The 2nd annual Yeo Writing Prize Prompt:

This year’s theme is centered on the gun violence epidemic. To quote poet, Amanda Gorman, “Maybe everything hurts. Our hearts are shadowed and strange. But only when everything hurts may everything change.” Gun violence in all sectors of American society continues to be a major public health concern. Many of us have either been touched by gun violence or know someone who has been. While there are many opinions on this issue, we all can agree that gun-related violence affects physical and mental health and must be reduced.

Tell us your story of gun violence. Using the following prompts or come up with your own approach to the topic:

-Share a story about how a situation of gun violence affects/effected you.

-Many people in our communities and even some people we know own guns. Share a story as to why someone in your community or someone you know owns a gun.

-Imagine you are writing a letter to a government official to win funding for a major grant to reduce gun violence. What story would you tell them?

First Place 2022

It was only one bullet | Mark Chilutti, Ast VP development, Magee Rehab

For almost three years, I used to park my car every morning and walk around the corner to my jewelry store looking forward to a day of helping people with meaningful purchases, andproviding the best customer service that I could. It was a daily routine, done six days a week, and one that I had worked towards for a long time. I never imagined that when I walked around the corner to my store on December 5, 1996,that it would be the last day that I would ever walk again. With the holiday season in full swing, it was a busy morning, and I finally got to take a quick break around 11:30. I sat down to rest and quickly finished my breakfast. A few minutes later the door opened and a man walked in. I greeted him as I would every other customer, saying, “hi, how are you?” He didn’t answer. The man behind him quickly pulled a gun and pointed it right at me. Having spent 9 years in the retail jewelry business (the first six years working for others), and being an Eagle Scout, I was always taught to be prepared, and take the best precautions that I could, knowing something like this could happen one day. I quickly threw my arms in the air while saying “please, take whatever you want. Just don’t hurt me.” As scared as I was, I knew that everything in that store could be replaced; everything except for me. I was hoping that my willingness to cooperate would work. It did for a few minutes. The guy with the gun took me to the back of the store, keeping his gun pointed at me, while he took jewelry and cash out of the safe. He also started taking the jewelry that I was wearing, while he gave orders to the guy who came into the store with him. “Tape him up. Tie him up. Break the cases and take the jewelry,” he yelled. Surprisingly, each of these commands was met with “I’m not going to do that.” These answers seemed to anger him, and, at that point, he turned around and shot me. For the next several minutes I laid on the ground, while I heard him go to the front of the store and break a few cases, take some jewelry, and eventually leave. I was bleeding, but was awake, alive, and conscious. I tried to get up, and I couldn’t. It was at that point that I knew something was wrong with my body. Rather than lay still, I managed to pull myself into the next room, and pulled a panic button to alert the police that I was in trouble. I stayed there, yelling for help, while the waiting began. It seemed like forever, but, in reality, it was only about a minute or two until I heard a familiar voice. It was Charlie, the bike cop, who routinely patrolled the avenue.

Mark, are you okay,” he asked. “No. I got shot,” I responded.

It was only one bullet, but, as I would learn later, it went in my chest, in and out of my lungs, and severed my spinal cord, leaving me paralyzed from the chest down.

More police officers started to arrive, and they made a quick decision to safely load me into police car and transport me to Nazareth Hospital. I was alert and conscious for the ride and was able to provide them with a description of the guys, and also told them the robbery was captured on video, which, in 1996, was not as common as it is today. remember getting to Nazareth and being rushed from the police car into a noisy room. I was still alert until they inserted a chest tube into me. Shortly after that, I got my first helicopter ride, as I was flown to Thomas Jefferson University Hospital. Meanwhile, back on Frankford Avenue, the neighborhood was in shock. Things like this just did not happen often, especially to nice guys. Officer Charlie knew that my brother was also a cop and had someone contact him. I have three brothers and two sisters, and they all started to receive the news. My brother Keith was the one who had the tough assignment of finding my parents at their weekly senior citizens meeting at church and telling them that their son got shot, and, contrary to what they would have guessed, it was not one of the two who were police officers; it was the jeweler. woke up around 8:30 that night after successful surgery, surrounded by my family. Nobody had to tell me that I wouldn’t be able to walk again, as I had already figured that out. The good news is that I was alive. I was lucky. I know it sounds odd that after getting shot and losing the feeling and control of over 70% of my body that I could feel lucky, but I did then, and I still do now; over 25 years later. After two weeks as Jefferson, I was transferred to this magical place on the corner of 16th and Race Streets called Magee Rehabilitation Hospital. It was there that I would learn how to begin to live a meaningful life in a wheelchair. I was 28 at the time and knew that life had too much in store for me to give up. After six weeks at Magee, I was finally able to go home, though I continued outpatient therapy for several months. I could write you a book on all of the good things that have happened in the 25+ years since that bullet changed my life, but, for the sake of this essay, I will just share a few of the highlights:

