By Jamie Jones

The emergency department, a bustling fray,
Trucks backed up in the ambulance bay.
A mother and child, full of fear,
Scared of needles, lots of tears.
So much the child couldn’t understand,
I took a moment. I held her hand.

In the dim-lit room, a girl of youth,
Afraid of judgment, skirting the truth.
Eyes darting around the room,
Feeling as though her life is doomed.
This was not the life that she had planned.
I stood in silence. I held her hand.

A young mother next, with babe in arms,
Bruised face and ego, escaping harm.
Head lowered, eyes to the ground,
Her quiet sobs the only sound.
So much in life she has had to withstand.
I sat in solidarity. I held her hand.

Midlife’s shadow looms, a woman sighs,
She’s heard it all, the deceit, the lies.
The speculum is cold, her eyes, morose,
As her thoughts consume her, her eyes, they close,
Remembering her life that used to be grand.
Knowingly, respectfully, I held her hand.

An elder then, with wisdom profound,
Afraid of leaving, of the final round.
Each breath uneven, her shoulders frail,
Her bones so fragile, her skin so pale.
She silently succumbed to eternity’s demand.
In quiet tears, I held her hand.

From tender youth to elder’s grace,
In every moment, I found my place.
Each heartbeat echoed in the air,
A silent promise to ease despair.
So, in the echoes of life’s symphony grand,
With gratitude in my heart, I held her hand.

Jamie L. Jones, Ph.D., RN, CNE, is a Clinical Assistant Professor and Academic Coach within the UAMS College of Nursing. With over 20 years of experience as a registered nurse, including intermittent work in the emergency department, and over 15 years as a nurse educator, Jamie is passionate about her roles. Jamie views nursing as a deeply human endeavor, centered on connection, warmth, and kindness. For her, it’s about more than completing tasks; it’s about fostering a sense of safety and well-being for every individual she encounters. Jamie’s overarching life goal is simple yet profound: to brighten at least one person’s day through her actions, every single day.

By Stephen Johnson

Like Aspen leaves adrift on yellowed-cold,
we flutter, down from youth – to frailty.

Bone overlapping nerve, vision narrower,
niggling fire- in an un-stoked furnace.
A familiar name, muted in the downdraft,
gait- become a trudge deliberate.

We swirl, blown about upon Time’s whim,
conjugating in our similarities.

Wisdom, begotten by present sorrow,
consoles- as does hot tea in deep winter.
Retrospection, wrings itself out upon us,
our frayed rag, draped on clean plates.

In groups, proliferous and alarming,
we settle, onto the still and waiting soil.

knurled hands laced with peace accepted,
feet – content to have at last arrived,
hearts, at-pace with the scope of quietude,
we bequeath the bustle, to those we love.

Stephen Phillip Johnson is a Mountain Home carpenter. Writing is his itch. Within the halls of medicine, where he’s been (repeatedly) healed, reside flocks of muses.

By George Christopher

Transition states not stasis not static
No longer substrate, not yet product
Highest energy on reaction coordinates
Breaking and making covalent bonds

Pre-med, med school, residency, possibly a fellowship, attending
Changing roles, responsibilities, locations, people, relationships
In changes from good to good or good to better
Some-things and some-ones must be given up
For new some-ones and some-things to be embraced

Transition states not stasis not static
Present becoming past
Undetermined future becoming present
Adaptation from cellular to social contexts
Work through grief, move on
Welcome the future in the open-ended
In certainties that give direction
Uncertainties that open new possibilities

George Christopher is a physician who has transitioned into retirement. He and his lovely wife Linda live near their two grown sons and grandchildren in western Michigan.

By Debbie Baxter

I watch my mom for signs she’s going to be leaving me soon, even as she’s still here. She looks more fragile. A little more lost. Is she? Is she between two worlds now? Who is it she reaches for when she’s sleeping? Is it her mother or maybe my dad? She told me he was sitting on the love seat, and when he didn’t speak to her, she thought he was dead, and then she said she knew it was a dream, a bad dream.

