Estevana Isaac, MSIII
My voice often feels muffled. People say I mumble. I come off as shy, hesitant and quiet.
“I can’t hear you.”
That was a lot of my feedback growing up. And now I wish I could tell you that adding my opinion comes natural to me. As a training physician, I still think about the consequences of criticism, rejection and conflict in both my work and personal life. To be honest, as a black woman, my opinion has never been as rigorously sought as it has been now. But what muffles it? Is it the system, my superiors, my peers or is it me?
I remember when President Obama first won the election in 2008. I was anxiously sitting in the lounge of my undergraduate dormitory. At the University of Pennsylvania, my peers and I represented a minority and now we suddenly mattered – a black president. For the night, we had a voice. We forgot about the divisions between race and class. We forgot our opinions were not that of the majority.
Eight years later and two successful terms in office, we now have the opportunity to witness another historical stride. Secretary of State Hillary Clinton has been a forerunner in the Democratic Party and the first female candidate to gather this much support in presidential elections. In February 2016, she visited us here at our institution, Meharry Medical College.
I witnessed the diversity of supporters that flooded the ballroom of The Cal Turner Family Center for Student Education. While standing in the crowd with my classmates, I knew my voice mattered. I am a black female voter with the opportunity to witness leaders that generations before me would have never imagined. The American political system has seldom allowed individuals that look like myself to have roles of leadership. As a result, my voice has always felt muffled in such arenas.
Regardless of who wins the 2016 elections, seeing candidates that look like me brings my viewpoints to the forefront. So the next time, I doubt voicing my opinion as a doctor, because of fear of being critiqued by my superior and peers, I must remember that I, too, am a leader. Children that look like me see my role as a physician and picture themselves in my place. And it’s my understanding of those patients with similar experiences that gives me an advantage in the quality of care that I provide. Hence, not applying my diverse background to the health care arena will only exclude my voice and that of my patient from the conversation.
So how can I speak louder than the system, my superiors and my peers? As an American citizen, not voting for the candidate that represents my opinion allows the system to drown out my views. As a physician, not advocating for patients that I empathize with stifles the concerns of my patient. And not speaking up for myself muffles my voice amongst my superiors and peers. But I stop mumbling when I project my voice louder than my own hesitations and vote for a 2016 candidate that empathizes and advocates for me.
Rechelle Jackson, D2
Last semester, The PULSE, formally introduced the college’s 12th president, Dr. James E.K Hildreth in our fall edition. Dr. Hildreth was named president in July 2015 and since then has been working tirelessly to make his presence known and goals realized.
However, as the old adage states, behind every great man is a great woman and Mrs. Phyllis Hildreth is no exception. The PULSE was able to have a few moments with the new first lady of the institution and learn more about her past, present and future.
Mrs. Hildreth was born in Berkley, California to an Oklahoma father and Missouri mother. During the interview, she frequently spoke of her love of history and how she felt everything happened for a reason and during a certain time. “I believe that our individual stories and community stories are so heavily marked by larger national and historical stories that seem not to be related, but when we pull back and pay attention we see why something happened,” she recollected.
During the Civil Rights movement, her father graduated from Lincoln University, an HBCU in Jefferson City, Missouri. Concurrently, the Korean War was taking place and opportunities for blacks were very limited. Therefore, young black scientists and doctors ended up on the West Coast where they could thrive.
“I was trained in California schools during a time when Sputnik happened and the Russians got to space first, so everyone felt the need to train more scientists,” she said. She also stated that she was brought up during a time where there were linear roles and individuals had to identify as one particular job. “There wasn’t any deciding my career path, it was fairly organic, the question wasn’t was I going to be a scientist, but more so what kind.”
Although Mrs. Hildreth did major in biology in undergrad and soar through ecology and learning about the macro systems, a part of her did not feel complete because of the lack of interaction with people. “There was no social component, so it did not interest me,” she said. She admitted to enjoying the bonding and identifying with others during her self-proclaimed “15 minute” stint as a pre-med student.
After graduation, working as a laboratory technician for five years did not stop Mrs. Hildreth from her true passion. She instinctively felt the need to help the family and believed that healthy families were the core of healthy communities. “I loved the centrality of maternal child health,” she said. “Maternal and child health systems are the heart of my universe.”
