AV Blog


A reflection on Major Depressive Disorder

You speed by and assume that I don’t see you
Because I am dead.
Or so they call me.
As if the road had anything to do with it.
I thought that the road would be safer than the wilderness
That the crowd would be safer than the isolation.
Mankill is more like it.
But what’s in a name?
Besides the fact that it labels you
Besides the fact that it leaves a scar
Seering you like a third degree burn.
Or so they call it.
You shriek in disgust as if I can’t hear you
Just because I am dead.
How can you so comfortably define what it means to be dead when you have never been here?
When you have never watched
When you have never listened to
The world go by around you
Without you.
You swerve around me as if I cannot feel you
Simply because I am dead.
Simply because my blood and my organs
My soul and my dignity
Are pulverized beneath your wheels.
You didn’t even look back.
You didn’t even think back.
Self preservation.
Or so they call it.
Due to the fear
Of getting too close
Of getting hit on this road
Of joining me here and becoming



Kristina Kelvy

Your heart is a muscle the size of your fist.

I Googled this sentence the other day. Real scientific, I know, but the sense of déjà vu as I repeated it in my head irked me. Like the itch you can’t quite reach on that one patch of skin right in the middle of your back. I knew I’d heard it before, that the neurons in my brain had somehow attached this meaning to it, that it stirred a rather undefinable response somewhere close to the unsettled nausea of simultaneous hope and despair.

Your heart is a muscle the size of your fist.

Google returned a nice plethora of results: it’s the title of a 2011 song for a punk rock band; it’s the title of a protest novel following the events in 1999 of a clash between police and protesters outside a meeting of the World Trade Organization in Seattle; it’s an often quoted (and often reproduced on Etsy) line from a memoir by an author compared to Kerouac. None of those felt right. None of them satisfied this constant repetition in my head.

Your heart is a muscle the size of your fist.

I held a human heart in my palm for the first time in December. Fitting perfectly in my hand was this collection of vessels and chambers, removed from its rib cage shield and held in delicate display. And for nearly a century, it felt every miniscule notch on the spectrum between happiness and sadness for my donor. Within its arteries, I could trace the remnants of blood that rushed through in excitement; I could see the muscle fibers that wrenched tightly when aching.

Your heart is a muscle the size of your fist.

Now, I’m perfectly aware that your heart feels no emotion, that it’s subjected to the physiologic responses triggered by the all-encompassing and mighty brain. Decades of research means we can now write more accurate Valentine’s Day cards. “You make the neurons in my limbic system fire when my optic nerve relays the data of your face to my visual processing center.” Somehow, I don’t see Hallmark rushing out to implement this idea.

Despite our advancements in science, the heart still reigns as the ruler of our emotions. The ancient Egyptians discarded every organ except the heart during the mummification process. The heart remained to testify for the deceased person in the afterlife. There I stood, in scrubs too big and surrounded by the hubbub of a day in the anatomy lab, trying to listen to this testimony.

I wondered when this heart was heard for the first time. Unlike me, her birth was too early for the sneak peak of an ultrasound. When was she first conscious of it racing with anticipation or pushing against her chest wall in a moment of fear. When did her heart move to sync with a lover’s in an intimate moment or quiet into mourning the loss of a friend. When did her heart just absentmindedly keep beating, through everyday life and the mundane simplicity of brushing her teeth.

The brain, in all its brilliance, is fallible. At some point, everyone forgets their keys, loses words on the tip of their tongue, asks people to repeat things that go in one ear and out the other. But our hearts, they’re steady and constant through sorrow, elation, uncertainty, and love. They’re present through that undefinable feeling of simultaneous hope and despair. So maybe having our hearts testify for us at the end of it all isn’t such a bad thing.

Your heart is a muscle the size of your fist.


PCM Reflection

Janaki Patel

It is in fact true that each physician and resident has far too much on their plate, probably a byproduct of systemic healthcare concern, however, each person still visits their patients at least once a day. Five minutes sitting at the bedside is equivalent to 30 minutes at the door – one of the first lessons we were taught in PCM. The biggest lesson I learned, however, was the importance of making a connection with each of my patients. It wasn’t about how much time I spent with the individual, whether I spoke their language, or whether I sat down, that made them trust me or connect with me – I couldn’t always do all three things for each patient. So what was the secret – I showed them I cared. Read more…


Stop; Feel, Now.

Michael Enich

Read the Transcript