·       I started driving again less than a year later, in a car equipped with hand controls that was purchased by friends and members of the community

·       I began working at Magee Rehabilitation Hospital in 2001, and since then our team has raised over $40 million to improve the quality of life of people who, like me, have had their lives turned upside down in an instant

·       I got married in 2003 and, together, we have traveled the world

·       I played wheelchair tennis and won 2 national championships in my division

·       I continue my involvement in the Boy Scouts of America, working hard to mentor and impact the lives of young people

·       Finally, the best benefit of working at Magee is that I can be a real-life example of someone who had something terrible happen to them but could find a way to make something positive out of it.

One important detail that I saved for the end is that I had a license to carry a gun, was properly trained, and, had a gun hidden under my vest the whole time. However, with his gun always pointed right at my chest that did not really matter. This disproves the idea that if more people had guns they could better protect themselves. Even though I might make living with a spinal cord injury look easy, I sincerely hope there will come a day when this senseless violence will end. I got shot, but it affected so many others too.

I am a lucky man, as I lived to tell you this story. Too many people do not have that chance. For that, I am eternally grateful.

Second place 2022

The Last Shot | Keyur Patel MD, PGY-5, Department of Surgery

The loudest moment of the night was not the police sirens or the clangs of instrument trays opening. Not the cries for blood and supplies. Not the heroic effort to save a life. Not even the shots that were fired. It was the silence. The silence after the pronouncement of death. The acknowledgement of life lost.

 I met you minutes before you were dead. With no warning, the police pulled up in an SUV. I was told signs of life. Life but fleeting. I went outside to find you. There, in the back of the SUV, you were covered in your own blood. Dried. But breathing. Chaos ensued as we brought you from your world to ours. Into the operating room. We did the dance. You were intubated and breathed for. You were coded. Your chest was opened. Your heart was beat for you. All your visceral organs were starved of blood as we tried to get your heart and brain perfused. We said we’d deal with the consequences later. We tried to identify holes and trajectories to put together this puzzle that was you. But it didn’t work. We couldn’t catch up to your injury. We had lost too much blood that your heart did not know what to do with itself. Each piece of you that we found missing was more and more vital. Even finding a bullet wouldn’t do us any good. We couldn’t solve you.

 So began the mutters. Whispers of what to do, if there was anything to do. Words almost reached our lips that we dreaded to say. I spoke up. Recounted our story of how we met and where we’d gone. How I’d gotten to know you, organ by organ. Then I asked if there were any objections to ending this story. So, with that most difficult of three-word phrases, “Time of death….”, it was closed. That was the pang. The rub. The silence. You felt heart rates slow down. You heard the dust settle. The previous cacophony of sounds finally reverberated out of the operating room. And I looked down at a life that once was. You were a task before. A victim of a gunshot wound. A set of tried and tested steps against hurdles to save your life. But you died as a person. The moment ended and slowly, the room emptied. The machines were turned off. The tools were packaged up. And so were you. The silence that encircled you so profoundly was lost once again to the orchestra of the hospital.

 I talk as if I knew you. But you were forced on me. Through senseless violence of metal slugs against human tissue. Metal often wins against man, but sometimes we like to think we can defeat the odds. And we do. But you, like so many others, didn’t deserve to die. So that moment of silence after you bowed out, it wasn’t only for you. It was for each person that has died alone, without an audience to care. It was for me, so I could find the composure to keep going because the next one was not too far away.

Second place 2022

One Surgeon’s Story of Gun Violence | Adam Frank MD, Department of Surgery

The consequences of gun violence are abhorred universally, but for the surgical trainee the benefits to training are also a reality of these cases.  Aggressive surgical action was highly encouraged in my residency.   The trauma bay was an area where large central lines, chest tubes, cricothyrotomies, and emergency anterior thoracotomies were performed.  It is in this context that I will relay the story of a gunshot victim that I encountered as I finished my fourth clinical year.