She recalls her last job being at Johns Hopkins University in the pharmacology department. She remembers one of her husband’s mentors pulling her to the side and asking what it was she truly wanted to do because she could not continue to hide in the lab.
“He did me a great service. I would have signed up for a career that did not have much black life or culture,” she said.
With the hopes of pursuing a degree at the School of Hygiene and Public Health at Johns Hopkins and the ultimate goal of studying maternal and child health, Mrs. Hildreth applied to the University of Maryland’s law school. In 1984, she became part of the first law school class at the university to matriculate a large number of African-American students. Incorporating her love of history she said, “With Brown vs. Board of Education they continued to segregate high school and higher education, so this class was a part of completing the desegregation process.”
In the course of her first year of law school, Mrs. Hildreth discovered that she actually liked it. Upon searching for a job during school she was forced to carry around her one-page resume stating that she had majored in biology, worked in a lab for five years and now wanted to be a lawyer. “The only person who said ‘yes’ was the public defender of Baltimore city,” she said. “They put me over the CINA (Child In Need of Assistance) division and I clerked there for the remainder of law school.”
Mrs. Hildreth went on to graduate in 1988—and because of her great work ethic and willingness to work in a narrow, but nevertheless, important area of law, she was offered a position at the public defender’s office. Immediately after swearing in, she had piles of cases waiting for her. “We must focus on that which we have passion and do it with exhausting excellence,” she advised when reminiscing.
Our first lady is currently a professor at Lipscomb University teaching conflict management where she was previously a student in the same program. When asked how she felt about having to move back to Nashville after her husband accepted the president’s position, she said that she had never left after he departed Meharry for California. “We were forced to have a long distance marriage for four years,” she stated. “But during that time I was able to empathize with mothers in a way that I had not previously. I was able to see what it was like for other families to have to do this and make it work,” she continued.
When asked how she deals with the pressure of being a professor, first lady and public figure, she said that she may work long and non-traditional hours, but the minute she gets home she has released everything and work is not the focus. Her hobby, knitting, is also a stress reliever that helps to ease the day’s worries.
In addition to assisting in fulfilling her husband’s goals for Meharry, she also hopes that, by her presence and practice, women of her generation begin to institutionalize a way to be easily accessible. “I want to figure out a way to have couch hours and it will be known that at a certain time on a certain day I will be findable,” she said.
Lastly, Mrs. Hildreth wants all Meharry students, whom she affectionately calls her babies, to know and understand that we are not just training to become doctors, dentists and researchers. We must realize that our purpose is bigger than ourselves, she said, and in some cases the things we want to do may not have been invented yet.
“If your goal is a value, then you have great freedom and flexibility to adapt to the different ways in which that value is manifested and addressed,” she continued. “However, if your goal is to a particular process, when that process is no longer needed, neither are you.”
Luther B. Adair, II, M.D.
There they were, my dad and my new cocker spaniel, Jocko (seemed like a great name at the time). It was no different a night than several other nights in 1982 when my father came home and trained Jocko in the concrete floored basement of our split-level, ranch-style suburban home. At the time, the stairs that led to the basement were open to the view of the basement from an unenclosed stair rail. As a 5-year-old, however, this was not a stair rail at all; it was a gymnastics paradise to display my ninjutsu expertise—plus a bonus view of my personal dog trainer and my new puppy. It does not get much better for a 5-year-old except for the frequent chastising I would receive for using the rail for that very purpose. “You will fall and hurt yourself,” was the usual caveat. On this particular night, that warning would go unheeded and my grip would betray me. Gravity was there to teach me a lesson. I fell head-first and landed on the concrete. Now much of what happened later is recalled from a post-traumatic memory and what my parents later told me, but to make a long story short, I remember waiting a very long time in an unfamiliar emergency room.
I guess now would be a good time to tell you that my father was a neuroradiologist, the chairman of the Department of Radiology at the more familiar hospital, and a student of the great Juan Taveras (MGH Neuroradiology) during the dawn of the CT scan. Needless to say, my father would not allow me to be evaluated with radiography alone and insisted upon having the hospital perform a CT scan evaluation of my head (imagine a time when routine brain MRIs from the emergency department weren’t the norm). My father’s hospital did not have a CT scan. I eventually received a CT scan and a diagnosis of a concussion. Subsequently, my father was able to convince his hospital board to allow him to use his personal finances to help purchase a CT scan for the hospital where he was employed.