There are people in her room these days, but she says she knows they’re not real. She’s stopped talking about them like she once did, but she thinks they’re sitting on her sofa, sleeping in her bed, or having picnics in the floor with their children, waiting for her to join them. They don’t speak, but they smile, gather around her, and sometimes, when she thinks I’m not looking, she smiles and waves at them.

Other times, she worries the blankets between her fingers, touching, always
touching the fabric, moving her hands along the edges, reading the soft folds
as if it gives her messages only she can see. When she wakes from her frequent naps, she’s confused and slurs her words. I bring her water, say my name real loud. She turns blind eyes my direction. “Who are you again?” she asks, smiling.

“Just me, Mom, no one important,” and we laugh. But it’s not really funny.

Deborah (Debbie) Baxter is an award winning poet who lives in Chesapeake, Virginia, with her husband and 105-year-old mother. A graduate of Old Dominion University, Debbie continues her creative writing education at The Muse Writers Center in Norfolk. Her poetry reflects her Southern roots and ties to family. Her amazing mother is the inspiration for many of her poems.

By Christopher Fettes

Sometimes forgetting is willful, even hoped for.
How he carried himself as he walked across the yard,
Between one building and the next.
How his pant legs were cuffed,
But still grew damp from treading through the dewy morning.
How his eyes pierced your facade when he looked your way.
The way the smell of his sweat hung on him
Warm and intimate, not staid or dirty.
The way he walked past watching eyes, showing no sign he noticed.
The way he disappeared across the lawn.
The way you wondered if he knew your name.
The thoughts you kept to yourself.
It is easier to let the sting of memory recede
Into the past without wondering what
Might have been or revisiting what was.

Christopher Fettes was born and raised in Little Rock, Arkansas, where he lives with his wife and their beloved pets. He earned both a bachelor’s and master’s degree in English from the University of Central Arkansas. He writes poetry and fiction. He serves as Poetry Editor for Medicine & Meaning and is a reviewer for Slant. He is the author of a chapbook titled A Loneliness in the Distance Between.

By William Palmer

For a DaTscan
to confirm 
I have Parkinson’s,
I am injected
with a radioactive tracer.

A few days later
my neurologist shows me
an image from my brain
that contains 
what looks like
a radiant horseshoe.

The tip, or heel calk, on the left side 
is gone.

The diagnosis is accurate.

But most
of my horseshoe 
is still there.

Each day I will try to throw a ringer.

William Palmer’s poetry has appeared recently in Braided Way, JAMA, J Journal, One Art, On the Seawall, Poetry East, and The Westchester Review. He lives in Traverse City, Michigan.

1. Multiple Alarms from Heaven

Arctic icebergs are breaking up,
Melting Antarctica airport-runways need new sub,
Strong gales have torn apart buildings, Oops:
Flooding also moved houses like floating cups.

2. The earth responds

The green leaves don’t say goodbye,
The remaining yellow resists snowflakes from the sky,
The brown and red spread out in formation,
This defensive camp has nothing to hide!

3. Human self-determination

We have seen more natural disasters,
Plants are adjusting their lifestyle set by regulators.
Everyone should do their duty,
so why do we still find it hard to be adjusters?

……………………………………………………………

Recite in Chinese

1.      Tiān shí yùjǐng 天時預警 (Multiple Alarms from Heaven)

běijí bīngshān liè,

nánduān jī jiàng nán

kuángfēng sī jiànzhú,

shuǐ yān yuè pínfán.

2. Dìqiú de huíyīng大地回應 (The earth responds)

lǜyè bùcí xíng,

cán huáng jù xuěhuā.

Hè hóng fēnbù zhèn,

hélì jié fáng yíng.

3. Rénlèi zìjué  人類自決   Human self-determination

tiānzāi yú shù fān,

zhíwù luàn xìng cán.

Rén rén yí jìnzé,

héyǐ wǒ réng nán.

………………..

2023 天地人     鍾倫納

1. 天時預警

  北極冰山裂, 南端跑道融, 狂風撕建築, 水淹越洪鋒.

