasionally a patient would be discharged with a comical face sketched on the back of his headwrap by an impish surgeon. This was all in good fun, since the patient was invariably in on the joke. But such antics belied the mission of the inscrutable Syllford Clinic. 

    Aside from the cavalcade of cosmetic procedures, the clinic saw a steady flow of complex reconstructive cases. In their crusade to restore patients to normal function in society, orthopedic and plastic surgeons battled the ravages of trauma, burns, congenital deformities, and disfiguring diseases. Certain patients, mainly youthful ones, had conditions that required multiple operations in tandem with physical therapy or wound care. Logically, then, Syllford provided thoseservices within its own recovery and rehabilitation unit.  

    Catherine had seen many of the same patients during successive visits; she suspected that some had become long-term– possibly indefinite — residents of Syllford. (And I suspected that she visited this place not just to rendezvous with her brother, but to nourish her own charitable soul by keeping the residents’ company.) Evidently a miraculous infusion of grants, donations, and clinic profits were funding the patients’ care; but to us, the specifics of the arrangement would remain obscure.           

    As we sat in the entry hall, the appointed time for coffee had come and gone, and Catherine forecast that her brother would be delayed even longer in the O.R. “I know,” she said brightly. “While I’m waiting, I can introduce you to the girls.” She had previously mentioned these two patients in passing, describing them only as giggling teenagers and “best buddies”.   

    But no sooner had she made the suggestion, than Andrew appeared, in surgical scrubs. He apologized for the busyoperating schedule; he had little time to spare. I urged Catherine to seize this precious “coffee moment” with her brother.  

    Running off, she called over her shoulder, “Maybe you can still chat with the girls. They usually hang around the library.” She gestured toward an arched doorway draped in burgundy velvet. 

    I approached the library entrance, and a voice trumpeted from within, “I thought I heard Cathy!” The owner of the voice poked her head around the velvet curtain. Though obviously crestfallen on seeing me instead of Catherine, she succumbed to curiosity and stepped out.   

    Now, I am not a tall person; my close friends have been known to call me “vertically challenged”. But it occurred to me that, in order to meet the gaze of this teenager, I had to look downward. Taking in her facial features and the form of her arms and legs, I identified her condition as achondroplasia – and commended myself, in silence, for my diagnostic skills. 

    Achondroplastic dwarfism is fairly rare in the overall population, but it is the most common kind of dwarfism. In truth, even the medically uninitiated would probably recognize its typical physical traits – prominent forehead, short limbs,torso of normal length – especially since there are celebrated scholars, actors and athletes, among others, who share this condition. I guessed that the young person standing before me was receiving treatment at Syllford for severe bowing of her legs, another trait associated with achondroplasia. 

    On the faculty of our medical school at that time was a physician-scientist with a fervent interest in genetically determined diseases like this one. Statistics have repeatedly demonstrated “normal intelligence” among those with achondroplasia. But our specialist would scoff at the sterile research data, insisting that these individuals were rather moreintelligent than the general population.  

    So many people with the condition had sought medical care at our institution, that some had taken up residence in the surrounding neighborhood, and more than a few had become valued employees of our medical center. Within the hospital community, the faces of workers with achondroplasia became familiar faces. In the eyes of our medical students (myself among them), their “peculiar” features began to seem very nearly ordinary.     

    So I felt quite at ease, launching into small-talk with the teenager who was now looking up at me — and sizing me up. I began, “You were right when you said you’d heard Cathy’s voice, but she’s off having coffee with her brother. I’mNancy, her classmate. It’s really nice to meet you.” 

    Relieved and smiling, the new acquaintance gushed, “I’m Jackie. It’s great to meet you, too!”   

    We exchanged niceties. I inquired about her age, her favorite school subjects, her favorite music. But then she stopped me. “Wait,” she said, “let me get my buddy.”    

    Jackie turned toward the library. “Lucinda,” she called, “come and meet Cathy’s friend!” 