It was a hot early Sunday afternoon between Mother’s Day and Father’s Day in 1999.    I was in charge, being the most senior surgical person present in the Trauma Bay as the patient arrived.  I think back now and suspect that I was full of bravado.  I thought I had seen a lot.   By that time, I had accumulated a few saves for which I took genuine credit.  As the patient rolled in, I thought I was going to be the hero again.  I was wrong.  I did have attending back up, and I know he came in, but it would be after all that could be done, had been done.  The time constraints were just too short as my patient really didn’t have a golden hour left.

The African American teenager was still talking on arrival, but he was super scared.  He knew he was in trouble.  I didn’t get much of a story from him; that would come later.  He had on nice clothes, and I distinctly remember a nurse in the bay being concerned about properly protecting a stylish, simple gold chain with a cross he wore around his neck.  I remember that he struggled to follow an early request to lie down.  We knew that he had been shot in his left chest.  I saw the centimeter sized hole in his left mid axillary line at around the fifth rib level.  It was not an easy wound to spot considering the activity in the bay.  Even if he couldn’t lie down, everyone else in the bay was doing their job.  A seasoned nurse was picking a target for a 14 gauge IV.  The anesthesia resident was already present and setting up and the ER physicians were also helping.  I had a second surgical resident with me, and I distinctly remember a female ER resident, two years junior to me who had rotated with me on trauma when I was a PGY 3 and she a PGY1.  I knew her to be conscientious.  She knew how the trauma team functioned and knew the hierarchy.   I had good help, but that wouldn’t change things.  Our patient tried to help too, but some things just weren’t going to go right.  He suddenly vomited, involuntarily creating a mess that had to be addressed at least in some manner.  We got him to lie down and soon we had his airway secure.  But, as soon as one thing was achieved, something else went awry.   His first recorded blood pressure had been normal, now it vanished.  I could not feel a pulse anywhere.  Everything seemed to happen faster than it should. 

I knew that the next step in his management required me to transition from being a team leader to performing an emergency anterior thoracotomy.  We had our roles, and that was mine.  I can save him, I remember thinking.  We had seen his whole body by now and he definitely had come in alive and all that was visible was that small wound on lateral left chest.  It seemed so small.  “I can fix this!” I thought.  “With that small a wound, perhaps he just has tamponade, and then when that’s relieved, we will get him back!” I proceeded with the well-versed physical steps of a procedure that I had probably done ten or so times previously.  Soon, I was in his left chest.  A moment later, the descending aorta was clamped.  And then I opened the pericardium which was bulging.  “Don’t hit the phrenic!” I thought.  But it wouldn’t have mattered.  So much blood!! The hole in his skin was so small.  How could there be so much bleeding!  We had good intravenous access, and the blood was running in.  But the blood was coming out so much faster.  I extended the thoracotomy to the right fracturing his sternum.  Suction was there, I had help, but it didn’t matter.  I was too slow, I couldn’t find the bleeding and his life literally raced around my fingers pouring out of his heart as I desperately lifted it praying that I could find the wound.  Almost immediately, his heart had no fill.  The blood darkened and then darkened further yet still and then it even slowed down as my inadequacy became more and more evident.  I could not figure out where the blood was coming from other than from the back of his heart.  After some time, I looked up and saw the ER resident who was still valiantly trying to clear the field with suction, crying.  Her disappointment in our failure was so apparent and so painful.  We desperately continued to search for the bleeding source but by now it became so much less meaningful.  As his blood passed out of his body so did his life.   He was dead.  I finally found the injury, but by the time I did, it was pathetically academic.  In fact, I truly remember today, two decades later, how the blood welled up frustratingly around my hands, as I searched frantically for the wound on his posterior heart, when he still had a chance to live.  But I have no recollection of seeing the actual cardiac wound, even though I know I saw it, in likely a near bloodless field.  I closed him for the coroner, but I don’t remember doing that either.  I know that I did speak to his poor parents with my attending.  But, I do not remember their faces. I am pretty sure that is the result of ingrained defense mechanisms against the incredible pain of loss they experienced. 