2. 大地回應

綠葉不辭行, 殘黃拒雪征. 褐紅分佈陣, 合力結防營.

3. 人類自決

天災逐漸繁, 植物亂興殘. 個個宜擔責, 為何我尚難    .

…………………

Tom Chung, Ph.D., M.Phil., B.S.Sc., is a professor in the Fay W. Boozman College of Public Health.

Tom has also maintained a life-long passion in the study of Chinese history, culture, and poetry. He is one of a few writers who has published in five Chinese societies and diasporas, despite their political differences.

The Poem in English 

green green   green yellow   green green red,          

yellow yellow   green green   green yellow red,        

red red   green green   red yellow green,                   

yellow green   yellow red   green green red.             

Pronunciation in Chinese

lǜ lǜ    lǜ huáng    lǜ lǜ hóng, 

huáng huáng    lǜ lǜ    lǜ huáng hóng,

hóng hóng   lǜ lǜ   hóng huáng lǜ, 

huáng lǜ   huáng hóng   lǜlǜ hóng. 

The Poem in Chinese

 綠綠綠黃綠綠紅、         

 黃黃綠綠綠黃紅、            

 紅紅綠綠紅黃綠、     

 黃綠黃紅綠綠紅.

Note*:  I was rushing through the New England highways, passing by shades of colors the foliage threw onto me.  I sometimes just felt the reds and yellows randomly cutting through the greens, but without thinking, without appreciation, without judgment. If I had some intention to interpret them, perhaps I could come up with certain meanings. I am sure that there are lots of people who want to and can find more meanings than those who try to interpret Impressionist Art, more meanings than a psychiatrist who meets a patient for the first time. 

Individual patient’s and significant others’ feelings have long been a key concern in psychiatry.  In public health research, there is an increasing emphasis on community participation research, which hopes to promote all stakeholders’ perspectives. This poem reports that a person may not have any perspective, any meaning, or even any feeling about certain things about everything at least some of the time.   

I ended up writing a poem to record such an experience. It is a new kind of poem that helps people share such impressions. This poem emphasizes a rough, ambiguous impression of three groups of colors: green, yellow, and red, while discarding the shapes within each. I am going to mix all these shades randomly into an impression of only three colors which reflects a state of mind free of meaning, free of feelings, free of intentions. As such, this poem must violate two major conventions of literature – by filling the whole piece with only three words, and all of them are adjectives, no noun, not even adverb.

Note**:  The closest format that helps me prune such an experience into a literary style is probably the Classical Chinese seven-character-in-four-line-poem. It fits the random line-up of short rows of colors along the highway, and I can still insert its rigid rhythm pattern that can be recited with a music-like sound effect. The carefully arranged framework enhances the rhythm effect of the whole poem (Try reciting this poem in Chinese, as shown in the block of Pronunciation in Chinese located next to the English version). Such a rhyming convention has been a key reason for the popularity of Classical Chinese Poems. It helps the spreading of messages. Over the last 3,000 years, millions of Chinese in each generation have been able to remember and recite at least a few of such poems, illiterates included. In addition to using only three characters to fill up all 28 slots, I have also to violate one more requirement of such convention – that there should be no more than one or sometimes two identical characters in a poem, especially not in the same line.  

Note***: Most Classical Chinese Poems require structured rhyming in every line and every location in a line.  While certain locations allow for flexibility, the last character in at least half of lines must come from one of several dozens of groups of tones. 

There are roughly two types of tones: Flat (F) and Ramp (R) tones. The location of each character must follow a certain pattern, unless either F or R is allowed (X). There are several sub-groups of the Classical 4 x 7 style poems, depending on the pattern of location of the tones. The version of this poem follows this pattern: 

X R X F X R F,

X F X R X F F,

X F X R X F R,

X R X F X R F.

Tom Chung, Ph.D., M.Phil., B.S.Sc., is a professor in the Fay W. Boozman College of Public Health. He has also maintained a life-long passion in the study of Chinese history, culture, and poetry. He is one of a few writers who has published in five Chinese societies and diasporas, despite their political differences.