    Two sounds penetrated the velvet curtain – a dainty but unmistakable squeal of delight, and then approaching footsteps. My first glimpse of Lucinda was her silhouette as she stood under the arched doorway, backlit by the sunset gleamingthrough the library’s rear window. She had the bearing and deportment of a dancer, and I guessed that she was taller than her friend Jackie by a foot, if not more. 

   Presaging my future interest in hand surgery, the next features to draw my attention were her fingers, delicately holdingthe curtain aside. I gasped (inaudibly, I hoped) at the sight of their taut, shiny skin, marred by scars and ulcerations. I recognized the hallmarks of the autoimmune disease scleroderma – which, in fact, was the particular cross that Lucinda had to bear. But worse, much worse, her digits were oddly short and lacking nails. And so, it appeared that lovely Lucindahad lost the tips of all her fingers. 

    To blame for the tissue loss and scarring, were the sinister agents of scleroderma: inflammation and spasm of small blood vessels, and abnormal deposition of collagen. Lucinda, so young and so brutally afflicted, must have had a rare and aggressive form of the disease. I felt satisfied that this was a fair-comprehensive-assessment-based-on-my-astute-clinical-observations. In reality, however, I remained desperately ignorant of how unprepared I was, for what was yet to come.   

   Lucinda said a lilting “hello”. I intended to return the greeting, but none was forthcoming. It remained lodged in my throat – because I had seen her face.      

   My encounter with Lucinda would prove to be life-changing. I have come to believe that my experience should be relayed in unadorned detail, for the benefit of others. But even now, years later, the words come haltingly. Can I tell the tale and still uphold the dignity of the human being who is Lucinda? I pray that her privacy may be safeguarded by her seclusion, the passage of time, and the name I have lent her for the purpose of this essay: Lucinda, meaning “light”.  

    To describe her physical features, which caused me such distress (at the time), I take refuge in the plain language of clinical narrative:  

    Lucinda’s scalp was hairless, save a few thin patches of stubble. The skin around her mouth was puckered and parched, and scar tissue hampered the motion of her narrowed lips. The tip of her nose was entirely absent, causing her nostrils to appear wide and skeletal. The demon scleroderma had not spared even her eyelids, with the result that her eyes seemed to protrude alarmingly. (I regret that I was reminded, involuntarily, of ghoulish images promulgated by the “entertainment” industry to entice and haunt the viewers of horror films.)  

    “Why didn’t Catherine warn me?” was my first coherent, selfish thought. The second was, “I hope I can get through this conversation, without the girls sensing the shock that’s piercing my soul.” I felt revulsion, shame, and fear, and then embarrassment at my faltering equanimity. Finally, in the little space that was left in my heart for Lucinda and her loved ones, there appeared the seed of great sorrow, and the spark of a firestorm of rage at the unjustness of this young woman’s fate. 

    And yet – it struck me as remarkable, that Lucinda could radiate openhearted amiability, despite the restriction of her facial motion. Gracious, kind, and deferential, her courtly manner was a pleasing foil for Jackie’s unabashed exuberance. I will forever be indebted to the girls, for taking the reins of our 20-minute discussion. I don’t remember a word of it(though I do recall feeling slightly less shaken, by the time they left for a tutoring session in English literature).  

    Neither do I remember much of the conversation I had with Catherine during the drive back to the city. Probably Imanaged a self-conscious, superficial accounting of my meeting with Lucinda and Jackie. I hope I told Catherine that it was an extraordinary experience – which, regardless, would have been a spectacular understatement. 

    That evening, and throughout the next several days, my thoughts duly drifted from self-absorption to concern about Lucinda and those dear to her. I pictured them as a loving family; given Lucinda’s luminous gentility, it would have been difficult to imagine otherwise. I supposed that she would remain cloistered for the rest of her days, and that she and her family would accept this as the least dismal of their dismal options. There was little prospect of restoring her physical appearance; the entire armamentarium of reconstructive techniques would depend for success on the very blood supply that was blighted by scleroderma. 