Soon, I heard the preamble behind his shooting.  It made me want to puke just like he had.   He had gone to church services with his parents dressed appropriately for the occasion.  Services finished and they went to lunch together at a nearby restaurant.  There, two other young men unknown to our patient, decided to resolve their argument with guns and our patient, an innocent bystander, got hit by a stray bullet.  A bullet that bested the team and me, even though he had come to the ER talking!  He was an honors student and a good athlete.  He had a very promising future which was abruptly cut short on that warm Sunday afternoon.

I can not envision walking in his grieving parents’ shoes.  The moment I truly try to enter their pain, I skirt it, and hide emotionally.  Oh, how unfair, and how wasteful.  How can this be endured?  Today, it is the reality for more than a few parents.  This is not part of the natural order of things. It is unbearable and unjust. We are obligated to do something, anything to lessen the chances of this happening again.   

Third place 2022

One Lucky Day | Margaret Kreher MD, Department of Family and Community Medicine, Division of Geriatrics and Palliative Care

“Excuse me, do you know what time it is?”  My back stiffened. I knew he didn’t want to know the time.  It had been a long day of office hours and hospital rounding.  I was still adjusting to the pace of work after the birth of my third child.  I was feeling guilty about being late getting home.  It was closing in on 8:00 PM the end of hospital visiting hours. 

I gripped the car keys in my hand.  A large red pickup truck with fat muddy tires was parked next to my car and blocked the full view of me from the sidewalk and street.  I turned around to see a young man with baggy shirt and shorts standing between the back of the truck and the back of my car.  He pulled a gun from his belt and pointed it at my abdomen.  My throat became instantly dry, I opened my mouth, but I could make no sound. 

I was at once both participant and observer.  All surroundings were in hyper focus.  He was talking to me, I was meeting his gaze.  He had a soft hairless face and doe-like eyes.   I was struck by how young he was.  I opened my bag.  It contained billing cards, a diaper, wipes, a lollipop and no money.  I meekly offered my credit cards.  He didn’t want them.  He was talking with anger.  I tried to listen to what he was saying but I was seeing and hearing everything around me with intense, loud clarity.  I could see over the truck bed. Visitors were leaving the hospital and going to their cars across the street.  I could not speak and no one looked my way.  I watched as an elderly woman folded a walker and put it in the trunk of her car.  She got in her car and drove away.  It was a normal evening at the hospital. 

He looked into my car.  I thought maybe he can’t drive a stick shift. I kept trying to look into his eyes still unable to speak.  If he shot me it would be messy I thought because I would be injured in my abdomen.  How long would I lie there between the parked vehicles before someone found me?  I would surely die there unnoticed.  I heard a voice saying, ‘let him get out of this’.  I sensed his hesitation.  He tucked the gun back into his belt.  He turned, walked away, picked up a bicycle that was leaning on a fence nearby and rode off.  Stunned, I took a breath unlocked my car and got in.  I put the keys in the ignition, but then I saw him.  He was on his bike and had pulled up to the driver’s side.  The truck was still blocking the view to the street.  Now I was fully out of view.  I thought I am to be killed in the driver’s seat!   I could not pull forward because a light pole was in front of me.  I would have to start the car and put it in gear to back up.  Too much time I thought to escape safely without being shot.  I heard myself say in a high pitched unrecognizable whisper, “God help me!”   He held out his right hand, there was no gun in it.  He said, “open the window.”   He pulled the gun with his right hand I thought, if he used his left hand to shoot maybe he’d miss.  I opened the window.  “I want to shake your hand,” he said.   I shook his hand.  He pedaled off. 

The city police visited my office the next day. By that time, I had decided my gunman was a boy, an adolescent.  I concluded that he had not been angry enough and chose not to harm.  Still, I wonder to this day why he did not shoot. Why was I so lucky to escape injury or death?  Was it because the car was a stick shift and he couldn’t drive it?  Was it because he saw my sheer terror, felt empathy and thought twice?  I thought for a long time that it was the latter. 

I am anxious. 

The Uvalde and South Street shootings have brought my memory of that long ago parking lot encounter back to my mind.    I tell my adult children to avoid crowds when going out.  The shootings were too casual and easy.  A teenager killed children.  He chose the school randomly and chose the most defenseless.  Teenagers may have randomly inflicted the most harm on South Street.  On South Street the lack of humanity and empathy can be seen on security cameras.  The shooters randomly shot into the running crowd.  They didn’t hesitate. They looked no one in the eye.   