This story seems inane now because most hospitals in the U.S. have CT scans that are readily available. However, in many cases such ubiquity has become another spectrum of the same problem—the overuse of such technology and the radiation associated with the overuse. There has been extensive controversy regarding the overuse of CT scans ordered by the emergency departments over the last six years—just “google” CT scan, pediatrics and CNN. Some argue that the legal system is causing doctors to practice defensive medicine. Others argue that the training of emergency personnel promotes a flippant approach to the use of diagnostic imaging.
Recently, my 8-year-old nephew suffered a head injury while playing and I realized after talking with his parents that the responsibility should also lie with the parents to understand their available options in similar circumstances. Hence the reason my company, Viewbox Holdings, LLC, and I decided to create our second (and most unlikely) product, a children’s book.
The book, Learning about X-rays with Lula and Ethan, is loosely based on my nephew’s experience and it attempts to educate the pediatric population about possible concerns around radiation exposure, but also explains its necessity in certain situations. Most importantly, and aligning with the ACR’s Heart of Radiology campaign to educate the public about our role as radiologists, this book introduces readers, both parents and children, to one of their key health care providers—the radiologist. This book was written for ages 7+ and features two children eating lunch and discussing one child’s experience of getting an X-ray. Obviously, it is our desire that parents would never need such a resource, but given the trend of increased diagnostic imaging in the emergency setting, as well as the large numbers of allied providers joining the health care force over the next few years, we believe this resource will help families and providers.
It is our hope that any provider that treats the pediatric population has access to this resource for their patients (even radiologists in the outpatient or emergency waiting rooms). You can purchase either the paperback version for $9.59 or the e-book for $4.99 directly from the publisher by following this link http://www.blurb.com/b/6950764-learning-about-x-rays-with-lula-and-ethan. The book will also be available through Amazon, Barnes and Noble, and in the Apple iTunes Store where you can also find our iPad application for radiology trainees, Viewbox. Because the information and message in Learning about X-rays with Lula and Ethan also aligns with the Image Gently Campaign, this non-profit organization has also agreed to endorse the book by placing it on their website: http://www.imagegently.org. During the editing process, we received guidance and amazing support from the chair of the Image Gently Campaign, Dr. Donald Frush, as well as my sister, Dr. Candace Adair, who is a child and adolescent board-certified psychiatrist. If you have any questions or comments please feel free to email me directly at email@example.com.
A review of Atul Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science
Peter Oluwaṣeyitan Bamikole, MSI
“Read Gawande.” That was the brief answer a doctor gave me when I asked him what medicine is like. So I started with this book, and thoroughly enjoyed it. To better commend it to you, I will briefly review it here. Dr. Atul Gawande, an American surgeon, opens Complications with two central assertions: “[Medicine is not] an orderly field of knowledge and procedure,” but instead “it is an imperfect science, an enterprise of constantly changing knowledge…” (Kindle p. 7). To support these claims, he compiles 14 essays loosely federated under three headings: Fallibility, Mystery and Uncertainty.
Acquiring a new skill demands a learning curve. “As patients, we want both expertise and progress. What no one wants to face is the contradiction” (p. 27). Novices improve best with experience, under expert supervision. But the skills practiced in medicine involve real-life human beings, and this makes all the difference. What ailing person wants to be practiced on? When Dr. Gawande had a sick child, he himself—at the time a resident—refused to let a resident treat his daughter. He demanded an attending. This understandable fear means that doctors must be discreet about the training process, and trained physicians are necessary handmaidens to their trainees’ mistakes.
This bothers us so much because contemporary medicine prioritizes machine-like perfection in delivering care. Dr. Gawande visited Ontario to find his illustrative example. North York’s Shouldice Hospital is a ‘hernia factory’: they exclusively perform hernia repairs, cheaper and faster than anywhere else, yet with better outcomes. From the staff to the building’s very design, Shouldice “deliver[s] hernia repairs the way Intel makes chips” (p. 40). But could this “factory model” work on a grander scale? According to Gawande, the medical establishment is wary of this sort of automation especially as it pertains to the “art” of diagnosis.
Yet, regardless of their operative model, doctors must be healers. After all, “nothing splits a patient and doctor like a mistake” (p. 45). An instance of medical error is usually seen as a case of bad doctoring. It is often not so. Medical mistakes happen. He offers this advice to physicians: be diligent, expect perfection and own your errors.