    Society was not, and is not, ready for the Lucinda’s of the world. On the contrary, we are too easily smitten by unattainable ideals of shallow perfection; and we tend to shield ourselves – and especially our youngsters — from what is perceived as “ugly”. There is no denying our visceral response to the scary or the different, which we might dismiss as the other in order to manage our fears. But as thinking, feeling human beings, it is within our power to surpass these darkerimpulses.  

    I hold in high esteem the heroes who have taken steps in this direction – including the artists, writers, and filmmakers who have sensitively portrayed disabled or disfigured individuals for a broader audience. Sadly, though, the transformation of society as a whole is not on the near horizon. In the meantime, there are those who would channel their sense of powerlessness and frustration by delving (as I did) into professions like reconstructive surgery — in the hope, at least, of transforming patients’ lives one by one. 

    During the few months following my initial visit, and until hospital duties supervened, Catherine and I continued to frequent the Syllford Clinic. Unexpectedly, I began to look forward to these occasions, each one more than the last. By the end of my third meeting with Lucinda, it occurred to me that the anguish formerly evoked by her presence was gone.This might be construed as mere psychological tolerance, a desensitization to her appearance. But I rejected this rationale as vastly inadequate for my transcendent experience: 

    It was quite as if a mask had been lifted from Lucinda’s face. Her heretofore horrific features had become, for all intents and purposes, invisible. Now when I looked at her, I saw Lucinda, not her veil of imperfection.  

    This revelation ushered in a torrent of elation, gratefulness, and insight. I now recognized that one human being could learn to truly know another; knowledge thus acquired could not fail to extinguish the relevance of physical appearance. I have never had cause to waver from this, my firm conviction. And to this day, I marvel that I was blessed to know Lucinda.  

    I wished that I could thank her for these gifts. I longed to help Lucinda see — that her life had a sublime purpose; that the enlightenment I had received through her would inspire my mission of patient care; that the fragile cloister of her body had no power to contain her magnificent spirit.  

    Yet, I feared that these exalted truths would turn to dust, if I dared to utter them in the banal language of our everydaybanter. I never found the courage to tell Lucinda what I thought. Perhaps she already knew.   

    Nor did I succeed in thanking my classmate Catherine, for luring me to Syllford Clinic on that first beautiful day. Every attempt at expressing my gratitude seemed so meager and so trite, that eventually I abandoned the enterprise. But I did convince her to take one Friday afternoon off, and join me for calamari at the harborside café. 

Author Bio: 

Nancy Falco Chedid, M.D. is a writer, musician, physician, and educator. She has lived and worked in the eastern U.S. and the Middle East. She launched the Humanities in Medicine program at Lebanese American University School of Medicine, where she was Director of Student Affairs. Her published works include essays in life writing and illness writing, scientific articles, and a memoir. At the moment, Nancy resides in Cambridge, Massachusetts, where she teaches English as a second language for healthcare professionals and sings in an assortment of choirs. 

Written By: Robert Paviour

I craved sedation, after an interminable wait for surgery, not looking my best in bouffant cap and three-day beard. The pre-op area was so polar that I draped a down jacket over the flimsy johnny. “I’m getting frostbite,” I told my wife. 

Realizing the delay was making me edgy, she said, “Don’t get cantankerous. You’ve had so many surgeriesthey’ve become recreational. Use the relaxation techniques you taught your patients.” 

Humor would help more, so I sang a few snatches of “20, 20, 24 hours to go / I wanna be sedated.” These must have been the magic words: Abracadabra!, I was whisked into the OR. Staff bustled around, bringing me warm blankets, propping up my right leg with pillows to take pain off a bum hip. I was appreciative. 

Today I was scheduled for a hernia repair, prequel to hip replacement, more steps to becoming Bionic Bob.Tattoos from earlier operations, including a kidney transplant, had been mostly erased by the miraculous healing powers of our skin. But despite the prospect of seamless upgrades, sometimes a surgery should be scuttled.  