I am angry.   

Why are there rules for driving a car and rules about who can legally buy and imbibe alcohol?  Usually we drive a car and drink alcohol without the intent to cause harm.  The only reason a gun exists is for harm whether it’s self-defense, putting meat on the table or sport.  Why are they so easily available, why are they designed to make it easy to kill so many at once? Why are there no rules to mitigate harm in any meaningful way?  Why are we hostage to the thinking and needs of the 18th century?  They were using flintlock weapons.  Is it the price we pay for our freedom to bear arms?  Yet, we are terrorized by the proliferation of random mass casualty events.  The people out enjoying an early summer evening, the children going to school all thought they had the freedom to do so safely.  Whose freedom are we talking about? Is it kill or be killed?  More guns do not make our lives safer.  

While families grieve we should commit to getting back the freedom to enjoy the normal things adults and children do to socialize, to learn, to participate in the community and to be good productive citizens.  We need to look deeply into the myriad of social, psychological, political and ideological problems that have put weapons of mass destruction in the hands of humans who lack the capacity demonstrate the maturity, empathy and humanity to responsibly bear arms.   

We can’t depend upon luck like mine.  The luck that a boy will make eye contact, hesitate, think twice and put his gun away before causing harm.  

 The First Annual Yeos Writing Prize Prompt:

BE A VOICE OF HISTORY. Imagine we’re creating a time capsule to be laid in the foundation of one of our new Jefferson buildings and to be opened 100 years from now, in 2121. Reflecting on the past year, what personal story would you put into the time capsule for future generations?

From a global pandemic to a national reckoning on racial equality, the past year has presented us with overwhelming and sometimes painful challenges and forced us to live our days in new ways. Each of us has experienced a range of emotions, suffered losses, and had a lot of time to consider what really matters.

Questions to consider: Use any or none of these prompts to inspire your story.

·      What things did you do to adapt to the changes of the past year?

·      What new strengths did you discover about yourself or others?

·      How did a personal sadness or loss lead you to a new level of understanding about yourself or others?

·      How did you see people rise to the occasion to meet the challenges of the moment?

·      What brought you joy during this past year?

·      How did you see people help each other get through and heal?

·      What did you do to heal yourself?

·      How did your relationship to the communities in which you are a part of change or grow?

·      Describe an act of extraordinary kindness or selflessness that you witnessed and explain why it was important.

 First Place 2021

June | David Peters, MD (Resident Physician, Department of Family and Community Medicine)

I was looking intently at a sandwich tray when I broke down in tears. The platter was centered on a timeworn table with a faded-pink laminate top, within a windowless locker room repurposed as a provider breakroom. The tray had arrived earlier that day, much to the delight of the ICU staff. I, in contrast, had spent much of the day trying to avoid it. My aversion to this tray was not because of anything I had against Primo Hoagies, but because it had been sent in by Bill’s family. I had spoken on the phone with Bill’s wife and son every afternoon since he had entered the Methodist ICU in respiratory distress the week prior, each call meeting their sense of optimism that he might wean off of the ventilator with discouraging news and regrettably reminding them of the COVID-19 visitor restrictions that prevented them from coming in to see him. Staring at the sandwiches, all neatly arranged in tiers of concentric circles, I envisioned Bill’s family; his wife, his siblings, his children, and his grandchildren – sitting around the living room together and sharing hopeful words through their masks. I imagined their mental picture of him: weathering the storm by himself but surrounded by attentive doctors and nurses. Though they knew he was unconscious, I wondered if they could still feel him reaching out for them. The sandwich tray was their refusal to be denied entrance into the ICU. It was both an expression of gratitude for his team and an assertion of love to revitalize Bill in his battle. Perhaps it would give him the warmth that was missing in their absence. I started sobbing, suddenly shivering with icy apprehension that I would soon tell them that he suffered a massive stroke overnight and would have no chance at recovery. I felt the sound of his son’s voice quivering over the phone burrow deep inside of me, nesting in the new space where more somber patient memories would soon dwell.  

