This essay will be a close in-depth reflection of my three essays. The peer profile of Peter Semaan, my personal narrative, and a research essay on pacemakers. They each explore different writing styles, with one being an interview style piece, another being a story of my life, and the other is an in-depth ethical review on pacemakers 

The first essay was formatted in an interview focused text with Peter Semaan, a budding writer whose experiences with language, writing, and personal growth served as the focal point. In this piece, I explored Peter’s journey through language strugglers and his eventual development as a writer, using an interview format. This essay demonstrated my ability to engage in critical thinking by delving into the intersection of Peter’s multilingual background and his growth as a writer.

In the interview, Peter shared, “Writing felt like a way of getting my thoughts out and became very therapeutic.” This personal insight showed critical reflection on the broader implications of writing as a tool for self-expressions and emotional regulation. By analyzing his struggles with multiple languages, I explored how language shapes identity and writing skills. Additionally, the anecdote about Peter’s relationship with his teacher, Mr.G, highlighted the transformative role of mentorship in overcoming self doubt, further emphasizing the interplay between personal development and writing skills. 

While this piece was effective in its narrative, I see opportunities to expand my critical analysis. I could have explored in more depth how Peter’s multilingual background impacted not just his writing but his perception of language as a whole. This would have enhanced the essay’s complexity and added another deeper analytical layer.

The second essay, focused on my personal struggle with anxiety in Mr. Ryan’s English class showed my growth in rhetorical knowledge. This essay allowed me to use something very personal that could connect with my readers on an emotional level. I was able to experiment with different rhetorical strategies, such as anecdotes and comparisons. I structured the narrative to first show my initial anxiety, followed by the progress I made both socially and emotionally.

A key moment in the essay was when I reflected on my feelings of insecurity and connected them to Piggy’s character in Lord of the Flies: “Piggy’s struggle to find his voice resonated with me, but unlike him, I found the courage to push past the fear.” This literary comparison deepened the emotional connection between my personal experience and universal themes of self-discovery and overcoming fear. The use of pathos was very clear, especially when I was describing the struggles I faced and the eventual relief I felt after gaining confidence in front of my classmates. 

While my essay’s narrative effectively conveyed the emotional aspects of overcoming anxiety, I could have refined my rhetorical strategies by expanding on the impact of my teacher’s role more explicitly. Maybe more moments highlighting the immense impact he had on me, which would enhance the pathos of the essay.

The third essay, which analyzed the ethics and technical aspects of pacemaker technology, showed my ability to follow a structured writing process. This essay required a lot of thorough research and careful analysis of articles. I had never done something as in-depth as this so it was definitely a personal challenge. I have some personal understanding of pacemakers, but I still wanted a more in-depth technical understanding of pacemaker functions. Then I did more research into the outcomes of pacemaker surgery and the ethical implications of their use. 

These essays represent significant milestones in my journey as a writer. They have shown my growth in critical thinking, rhetorical knowledge, and writing processes. Every piece I have learned to approach it with more confidence and purpose, which are lessons I will continue on to my future work. Here’s to my continued growth as a writer and future physician.

Every heartbeat is a testament to the body’s resilience, yet for millions, that rhythm may falter as they age, putting their lives at risk. For elderly patients, the idea of surgery, especially for something as vital as installing a pacemaker, can be scary due to the possible risks and the physical toll. However, pacemakers — small devices implanted to help regulate the heart’s rhythm — have transformed cardiac care, offering patients a longer life by preventing slow heart rates. While it’s true that surgery can be particularly challenging for elderly patients, the life-enhancing benefits of pacemakers far outweighs the potential consequences of going through this procedure. 

Pacemakers are important devices that help treat bradyarrhythmia, a heart rate beating fewer than 60 beats per minute, which can be due to family history, medication side effects, heart defects, and heart attacks. “All cardiac pacemakers are generally composed of a pulse generator that generates the electrical current required for stimulation of heart musculature and 1 or 2 electrodes, which are responsible for transmitting the electrical activity generated by the pulse generator to the heart musculature” (Lak, 2022). The pacemaker essentially sends an electrical current replicating the one a normal heart is supposed to have. It sends the current through these electrodes whenever the heart falls below a certain beats per minute that could be dangerous to the patient. The electrical current gives the heart a shock and allows it to return back to a normal, safer rhythm.  

Living with a pacemaker does require adjustments to daily life. For example, patients must avoid electromagnetic interference by maintaining a safe distance from certain items, such as airport security scanners, MRIs, electric drills, and cell phones (Richard N. Fogoros, 2024). These changes can significantly impact an elderly patient’s day-to-day activities, requiring additional care and awareness. Richard Fogoros’ article, 14 Things You Can’t Do With a Pacemaker, outlines some of these challenges and the necessary lifestyle modifications. While these adjustments might seem restrictive, they are minor compared to the benefits pacemakers provide in improving heart function and extending life. 