This fiasco began with a routine safety check, my surgeon asking for name and date of birth. Now giddy, and never one to pass up a captive audience, I answered, “Bad Bunny,” with an execrable Spanish accent. After hearing only asnicker, I supplied my correct name, more ready than ever to go under. But a rapid-fire, head-snapping series of mood reversals loomed, not oblivion. 

The young anesthesiologist obligingly fitted a mask over my mouth and nose. I gave her a thumbs-up in gratitude, glancing at the cocktail of drugs – deliverance so close now! She reached for the stopcock, but was interrupted byirregular, nagging beeping. Frowning, she said, “Wait,” as she checked the screen and electrocardiogram leads. 

Instead of the longed-for drugged fog, a foreboding crept over me, validated when she said, “You’re not going to like this: there are too many PVCs, a heart arrythmia.” 

 “I know what PVCs are.” And I understood she intended to call off the procedure, but after fasting, prep, and lengthy holdup, I became unhinged, behaving badly, yanking off the mask. “My EKG was unremarkable last week!”  

“Not today. I can’t take a chance.”  

“I had PVCs before, during a colonoscopy. They were nothing.” The gaggle of nurses, techs, and my surgeon milled around while we volleyed, their heads swiveling back and forth as if this was Major League Pickleball. “I swam half a mile on Wednesday. Took a four-mile hike last week.” 

Without thinking, I sat up, almost wrenching out the IV, which a tech dashed in to steady. EKG leads peeledloose, and beeps went haywire. This was morphing into farce. All I had to do was act naturally, nearly naked in the Antarctic OR, an old clown with a silly blue crown. Cranky, crazed, shivering scarecrow of a human being.  

Over a cacophony of loud chirping, the anesthesiologist said, exasperated, “I don’t want to kill you!” Techsfrantically attempted to stabilize the leads, some of which hung like limp strands of spaghetti. 

I looked around, appealing desperately. “This is iatrogenic, caused by no fluids pre-op, electrolyte imbalance, and anxiety.” My narrow range of medical knowledge put me more at risk than PVCs. Fact-check everything I say with Dr. Oz. 

“Sorry, I don’t want to kill you,” repeated the anesthesiologist. 

She shut off my monitor and the racket ceased. I lay down with a thud, deflated, speechless, seething with peevish suspicions that she was more fearful of litigation than death. Struggling for equilibrium, seesawing, I argued with myself: stop whining, it’s not like you were lying mortally wounded in a field hospital that had run out of Ketamine. Consider all the time and effort spent on you here. Then my crabbiness spiked again as I thought of reprising the whole rigmarole. My wife would have countered, “Come on, collect yourself. This’ll make a good story.” 

It was inevitable my insurrection would fail. Accepting this would have been easier had I known the decision to terminate was fortuitous. And I realized that the anesthesiologist deserved an apology: though I was right about PVCs, she had unwittingly saved me.  

When we re-booked the repair, new bloodwork revealed the precious kidney, gifted years ago from my brother,was faltering. Only immediate heroics rescued it. Had the doctor not stood her ground, I would have won the debate buttrashed my kidney.  

Author Bio:

Robert Paviour is a former journalist who became a psychotherapist, and lives in Charlottesville, Virginia. He has published stories in The North America Review, The Ravens Perch, Poydras Review, and Virginia Country. He is keenly interested in the native plants of Virginia, and spends as much time as possible in the Alleghenies and Blue Ridge mountains. He is a Medicare frequent flier. 

Written by: Afsaneh Morteza 
Edited by: Quinton Lowe 

It was an unusually busy day for me. People were calling back-to-back and my morning was filled with patients. I was in the middle of a call with a trial sponsor and had to run to the clinic to see a patient when I received a call from an unknown number. It was an older man calling on behalf of his wife. They did not know who else to contact and had received my number from the clinic nurse. They had an appointment with their oncologist yesterday here in Texas about her cancer management andwere already on the drive back to their house in another state, when they received an alert for scheduled imaging back in Texas that same day. Frustrated, he was calling to double check if there were any other tests they needed to do urgently for our trial eligibility, because they did not want to be called again to come back at the last minute. 