By Kacee J. Daniels

Pain lives in both misery and joy, respectively
it is the volume and projection that differs among them.

… at least that is what they tell me; I believe it.
It is my existence. I know no other way.

Force feeding me a game that destroys me by design
I swallow every bite and ask for more.

Blood drips from my lips–the glass shards.
I love them. 
At least I know the infliction to come when I see them glisten on the fork.
I love them. I really do. I must. I love them. 

Consuming them satisfies the sovereign, 
Who am I to disappoint?
So I crave them, and I ask for more…

Explanation:

This poem sheds light on the experience of a young black male who has learned to convert the conformity, discomfort, and pain required to become successful in a world not made for him into something digestible. As twisted as it sounds, he has convinced himself that he enjoys the very things that inflict harm to him internally. That young black male is the author, me — Kacee.  

Misery and Joy: Double Consciousness in American Medicine

Commentary by Billy Thomas, M.D.

Kacee Daniel’s Pain Lives in Both Misery and Joy reminds me of the concept of “Double Consciousness,” first presented by W.E.B. Du Bois. It is evidenced in the lines “Force feeding me a game that destroys me by design, I swallow every bite and ask for more.”

In 1903, during the post-Reconstruction period and more than four decades after the passage of the 13th Amendment, W.E.B. Du Bois introduced the term “double consciousness” to describe the internal conflict that existed in newly freed enslaved Black persons as they struggled to survive and assimilate into an environment dominated by a white majority. Du Bois states: “One ever feels his twoness – an America, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose dogged strength alone keeps it from being torn asunder.” These two warring ideals—to either join mainstream society or to reject it and define the world and relate it entirely from a Black perspective—are at the core of double consciousness, resulting in a struggle to establish one’s identity (Du Bois, 1903; Bonner, 2006). Black Americans lived in two worlds: one composed of like individuals who shared ancestry, culture, religion, values, and experiences and another world dominated by a white majority and a culture in which there were very few shared experiences, ancestry, or values—namely, a world in which Black Americans were not considered truly human, only property. In order to survive, formerly enslaved people found themselves in a position in which they had to conform and assimilate into a white society. In order to assimilate and progress socioeconomically, Black Americans were forced to take on the values, manners, ideologies, and the religion of a people that were foreign to them and, according to the ruling majority, pre-ordained as the only true human beings, creating an aspirational level or standard of humankind to be achieved by Black Americans. As is the case with many minority populations, this overwhelming internal struggle may give way to the adoption of the dominant group’s values and ideals, resulting in the dilution or even the erasure of the minority group’s values and structure—in this case Black Americans—leading to the loss of personal and group identity.

How does one make the transition to fit into a social structure that historically has been discriminatory, polarizing, and abrasive to individuals who are different from the dominant group? Black Americans were torn between trying to retain their true heritage, culture, and values as human beings (i.e., personal and group identity) and conforming to a system that demanded shedding all that was representative of their personal identity and culture in favor of adopting ways of life and thinking that were foreign to them and based on the norms, values, religion, and ideologies of a white majority.

In many ways the poem highlights the ongoing inner struggles of coming to grips with one’s efforts to become part of a culture and educational environment in which minority and marginalized people have historically been less valued. It is about retaining one’s personal identity in an ongoing struggle to assimilate and progress through an educational system and a society that was developed by and in many ways favors the dominant majority. It is about the day to day pain and exhaustion of attempting assimilation and navigation of social structures and educational systems along with the ongoing struggle to find one’s personal identity in a political, economic, and educational landscape normalized to the dominant majority. It is about an ongoing quest for knowledge and assimilation at the risk of losing one’s self.