Our view of pain is historically Cartesian (“pain is like pulling on a rope to ring a bell in the brain”), but was replaced by Gate-Control theory (the spinal cord modulates pain percepts before they reach the brain, so the “bell itself modulates the rope”). Now we think pain is “all in the head.” Under this dispensation, pain and other sensations are “neuromodules” in the brain, like computer programs. But these neuromodules are entire networks (mood, emotion, memory, anticipation etc.) that together decide the threshold at which they play. Pain, therefore, “is a symphony” (p. 124). This means that a mere toe stub is more complex than we thought, and it also explains why limbless people feel limb pain. Despite its physical basis, in the brain all pain is the same. Gawande weaved the story of a patient through this essay to strengthen his conclusion: the social coordinates of chronic pain merit our attention. By paying attention to the non-physical factors that may cause pain, this new model has, surprisingly, made pain political. What unites the essays in this section is the observation that mystery comes with the territory of doctoring. So make your peace with it, early and often.
In the opening essay, Gawande cites a 1971 paper about the nature of fallibility in science. Its authors argued that in applied sciences like medicine, perfect knowledge of a particular case is impossible. For example, who knows precisely where a hurricane makes landfall? They called this “necessary fallibility.” Yet some things (like ice cubes in a fire) are firmly predictable. Ignorance and ineptitude are surmountable sources of error, but necessary fallibility cannot be helped. So in medicine, “are people more like ice cubes or like hurricanes?” (p. 198).
Autopsies are on the decline, perhaps because of “medicine’s 21st century tall-in-the-saddle confidence” (p. 193). Folk wisdom states that autopsies rarely implicate misdiagnoses in the cause of death. But the four studies Gawande provides suggest that 33 to 40 percent of autopsies revealed misdiagnoses that would have saved lives had they been caught. And these rates haven’t improved since at least 1938. For his part, Gawande reckons that humans are equidistant between hurricanes and ice cubes: “permanently mysterious” in some sense, yet—given enough systematic investigation—“entirely scrutable” (p. 199). Gawande’s final essay recounts the case of a young girl with necrotizing fasciitis, and the book ends with the unsettled nature of his treatment decision. It helps the reader see what medical uncertainty looks and, perhaps, feels like.
These 14 essays are a humanizing account of medicine for doctor and patient alike. From Gawande’s description of cutting live skin for the first time (“thick and springy”) to his reflectiveness as an author, his writing gives one a sense of what it is like to newly enter this guild. Altogether, the essays are fertile ground for thinking about what it means to practice compassionate health care amid the necessary competencies of 21st century medicine. If systems simplify modern medicine, then remember older dimensions of care like talking to patients. To reduce medical errors, go after processes, not people. Don’t be so certain about the relationship of appetite and willpower in obese people. There are many more insights to glean, and some of the essays even function as a kind of cultural anthropology. Apparently, doctors—like all humans—are a superstitious lot. Also, who knew surgeons got lonely? And prior to a medical tragedy, does anyone care? Most of these essays are open-ended and consequently great for reflection. For us who strive to worship God by serving mankind, books like this are grist for the mill.
Bassam Zahid, MSII
It’s looking like another idyllic spring just north of Charlotte Avenue, as the season turns and the trees start to bloom and the birds begin to chirp. For all intents and purposes, Meharry Medical College has had a successful year and we still have a few months left. This year, our school opened up The Cal Turner Family Center for Student Education for full-time use. Meharry and 2100, the school’s health and technology interest group, also launched the school’s first mobile app, Meharry Mobile, which was born out of student-administration collaboration. And the School of Medicine Class of 2016 has found its match in competitive residencies and specialties. Justifiably, there is a feeling of accomplishment and success in the air.
But as we pat ourselves on the back, we must also be aware that there is a revolution happening at medical schools across the nation. Certain institutions are leading the conversation on what medical education will look like. They are not doing it based on their name or their rank or their level of experience in medical education. Instead, these schools are reinventing medical education simply by being the first to act.
This past year, University of California, Irvine School of Medicine piloted a program where they distributed Google Glass to third- and fourth-year students in the operating room and emergency room departments. They also gave first- and second-year students the opportunity to test out Google Glass in anatomy labs, the medical stimulation center and in the classroom where live patient-physician encounters were broadcast between the medical center and the lecture hall.
At Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, administrators have revamped their curriculum to include a design track in order to equip medical students with training in design thinking to solve health care challenges. It is the beginning of a trend where the traditional STEM fields are being merged with art disciplines to create STEAM (A for art!). Design thinking is a popular philosophy of execution practiced by designers and, in recent decades, has found its way into fields like computer science, higher education and, of course, health care.
And at the most extreme level, the University of Texas at Austin is opening its doors to the first class of Dell Medical School, an educational institute designed in the spirit of fostering innovation, creativity and design thinking principles from the beginning. They are going so far as to hire designers from the internationally known design school, IDEO, to head up their Design Institute for Health. Their mission is to re-imagine medical education.
In March, I attended the National Association of Student Personnel Administrators (NASPA) conference, an annual student administrators gathering, with Tammi Lavender, director of student life at Meharry, to present some of the advances we have made at our school. In between studying and preparing for our presentation, I attended a talk on “Design Thinking in Higher Education” given by the jCENTER at the University of Minnesota, a think tank dedicated to reinventing higher education using design thinking principles.
Design thinking is used by a number of major design and technology companies from IDEO to Google to IBM to the Stanford d.school (d for design). It is a human-centered, solution-focused, and action-oriented philosophy that revolves around solving problems by acknowledging that there are multiple paths to an answer and that we should be open to them all. Ultimately, design thinking does not reside in the realm of theory. It requires actually doing, making, creating in order to learn and grow.
Design thinking is not necessarily point A to point B thinking. It is a non-linear process that requires one to be systematic and imaginative. At times you want to be razor-focused on the task at hand, while at other times you want to let your mind wander. This is called convergent and divergent thinking. Sometimes you will need to rely on experience and other times experimentation will be more useful.
Design thinking starts with the human. At the beginning, it is important to start with empathy. Who is the population and what are they struggling with? For example, in the classroom, how are the students learning and what can we do to enhance their learning? In the clinics, how can we redesign our teaching so that the patients get the best care possible? Next, we want to define the problem. We want to identify a problem that we can fix. After that, we want to generate as many ideas as possible. This is where the convergent and divergent thinking comes into play. This is a no judgment zone.
I mentioned earlier that design thinking is action-oriented. This is where coming up with a prototype and testing it are paramount. The goal of design thinking is to learn by doing. Instead of great ideas and initiatives becoming lost in the bureaucracy of committees and meetings and emails, the onus is that we act as soon as possible. Ultimately, at the end of the testing phase, you reiterate and return back to the start with empathy. You keep trying to improve your product or service until you have a result you are satisfied with.
So, as I sat in this conference room and listened to the researcher from the jCENTER espouse the amazing benefits of design thinking, it dawned on me: Why are we trying to catch up in a medical education system that will likely be obsolete in 10 years? Schools reinventing their curriculums to include design principles or introducing cutting edge technology to their students or participating in AMA’s Accelerating Change in Medical Education Consortium (which includes Vanderbilt by the way) will be rewriting how medical education is delivered. Are we really just going to wait for the change to come to us? What if we paved our own way?
In order to revolutionize medical education, we need to start with the classroom experience. Let’s encourage professors to update their lecture slides every year. The knowledge in medicine doubles every four years and our society is already overwhelmed by information overload. Asking students to look at slides that contain the names of obscure drugs is an exercise in futility when time and resources are limited.
Let’s start videotaping lectures, which will not only allow students to revisit a lecture if they need to, but can also be a way to improve the delivery of content by the professors in the classroom. If professional athletes can break down their tendencies with game film why can’t educators? After all, isn’t teaching an art?
Let’s create a live internet audio feed for all lectures. From the physics of sound waves we understand that these longitudinal waves dissipate over distance so that what students hear in the front will be different from those in the back. I won’t hear the name of that obscure drug the professor mentioned because the sound wave has bounced off the heads and laptops of the 10 rows of students in front of me. But what if I could just put on my headphones and listen to crystal clear audio of the professor as she spoke from the front of the room? Wouldn’t that also cut down on distractions while creating a more personal learning environment?