I had spoken with his wife on the phone once before, three months ago, to get her consent regarding testing her tumor’s tissue for a target protein that would qualify her for the clinical trial. We had gotten a tumor tissue sample from her metastatic liver site four weeks ago for screening, in which she tested positive by the hospital lab for the target protein. But we were still waiting for the official result from the trial sponsor company. If the result from them was negative, she would be ineligible for the clinical trial, and the next step would be hospice. In the meantime, the oncologist wanted to proceed with further imaging in case she was approved for the clinical trial, enrollment steps were already being taken. To me the oncologist was jumping the gun. I was juggling too many things at the moment to explain all the machinations, so I just told them “Trust me, you do not need to return to Texas right now. Make it home safely, and I will call you later to explain all the details.” 

A few hours later, when I finally had a quiet moment, I called them back to continue the conversation. I explained to the husband that it will be two more weeks before we receive a result from the trial sponsor. If the trial sponsor approves them for clinical trials, they can return to Texas and do the necessary imaging and tests all at once. They were relieved to know they didn’t have to return immediately and were very thankful someone had finally called them back to answer their questions. 

A week later the trial sponsor called me to say they were unable to evaluate the tissue sample. There were two options for the patient. She could agree to another biopsy, which would involve surgery, but would allow us to retest for the target protein. Alternatively, we would have to screen-fail her, which would exclude her from the clinical trial and refer her to hospice. I informed the oncologist of this update, and she asked me to discuss the situation with the patient. 

It would be my very first time talking about hospice with a patient. When I was a physician overseas, I sawmany patients who were terminal, but where I’m from, hospice isn’t a thing; instead we would continue to sell these patients hope, which was difficult. But this conversation about hospice was even more difficult. I felt very limited under the coordinator title with what I could say. When I had a calm moment in my schedule, I made the call. The same anxious voice of her husband answered. I could hear her trying to speak through him in the background, “Ask her this… ask her that”. I explained to them the new findings of the liver biopsy, and the options for moving forward. I did not mention anything about hospice, and then it came up. She grabbed the phone from her husband, “If I say I don’t want another biopsy, that means hospice, right?”. I couldn’t get myself to say “Yes”, and I couldn’t get myself to say “No,” because then I’d feel like I was selling her a false hope. Before I could say anything, she broke the silence by asking if she could call me back later. 

Two hours later she called back, her voice was shaking as she asked, “What would you do if you were in our shoes?”. Again, I froze. I wasn’t her doctor, I wasn’t a nurse, I was just a coordinator. She continued “You have been an amazing coordinator, you’ve answered all our questions, and listened to our complaints, but I am so frustrated”. She hadn’t received any treatment for three months and was fearful it meant hospice. She had heard there are options with phase 1 trials and wished to be enrolled in them. She also asked about switching back to her old meds. She was reaching for any option that wasn’t hospice. 

I thought to myself she does not seem to understand how cancer treatment works. When her cancer grows onone therapy, it means that therapy is ineffective. And she has tried all available therapies. Now she’s been referred to clinical trials, but no one on the team has discussed phase 1 trials with me. I did not want her to sense my uncertainty, so I just continued to listen and try to understand her state of mind. 

“It is not on you,” she told me. “You have been doing a phenomenal job, but all this waiting, first for the tissue biopsy result, and now knowing it has been useless, makes me very angry. Why does it take so long and who is responsible for it? I haven’t received any treatment for three months. Why can’t they just give me something?” I assured her that it’s okay to be frustrated, and that I was a safe place to vent that frustration.  

I asked if she had any physical pain. She said she didn’t have any physical pain, and that’s the irony of it. Physically she feels fine. She has been camping and hiking and overall feels great. It’s the idea of having aggressive cancer and not receiving treatment that’s been hard for her. 