Double consciousness is not unique to Black people and applies to any minority group of people who seek to integrate and assimilate into a large homogeneous majority population. It likewise applies to the large number of people who have immigrated to this country from around the globe. In many cases the difference in the level of assimilation has been determined by skin color as a proxy for race. The very visual evidence of skin color has been used to deny access at multiple levels. Although this affects all people of color, its overall impact is more pronounced on Black Americans whose ancestors were bought and sold as slaves and whose basic make-up has been shaped by generations of enslavement, discrimination, and marginalization. The result is a deep internal conflict with one’s self and a continuing struggle to overcome the internal racism, low self-esteem, and loss of self-created by systemic racism. Perhaps the best illustration of internal racism, the lack of identity, and the feeling of inferiority produced by racism is a series of experiments conducted by Drs. Kenneth and Mamie Clark in the 1940s in which Black children between the ages of 3 and 7 were asked to identify the race of dolls and which dolls they preferred. A majority of the children preferred the white doll and assigned positive characteristics to it. The study concluded that prejudice, discrimination, and segregation created a feeling of inferiority among Black children and damaged their self-esteem, resulting in a loss of self-identity and creating what we now consider internalized racism (Jones, 2000; Clark & Clark, 1939; Green, 1997).

Researchers have applied the term “toxic stress” to the effects of persistent adverse life circumstances—such as racism, discrimination, and poverty—that may influence the genetic predispositions that affect an individual’s emerging brain architecture and long-term health. Toxic stress has been shown to have a pronounced effect on those areas of the developing fetal brain that primarily function in our critical thinking, behavioral responses, cognition, linguistics, and ability to respond to stressful situations (Shonkoff J P, 2012). Long-term effects have been shown to be intergenerational. Historically, Black Americans are the descendants of a population that was subjected to an environment and culture of constant stress and fear of being beaten, killed or lynched, and sold at the whim of their owner (Blight, 2011). Along with the unmeasurable trauma of separation of families, this produced a level of chronic toxic stress that may manifest itself as both implicit and explicit changes in behavior, critical thinking, and ambiguity about one’s true identity. These long-term changes could serve as defense mechanisms and operate at the core of double consciousness. Black Americans continue to conform in an attempt to assimilate into a majority world that, in many cases, continues to be unfair and marginalizing. As our understanding of the long-term biological effects of toxic stress improves, we may be able to identify an unconscious and biological basis for double consciousness.

While double consciousness maybe the internal manifestation of biological processes (i.e., epigenetic) that have become deeply engrained in Black Americans and profoundly affects critical thinking and behavior, code switching may be considered the superficial manifestation of double consciousness. It can be unconscious or deliberate, and it may play a significant role in our daily behavior and activity. The foundation of code switching is based on linguistics (or language variations) and situational behavioral changes during social interactions (McCluney et. al, 2019; Nilep, 2006). Code switching is ubiquitous throughout society, more specifically in minority communities, and is a conscious effort to fit in or conform. It is controlled and applied at will and is readily used to fit into daily interactions, events, and environments. Although superficial, it creates a baseline level of chronic stress.

As long as there are dominant and subordinate groups, remnants of double consciousness will remain. Our goal should be to look at double consciousness from a historical perspective and try to understand its manifestations in Black, Indigenous, and People of Color (BIPOC). In order to do this, we must first try to understand the mitigating circumstances of slavery, segregation, institutional racism, and their generational effects on Black and White Americans in creating dominant and subordinate classes based on race. We must realize and take ownership of past wrongs and move to change. In order to move forward, the possible origins and realities of double consciousness must be recognized, put in context, and applied to our current state of racial tension. How did we get here?

Behavior is not fixed (nature) and is influenced a great deal by the surrounding environment (nurture) (Jones, 2000). Individuals and populations exposed to continuous toxic stress develop specific responses that can be heavily influenced by their support systems—such as families, communities, religious leaders, teachers, health care providers, and mentors—resulting in an increased awareness and understanding of existing social structures along with the development of skill sets that allow individuals to overcome social barriers and progress in a majority-dominated world. (Hughes, 2006). As is the case with many minority and marginalized groups, BIPOC must strive to overcome the barrier of double consciousness in order to find a place in which the very soul is at peace, where self-worth overrides external factors that could create barriers to attaining consciousness of self, development of personal and professional identity and fulfillment.