Intern year crawled along, and I watched more people labor through their last breaths alone. These were sobering moments that I struggled to exhale. I could not wholly express them to my partner, family, or friends, separated 300 miles apart from them. My smile withered without their laughter. My feet numbed to the once soothing feeling of my socks pressing on the creaky wooden floor of my apartment. The jovial relationships I had envisioned sharing with co-residents and hospital staff were replaced with transactional conversations held behind masks, face shields, and phone screens. Escaping for a few minutes to the top floor of the hospital where I could silo myself inside of a call room was freeing. Alone, I could feel my lungs scrape my chest as they filled with air and hear the hum of the nearby generator whispering to me while I lay face down in the call room bed, embracing a pillow. I was nothing but a keyboard and a mouse. I was just white noise walking through the hallway.  

“Let me see you without your mask,” she pleaded. I lowered my mask. “Oh! you are going to make such beautiful babies,” she said. I blushed. Her comment surprised me. It was funny and colorful, gleaming through the silt of a series of identical, dispiriting days. To June, a 67-year-old woman with newly diagnosed pancreatic adenocarcinoma, I was transparent. She knew that I did not understand the complexities of her condition well, and that the vague updates I gave her each day collectively implied her bleak prognosis. Confronting her mortality over the course of her admission was as unpredictable as it was painful for her, an oscillation between emotional extremes, an avalanche to endure without a soul to receive her rescue signal. Her abdomen seared from within. Her red, sunken eyes echoed a depth of suffering beyond what I could conceive. But, through the scrap heap of my annotated handoffs and used gowns, she found something to hold on to, something from which I too had become estranged: me. She actually appreciated my clinical inexperience and my innocence. I did not have much to say as an intern, but I was someone who could listen, a friend unbound by the COVID visitor restrictions. My visits with her gradually became less medical. At times it seemed as if we were just sipping coffee together, taking time to show each other pictures from our lives beyond the four walls of her patient room on 7 West. With each passing day, I watched a stack of envelopes on June’s bedside table grow. The return labels held the names of her children, grandchildren, friends, and members of her church community. I asked her why she had not yet opened them one morning, to which she calmly replied, “I’m not ready yet.” I was immediately struck by this, for this statement was not a denial of her illness, but rather an acceptance of her mortality. She knew that she would never get to physically see most of her family ever again as a result of the pandemic. Those letters, thus, contained their presence, and would serve to stand in for the goodbyes that she would never get. They were the light to guide her through her last day of life. The letters were her sandwich tray. June died on the first day after she was discharged to inpatient hospice. I do not know how she spent her last day, but I like to imagine that she opened those letters, and one by one felt the warm touch of all the people whom she loved. I often reflect on that time I spent with her, and I wish that she could read the letter that I would write to her now.  

Dear June,  

You told me once to not see you as the person who was sick and dying in the hospital. You wanted me to see you the way you lived your days before those final three weeks. You showed me a picture of you with your family, dressed up and standing in a parking lot, with an ear-to-ear smile, your arms around your grandchildren. You showed me a picture of the sun setting from the view of your living room. You showed me a picture of you drinking a ginger ale. Most of this year, I have felt like I’m not supposed to be here in Philadelphia. I have longed for my family, my friends, and my partner every day. I have felt so alone, hidden behind the mask and the face shield that I wear. I have felt overworked but irrelevant, responsible but unfulfilled, and engaged but hollow. The pictures I shared with you of my life in Boston were how I thought I wanted you to see me, but I changed my mind. Please see me as the young doctor who ran out of answers and just sat beside you. Please see me as the friend whose hand held yours when morphine could not alleviate your pain. Please see me as the broken person that was revived when you said, “I love you.” You showed me that there is always light in the darkest of places. You showed me that there is always a path to happiness in the present, even when you run out of tomorrows. I love you too,

Second Place 2021

The Elevator Crisis | Ellen Solomon (4th-year Medical Student, SKMC)

On my first day of third year clerkships, I spent two hours in an elevator. That elevator in June 2020 in the middle of a global pandemic provided the most profound learning experience of my third year of medical school.  

I walked into clinic that morning with my white coat draped over my arm, a symbol of my much-anticipated admittance to the world of hands-on learning. I carried with me, too, the excitement, anxiety, and uncertainty that comes with translating knowledge into practice. I was rotating in a clinic that focused on caring for patients with Intellectual and Developmental Disabilities (IDD). That morning I watched with amazement as my attending cared for her patients and their caregivers in a way that so clearly communicated empathy and understanding of their specific challenges. These challenges were exacerbated by the pandemic; routines were disrupted, day centers were closed down, and caregiver exhaustion was at its peak.  