The benefits of pacemakers are clear in survival data. “The observed 5-year survival was 45% in our patients aged 85 years or more. It compares well with previous studies on patients > 80 years that showed a survival in the range between 40% and 49%” (Marini et al. 2019). For instance, nearly 90% of 50-year old patients who receive pacemakers can extend their lifespan by 10 years. These findings emphasize the importance of timely intervention, even for elderly patients. Extending life by even a few years can provide precious time for individuals to enjoy with loved ones and pursue meaningful experiences. 

Figure 1: A graph showing survival of patients based on age group after pacemaker implantation (Trabosky et al. 2023)

According to Trabosky et al., the later you implant pacemakers the decreased probability of survival as the years go by. In the figure above you can clearly see that when the pacemaker is implanted into a 50 year old, almost 90 percent have their lifespan increased by 10 years. As the age you implant the pacemaker increases the positive impact on the lifespan of the patient decreases. In patients that are 70 years old less than 50 percent have their lifespan increased by 10 years. The graph clearly shows the later you receive the pacemaker the less it will add to your lifespan. This figure shows just how much of an impact pacemakers can make. An elderly patient that is 65 and above can have their lifespan increased by even a couple years is an amazing feat. It means they can have more time to spend with their significant others, their kids, and their grandchildren. Even the extra year a pacemaker can provide is vital to allowing a person to live out their life to the fullest. 

However, opposing sides argue that even with the increased lifespan that pacemakers may provide, how long does it actually take elderly patients to recover from surgery? Older patients will have a longer recovery time than a younger patient and are expected to have more complications. Elderly surgery patients will require more support than a younger one, from both professional healthcare providers and other individuals (Whitlock). For elderly patients the path to recovery becomes much different after a surgery. They require more oversight and may even need to be put into a rehabilitation facility to receive proper care. Due to their age, they have increased chances of complications which can increase recovery time even longer. These unknown variables make it an even scarier experience for the elderly. The increased lifespan that pacemakers can provide just becomes used to recover from the surgery and not actually be able to enjoy your life to the fullest. 

Furthermore, Kenneth Covinsky’s research on the cognitive, functional, and psychological effects of surgery raises valid concerns. Overall, 17 percent of the patients who underwent major surgery died within a year. This led to increased mortality, including activities of daily living, inability to walk several blocks, dementia and depression (Covinsky, 2024). These factors highlight the potential risks and the need for a balanced approach when deciding whether surgery is the right choice for elderly patients. The association between increased mortality and difficulties with activities of daily living, mobility limitations, dementia, and depression suggests that these vulnerabilities may compromise a patient’s ability to recover from the physical and psychological stress of surgery. 

With so many possible side effects, researchers are trying to look for non surgical methods to help cure bradyarrhythmia. The article “Harnessing cell reprogramming for Adrian biological pacing” by Chih-Min Lin M.D., director of the division of cardiology at Taipei General Hospital, talks about the potential of biological pacemakers as a natural alternative to conventional electronic pacemakers. Current electronic pacemakers are effective but have many risks such as mechanical failure, infection, and a lack of adaptability. The authors advocate for cell programming as a solution where normal cells are converted into pacemaker cardiomyocytes. These cells mimic the body’s intrinsic rhythm, and they are a more organic reliability solution because you are using the person’s own ordinary cells. This article talks about an alternative to electrical pacemakers that could be safer, reduce reliance on implantation hardware, and reduce the surgery’s needed.

Figure 2: Development of pacemaker implantation (Liu et al. 2023)

The figure above from the article “Harnessing cell reprogramming for Adrian biological pacing” by Chih-Min Liu, shows the progression of pacemakers throughout time. But the fourth image is the alternative method that these researchers hope will become the new norm. It’s a clear diagram of the heart and shows the placement of the catheter which will place the biological product into the heart and allow the creation of a biological pacemaker. 

Pacemaker implantation in elderly patients presents a complex ethical problem that requires careful consideration of several key principles. Foremost among these is patient autonomy—the right of individuals to make informed decisions about their own healthcare. Ensuring that elderly patients fully understand the benefits, risks, and potential outcomes of pacemaker surgery is essential for honoring this autonomy. This involves transparent communication about the procedure’s impact on quality of life, possible complications, and the realistic expectations for recovery and longevity. Additionally, healthcare providers must provide an explanation of the potential benefits of pacemaker implantation against the risks and burdens it may impose. For some elderly patients, especially those with other illnesses or limited life expectancy, the invasiveness of surgery and the recovery period may outweigh the advantages of the device. Therefore, a thorough, individualized assessment is crucial to determine whether the intervention aligns with the patient’s overall health goals and values.