The intent of this commentary is to increase awareness, educate and promote change. As an African American male who has spent an entire career in academic medicine I’m very aware of and have experienced the external barriers and internal struggles that result from assimilation into an educational environment with very few or no minorities. I’m also the product of a segregated, and later, integrated public school system. Neither of these facts makes me an expert on poetry or an authority on the genesis, biological basis, and reality of double consciousness, but as one with a lived experience that encompasses many of the conflicts highlighted in the poem, it does give me a very unique perspective and insight surrounding the behaviors, perceptions, and perhaps critical thinking of students and faculty of color as they seek to become part of the medical community. Over the years my role as a faculty member as evolved from one as primarily a clinician and researcher to one as a teacher, advisor, mentor and coach. As a faculty member part of my responsibility (duty) is to share my perspectives and past experiences and possibly give meaning and basis for the feelings of isolation and ambiguity experienced by many students and faculty as they struggle to find themselves and develop their personal and professional identity. This has given me the opportunity, privilege and honor to be involved in the personal and professional lives of multiple students and faculty. Needless to say, it has shaped me personally and professionally.

Lastly, and maybe more importantly, the poem highlights the value and critical need of an institutional awareness and culture along with transitional programs and support systems that serve to mitigate the experiences of minority students and faculty as they adapt and maneuver through an academic environment that may not be inclusive and nurturing. In spite of what may seem an overwhelming struggle, I remain optimistic as local and national health professions institutions continue their efforts to address the lack of diversity in medicine through the creation of leadership positions in diversity, equity and inclusion and organizations like the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education continue to institute policies and provide guidelines and strategies that seek to increase diversity and ultimately change the culture of medicine (Association of American of Medical Colleges, 2020).

Notes

• Association of American Medical Colleges. Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments. Academic Medicine. December 2020 Supplement, Volume 95, Number 12. S1 – S177.
• Blight D W. Race and Reunion: The Civil War in American memory. The Belknap Press of Harvard University Press. Cambridge Massachusetts, and London England. 2001.
• Bonner F A II. The Temple of My Unfamiliar. In Faculty of Color. Teaching in Predominately White Colleges and Universities. Staley CA, ed. Anker Publishing Company, Chapter 6, pp – 80-99, 2006.
• Clark K B and Clark M K. The Development of Consciousness of Self and the Emergence of Racial Identification in Negro Preschool Children. The Journal of Social Psychology Volume 10, 1939, issue 4. 591-599. https://doi.org/10.1080/00224545.1939.9713394
• Du Bois W.E.B. The Souls of Black Folk. Penguin Books, 1903.
• Green C D. Classics in the History of Psychology. Clark K B, Clark M K. The Development of Consciousness of Self and the Emergence of Racial Identification in Negro Preschool Children. Journal of Social Psychology Bulletin 10 591-599. https://psychclassics.yorku.ca/Clark/Self-cons/
• Hughes D et. al. Parents’ Ethnic–Racial Socialization Practices: A Review of Research and Directions for Future Study. Developmental Psychology. 2006, Vol. 42, No. 5, 747–770
• Jones C P. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000 August; 90(8): 1212–1215. PMCID: PMC1446334
• McCluney CL, Robotham K, Lee S, Smith R and Durkee M. The Cost of Code Switching The Big Idea Series/Advancing Black Leaders. Harvard Business Review. November 15, 2019. https://hbr.org/2019/11/the-costs-of-codeswitching
• Nilep C. “Code Switching” in Sociocultural Linguistics. Colorado Research in Linguistics, Volume 19 (2006). https://scholar.colorado.edu/cril/vol19/iss1/1
  DOI: https://doi.org/10.25810/hnq4-jv62
• Shonkoff JP, Leveraging the biology of adversity to address the roots of disparities in health and development. PNAS, 17302-17307, October 16, 2012, vol. 109, suppl 2. www.pnas.org/cgi/doi/10.1073/pnas.1121259109