I asked her if waiting to hear about the clinical trials, and the uncertainty of the enrollment process, has been hard for her. She said “That’s it exactly! I don’t know what will happen and it feels as if my life is dependent on one test or another. I have been waiting to enroll in this trial and can’t stop thinking about what would happen if I can’t. It’s the waiting that’s killing me, and it’s become more of a mind game than anything else.” 

She then burst into tears… I could understand where she was coming from, it was a hard place in life to be. Her husband took the phone and tried to calm her down. He went back asking about eligibility for the phase 1 trials. 

I felt like I shouldn’t share personal information with them, I didn’t want to make this conversation about me. I’ve never been in a situation like hers, but I’ve thought about my own mortality, and I’ve been confronted with persistent uncertainty, so I could understand aspects of their pain. It took all my courage, but finally I said “I understand the waiting game, it’s unbearable, it can drive you crazy. I studied medicine overseas and came to the United States to become a great doctor, it is my dream. For eleven years I’ve applied for residency in September, and then the following March, I get the news that I have not matched to a program. I postponed marriage, postponed having a family, limited my life with friends, and even rejected jobs thinking I couldn’tcommit to them until I got my medical license. 

In the first few years, I cried when I got rejection letters. But then I thought, maybe taking a job related to my field would help me to get a residency. I took a break from applying for a year, but the subsequent rejections were still painful. I eventually opened my eyes to accept the current reality of my life as a clinical research coordinator, as limited as it feels to me. Now I see the value in what I do and can forgive the past ten years of living my life chasing the dream, although I would be lying if I said I don’t daydream about what my life would be like if I were accepted for residency. And I proved to myself how long I was willing to wait for an opportunity. No one has ever said how long you’re supposed to wait to live your dream, and maybe I will never get anacceptance letter, but I’m still willing to wait, because there will always be hope in my heart”.  

The patient was silent for a while, and I think she had even stopped crying. Eventually I heard her voice on the other end, “What you’ve been through sounds awful, maybe even worse than what I’m dealing with!” We both laughed, it was a nice way to break the tension. She said, “I don’t know if I mentioned it before, but I have grandchildren, and I’d really like to stay alive for them”. She and her husband made it clear to me that no one else had really talked with them about what they’d been going through, no one else had expressed such sympathy for their situation. Her husband ended the conversation by saying “You will be an amazing doctor one day, you’ve done so much by just listening and talking to us in a way no one else has.”  

They decided to do another biopsy and I sent a request that day. By the end of the week, the treating physician informed me that the location of her tumor is complicated and neither surgery nor biopsy are possible. She was then referred to a different phase 1 clinical trial. A few hours later, I received a text message from her, sharing her decision with me to do the clinical trial, and thanking me for being on the human side of the team. I never met her or her husband in person, but the conversation we had touched me. It gave me a better perspective of who I am and how valuable I am to my patients. I faced my greatest fear by allowing someone else to see my vulnerability and learn about my failures. By sharing my story with a patient who trusted me, I challenged an old belief. I had thought that if she knew I had made repeated mistakes and experienced failures, I would lose her trust. Instead, she continued to trust me, and that was my victory. I have always been healthy and haven’t experienced physical pain or fear of death, but I feel the death of my identity by not practicing medicine. Not meeting professional criteria in the medical community such as a class grade, year of graduation, or a failed test, is frowned upon. These experiences, for me, feel very similar to what my patient was going through, the Waiting Game.  

I’ve thought about her often and had hoped to meet her in person. I don’t know why, but maybe it was for a sense of closure. I think the healer and the patient can often share the same pain in different parts of life. Maybe you can only meet people as deep as you have ever met yourself. 

Short Bio 

Afsaneh Morteza, MD, MPH, is a Research Coordinator in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center. She earned her dual MD/MPH degree from Tehran University of Medical Sciences, where she conducted extensive research focused on diabetes and chronic inflammation. Currently, Afsaneh is working toward obtaining her medical license to practice as a physician in the United States. Outside of her clinical and research pursuits, she is an avid writer, swimmer, and hiker who enjoys solving mathematical problems. She loves painting and currently focuses her artwork on transmitting and evoking deep human emotions.