Furthermore, the decision-making process should involve a multidisciplinary approach, incorporating insights from cardiologists, geriatricians, ethicists, and, importantly, the patients and their families. This collaborative strategy ensures that all aspects of the patient’s health—physical, cognitive, and emotional—are considered. It also facilitates discussions about alternative treatments, including less invasive options or palliative care, when appropriate. By engaging in shared decision-making, healthcare providers can respect the patient’s autonomy while also fulfilling their ethical obligation to act in the patient’s best interest. Ultimately, the goal is to arrive at a decision that reflects the patient’s preferences and values, ensuring that the chosen course of action promotes their well-being and dignity.

This new innovative research highlights a different approach to treating bradyarrhythmia in a non surgical way. Patients could just come in and have a catheter that will turn a person’s normal cells into tiny pacemakers. It would be non invasive, no recovery time needed, and would provide the same benefits that pacemakers already provide just with less risk. More research is definitely needed, but this showcases how there is so much more to be done within medicine. So many areas where we can improve outcomes and the general quality of life for our patients. 

As future doctors we must be aware of the needs of our patients and the treatments that are best for them. Many of our future patients will be elderly and that completely changes the way we approach them in terms of treatment plans. We must be able to put ourselves in their shoes. Do they have the support they need to be able to properly recover after surgery? Do they have a support system at home? Are there alternative uncommon methods to help them? We must be able to think outside of the box and be aware of new treatments for our patients. This new alternative nonsurgical method being developed to treat bradyarrhythmia will be so helpful to the elderly. It will decrease recovery time and potential risks of treatment. 

Pacemakers have already revolutionized the treatment of bradyarrhythmia, and their impact on cardiac care continues to grow. Despite the challenges of surgery and recovery, their ability to extend life and improve heart function makes them an invaluable option for many elderly patients. There are still improvements to be made that can remove the recovery time of surgery. Alternatives like biological pacemakers promise to further enhance care, ensuring that patients can live longer, healthier lives with minimal disruption to their daily routines. This progress underscores the endless possibilities within medicine to improve outcomes and quality of life for all patients. 

In this new edition of the New Yorker magazine, I have had the pleasure of interviewing Peter Semaan, a recent publisher of his short text “The road to a new narrative.” I was able to have the first ever interview with Peter Seeman, an upcoming writer that everyone has their eyes on. This is his first published text and he has already won accolades from critics from the TIMES Magazine and New York Times. This article will focus on our interview and a look into his life as a writer. 

This interview was the first time I ever had the pleasure of meeting Peter Semaan. As soon as he entered the room for our interview he had this gentle smile and warm glow. It only excited my intrigue to get to know Peter better. Throughout our interview I could tell he was a jolly guy, excited to be on the show and share his story about language and writing. 

Interview Highlights

Question 1: Peter, how long have you been a writer for?

“Most of my life I had been writing for school assignments and never really took the time to write for my own pleasure. It wasn’t until I started journaling about my daily life and writing in my little notebook that I started to enjoy writing outside of school. Writing felt like a way of getting my thoughts out and became very therapeutic.” — Peter Semaan 

Peter’s story felt very relatable because many people only write for the purposes of school. His branching out to writing on his own time revealed how much he actually enjoyed writing, which was the initial spark he needed to eventually publish this short text. 

Question 2: Peter, is there any reason you specifically chose this text  to write about and publish to the world?

“This text talked a lot about my struggles with multiple languages as a child from a multilingual family. I feel that many people relate to these struggles and wanted to publish something that showed people they weren’t alone. Dealing with multiple languages was also a big part of my life and has made me who I am today so it felt like the right topic for my first published text.”— Peter Semaan 

In his text Peter talks a lot about the English language he had to learn for school, the Arabic language spoken at home, and the Coptic alphabet he needed to learn for church. A specific anecdote he uses is how easily confused he got with the Coptic and English alphabet. Writing in Coptic that said pain looked like rain, which led to many struggles with grasping the differences between the languages. This gave some backstory to how dealing with three different languages hurt his ability to grasp grammar and syntax, which impacted his writing skills in school. 

Question 3: Can you talk more about the impact Mr. G had on you?

“Mr. G helped me realize what I was really missing in my writing, but also helped me through a lot of personal growth. He made me realize that comparing myself to others wasn’t going to get me anywhere and will only put me in a bad mindset.”— Peter Semaan 

Mr. G was Peter’s sophomore high school English teacher who was a little goofy, always ending class by singing a song on his guitar. This teacher became a role model to Peter; Mr. G helped improve his writing skills and eventually overcome his issues with grammar. 

Question 4: Peter, why did you use these specific rhetorical strategies within your writing?