Around 1pm, my attending and I were called out of a patient room mid-visit with a request for help. We learned that one of the morning patients was refusing to leave the clinic. It caught us by surprise, as this 19-year-old gentleman with autism was remarkably calm, cooperative, and interactive during our visit. Now, in the discharge area, he was hunched over in a chair, hands clenched around a clinic toy, eyes fixed on the floor. It was clear that he had been in this position for nearly an hour. Finally, after thirty minutes of coaxing and help from various team members, his rigid posture relaxed, his furrowed brow softened, and he hesitantly stood from the chair. As we took careful steps towards the elevator, I saw relief bloom on his mother’s face.  

This relief was short-lived. As the patient crossed the threshold of the elevator, his demeanor shifted. In a moment, he was curled in a ball on the floor of the elevator, head in hands, and unwilling to move. We tried everything: toys, snacks, a call from his father, fewer people, more people, a water bottle, his favorite song. He wouldn’t budge. He was frozen in time, scared, beyond our reach.  

An hour later, my patience started wearing thin. The constant, irritating buzz of the elevator, angry that we’d been holding the doors open longer than its programmed time, was a nagging reminder that this moment of crisis defied the limits of any plan, schedule, or timetable. The whispers and glances of curiosity from onlookers frustrated me. The patient’s meltdown was on display while we seemed to be making no progress, adding to my feelings of helplessness. As my mind wandered, I looked to the mother and saw patience, love, and resilience—strength I couldn’t comprehend.  

Ninety minutes later and out of options, we decided to physically remove the patient from the elevator. We knew that the use of force would only escalate his fear and resistance, but there was no alternative. It was physically difficult, as he was a well-built, strong 19-year-old, but even more, it was emotionally jarring. As his mother and a security guard carefully carried him over the elevator threshold, his body tensed and his agitation grew. As he lay on the lobby floor, he grabbed his mother’s shirt, all his fear channeled into his desperate grip, pulling her closer in panic.  

After nearly two hours of patience with no visible frustration, his mother broke down. Bent over his body, her tears flowed onto the son whom she loved but could not rescue from this moment of fear. My face shield began to fog as my eyes teared. I saw the exhaustion on my attending’s face. One of the medical assistants who had been helping for the past hour began to cry, thinking of her own son with autism. The patient’s father soon arrived, having left work to help physically get his son into the car. We could hear the fits of screaming and agitation even from the 2nd-floor clinic. 

I walked into clinic that morning excited to learn, to feel like a doctor, to move towards certainty in diagnosing and treating diseases. In the span a few hours, I felt farther from certainty than ever. I felt like I bore witness to a collision of the pain, uncertainty, and fear of this moment in history with the lives of this patient and his mother.  

The disruption of routines, which everyone felt in the height of COVID-19, is more visceral for those with autism who rely heavily on routines to calm anxiety anxiety. COVID-19 has also exacerbated caretaker burnout as daycares, family members, and other sources of support can’t operate in the ways they normally would. Particularly poignant, in light of George Floyd’s death just a few weeks prior, this moment of crisis could have ended tragically for the patient and his mother, who are Black. George Floyd’s death has brought to front of mind the history of police violence towards Black Americans and the deadly consequences of racist presumptions of danger associated with Black men. It was all too easy to imagine how this patient, agitated and unyielding, could become a victim of police violence. If this same crisis happened in a different location, without the support of the clinic staff and understanding of the context, it could have ended very differently. 

In healthcare, we can’t avoid the messiness of humanity––family stress, broken systems, physical suffering, collective grief, historically-rooted racism, one young man’s meltdown, a mother’s exhaustion. And for all these problems, we don’t have easy answers. The elevator crisis continues to remind me that there are so many problems that a prescription or vaccine can’t fix, no matter how many years of clinical training and experience I complete. 

The elevator crisis also reminds me that as a doctor and as a human being, there is more I can offer when answers and solutions run out. When I think back to the elevator crisis, I remember not the absence of certainty, but the presence of my attending’s compassion that extended far beyond the walls of the exam room, the presence of an interdisciplinary team that dropped everything to respond, and the presence of a mother’s resilience and love for her son.