Let’s begin collaborating with students beyond just putting out an impersonal survey. Organize us in random, cross-disciplinary focus groups and then talk to us. Do the same with administrators, faculty, even the grounds crew. In fact, organizations like Pre-Alumni Association, 2100 and class E-boards should probably do the same for their students, faculty and administrators as well. Let’s start from a place of empathy. As health professionals, isn’t that what we are best at?
These are just a few ideas I have, but what else can we imagine if we put together the experiences and brain power of hundreds of professional students, teachers and administrators? I am calling for a shift in our attitudes and our energy so that we work collaboratively instead of antagonistically. Meharry was the only school that gave many of us a chance to fulfill this once-in-a-lifetime dream. So when we advocate for change, we mean it from a good place. Let’s not forget that.
So as we put the cherry on top of yet another productive year, make sure to enjoy the spring galas and the inauguration festivities. Take the time to reflect on how amazing it is that Meharry is still standing and how we survived the Flexner Report. Give thanks to the giants that paved the way for us and raised the bar. Toast President Hildreth and the graduates of 2016 for leading the way. But remember, after the inauguration, after that collective sigh of relief, the honeymoon is over. Now the real work can commence. Let’s innovate medical education to revolutionize health care. In other words, let’s change the world.
Sara Nelson-Owens, MSIII
Let me tell you why I love him:
“‘Cause he is the truth, and he is so real, and I love the way that he makes me feel”
Not a fairy tale reality, but pretty brown eyes of affection and integrity, an integrity so true that I will
follow him, down the deepest, darkest and the most uncharted pathways of love, life and lust
In him the design of our relationship, as he brick and mortar lays a foundation that won’t be swayed by
earthquakes, hurricanes or waves nor bosses, friends or kids
I believe in him
See in order for him to be the The Truth, there had to be trust and with trust comes believing
“The truth it needs no proof, either it is or it isn’t”
And it is
Because faith told me and she ain’t the average girlfriend throwing salt ‘cause his life is bland, you see
faith believes in things longed for and unseen
so I carry his dreams!
And not like a burden to be laid at the alter, but an ethereal cloud
resting upon my shoulders
I vacation in the cortex his mind just be embraced by him
I reside in the corpuscles of his feet just to be carried with him
I eat, sleep and live in this man’s organs just to be surrounded by him
“You know the truth by the way it feels”
A feeling that paints my soul with joy, that translates into a smile, a smile so commonly formed from ear
to ear just to let the world see my hearts truest reflection of him
“And if I am a reflection of him, then I must be fly, because his light it shines so bright, I would lie”
I wonder if he knows that he is…
Erin Smith, MSIII
You are the BEST?
She said with a smirk
As she prepared herself to hit the dirt
The best of you is of others’ invention!
It spewed from her lips
Like unfiltered venom
You think you’re so smart
But your brain is a weakling
With knowledge borrowed from the pages of Wiki
A great taste in music
Of which you are so proud
Comes straight from that iPhone, from Siri, the Cloud!
That humor and wit
Has others rolling to and fro
Would they laugh at all if they too watched the Late Show?
You are a human compass
But where would you be without GPS?
Completely informed political views?
How informed must you be
To simply disagree with FOX News?
From what I recall
Your sculpted physique
Is the product of photoshop and printer ink
I say one thing of yours is truly the best
You lie and you cheat
To bamboozle the rest
Congrats on your achievement!
You’ve won this round
You’re also the best at pushing me out.
Laeia Jackson, MSIII
This is the beginning
The rich land of kings and queens
Of pyramids and dynasties
And fertility, prosperity, eternity
In our eyes and in our blood is golden
A lineage that runs through the ages
This was our land
Tell us about their lineage
Long, everlasting, and enduring
This is the middle
Things have had time to get complicated
Our legs and hands are tied
And the sound of the whip
The crack against our back drips gold
A cold gold into the ground
That we chose to call our home
And sweat that tilled the soil
Diamonds in the hot summer sun
Tell us about our lineage
We run with barking at our backs
From the crack of the whip and a gun
Tell us about our lineage
But our race has just begun
Every eye is turned north
The source of every dream
The reason that we cry
The reason why we bleed
And this is the end
The end that never comes
A silence that speaks of dreams
The burning cross in your front yard
The end of a looped rope hanging from a tree
Here the stage is littered with bodies
The price of freedom paid
This is our land, our blood is in it
The destination that we cannot help imagining
The beginning of the end,
But only the beginning