 Third Place 2021

Being a Black Nurse During Two Pandemics | Chanel Hart, MSN, RN (Clinical Nurse Coordinator, Department of Family and Community Medicine)

Who knew that, in the year 2020, “I can’t breathe” would change the world forever?  At first, it was the cry of the people, mainly African American or Black like me. It was a cry of injustice at the hands of the police but later turned to the cries of the people regardless of race, religion, or sexual orientation. “I can’t breathe” was but an ignored whisper from the lips of George Floyd, but there was no ignoring the screams of “I can’t breathe” that came from the millions of men and women who gasped for air after being infected with COVID-19. In the midst of it all stood me, the black nurse in a predominately white profession who had to help the sick both physically and mentally while being heartbroken at the loss of another black man at the hands of the police.  

I listened to colleagues say, “don’t treat him like a martyr.” Yet, he was not a martyr by choice but a man murdered by chance. His death started a movement that started a rage, that began to burn so hot and so bright that the pandemic of racism that has plagued this country for centuries no longer would be ignored. At the same time, the arrogance of man proved itself again too much and the universe answered in kind. It felt almost biblical. When Mr. Floyd cried out for his mother, every mother cried to the heavens on behalf of their sons. It was like God answered by taking the breaths of so many. I noticed the louder hateful voices rang promoting hate, the louder the cries of “I can’t breathe” rose until you could not decipher whether it was a chant for anti-racism or fear from those afraid to die.  

In the midst of it, all was me, a little black nurse who works in a predominantly white profession, put in a position to educate the oppressors on why their actions are oppressive— while also taking control of the fear to treat the sick that surrounded everyone.  How I did both and kept my sanity still amazes me to this day. Being a nurse during parallel pandemics did not afford me the time to be afraid, but I was. It didn’t allow me to second guess myself, but I did. I was not allowed to show weakness, yet I felt broken every day. It was to the point that I, too, could not breathe. What choice did I have? None––I am a black woman with a son, I am a black nurse in a white world. More importantly, I could change the world if given a chance. So, since no one gave me one, I took one. 

When I had to be a nurse, I gave 100%. I treated my patients with respect and dignity. It did not matter whether they tested positive or negative, they were afraid and my job was to be there for them. I listened to the fear, educated the ignorant, mourned those that could no longer fight, and cheered those that survived. All the while, I was afraid to catch the virus because I am immunocompromised. I was afraid to take it home to my family. Above all, I was afraid of dying and my family having to say goodbye over a tablet. But, in the words of Maya Angelou, “Still I rise.” So, each morning, I got up, took a deep breath and breathed.  

More than a year has gone by and I have learned true resilience through faith. I have always been spiritual even when I was not religious, but 2020 taught me grace, renewed hope, humility, and recharged my humanity. The most important lesson I learned is knowing one's value. Not all value is monetary, but rather what you bring to an organization, community, or group. During this year, I have joined Jefferson Community and Family Medicine’s Social Justice committee; the value that I bring to this group is being unapologetically me. I will not allow the past culture to ignore its cultural bias or microaggressive behaviors any longer. I am not afraid to be shunned or ostracized because I have right and wrong on my side. If we have seen nothing else during these pandemics, we see the cries of the righteous will no longer be silent.  

Taking off the mask of oppressive behavior does not mean belittling or attacking a person's character; it means putting the spotlight on the behavior and charging those that claim to want change to address it. Removing the mask and seeing people for who they are, opens a conversation, hopefully––a truthful conversation about behavior they may not even know they are demonstrating. I have learned not everyone that acts in a racist manner is racist, just ignorant. It is left up to people like me to educate and inform so that they can chose whether to continue the offensive behavior. It also allows me to make informed decisions if this is someone I want to know. After all, tolerance and acceptance go both ways.  

Also, through faith, I have started to heal. The very idea that none of us would come out of these pandemics without some form of PTSD is laughable. But accepting our biases and fears is a start. I know that we live in a world that judges based on the color of one’s skin. My future in health care may very well be limited because of someone's belief that I am less than my white peer or afraid that I may outshine them. I have to teach my children how to interact with the police just to get home safely. I have to pray daily thanking God that my family is whole, but this is all okay.

I have survived a pandemic that stole the breaths of millions. I have survived a pandemic of hate that stole the breaths of black men and women throughout the country. For so many who have been silenced, I have gained a voice so strong and so clear on behalf of my patients and my race that my mere whisper will shake foundations.