“I chose anecdotes because it made it easier for me to refer to in my writing. I wanted to create a text where people could see themselves in my shoes. Where they could understand what I was going through and see it in my perspective. It would make it easier for them to relate their own experiences to my anecdotes” — Peter Semaan

The reference to anecdotes really helped deepen the emotional connection to Peter’s text. Every anecdote felt relatable such as when he was dealing with the frustration of the bad grade on the essay. I personally have had countless times where I have just been disappointed with my performance, but Peter shows how you have to just push through and try your best to improve. 

Question 5: Are there any other texts or books currently in the making that readers should be keeping a look out for Peter?

“Right now nothing is really in the works, but I am brainstorming some ideas currently and hope to get it to my readers soon.”— Peter Semaan 

Sadly we couldn’t get an inside scoop on any next writing that Peter is working on. But that is okay because when we hear something our readers will be the first to know!

Text Analysis 

These five questions helped showcase the main points of my interview with Peter. The use of rhetorical strategies really drove his essay forward. The use of personal anecdotes such as his experience with Mr. G showed a pivotal moment in his life. We see so much of Peter’s growth from before he had written his paper to after through the relationship with Mr. G. These relatable anecdotes helped illustrate how Peter progressed in his writing skills and self confidence. He was always comparing himself to others and wondering why he couldn’t do as well when writing essays. The buildup of his confidence through the improvement of his writing helped show an amazing connection that couldn’t have been possible without Mr. G. 

A main point in the anecdotes was the importance of a role model in a person’s life. To readers of this editorial, is there someone in your life that you look up to? Someone who has had a great impact on your growth? Having a role model can push someone to make great changes in their life due to the inspiration they bring. 

This role model helped Peter with his self confidence, which seemed to have sprung from his earlier struggles with grammar and writing. Peter’s usages of compare and contrast helps the reader see the tension he feels. The thoughts of not being good enough or being behind. 

This has a heavy appeal to pathos because of the emotional vulnerability Peter shows, especially after receiving so many corrections on his essay. His initial comparison to his peers only made his mindset worse and increased his feelings of being behind. The role of Mr. G helped lead to a transformation from insecurity to confidence creating a very uplifting story. It leaves the reader with a sense of hope and motivation to think that anything is possible as long as you put in the work. 

Peter wraps up the text beautifully by showing his personal growth as a writer and in his self confidence. He began tutoring younger students and trying to help them with the same problems that he had faced. The grammar errors and frustration that he originally felt with writing were all problems he understood. This understanding allows Peter to be a better teacher to younger generations and help them face these problems. In the same way Mr. G was a role model to Peter, Peter became a role model to his younger students. 

As soon you can see, Peter began this text highlighting his struggles with languages, writing, and self confidence. But through the rhetorical strategies showcased how he was able to master writing with the help of Mr. G. Through his own first person perspective we got a look into his thoughts and frustration, but as the text went on the tone was very reflective and encouraging. Peter was always listening to the critics of Mr. G and learning life long lessons that left a huge mark on him. These lessons helped him come full circle as he mastered writing and then became a tutor so that he could also help others who struggle with the same issues. 

Peter showed his vulnerability, kindness, and grit in this phenomenal text. Readers will find a lot of relatable moments that can make them think of their own experiences. As a fellow reader, I really enjoyed this text and would recommend it to all. It is the story of how Peter turned his weakness into a strength and learned valuable lessons along the way. 

Anxiety, the feeling of your heart dropping through your chest, while your brain is going a hundred miles per hour. Every thought is filled with “what ifs” and endless possibilities of what could go wrong. These were the only thoughts in my head when I had moved to a new high school in 10th grade. 

I was sitting in the far corner of my English class with my mask on, everyone else conversing about the reading assignment within their groups. “What should I talk about?” “How do I even start a conversation?” “What if they don’t hear me?” “What if I say something stupid.” My head thought of everything that could go wrong if I tried to talk. During this internal discord, my English teacher, Mr. Ryan had approached me, “Do you have anyone to work with?” My heart felt like it had been stomped on. I could see the pity in his eyes and I hated it. I nodded no and he left me alone, letting me sulk in my internal discord. This constant struggle affected me throughout school and I hated this anxious feeling and decided I would avoid it at all costs. In class I focused on getting my work done and at lunch I would just listen to music. But rolling up into a ball and avoiding social interaction only continued to hurt me. Having no one to talk to or anything to look forward to in the school day other than going home. 

I felt all alone, but I wasn’t. In his own little way, Mr. Ryan was trying to help me. For the next few weeks he constantly called on me trying to get me to talk. In discussions he would call on me first and keep asking questions to hear my thoughts. At first I was always terrified, scared of making an idiot of myself — of potentially saying the wrong thing. I was scared of being judged. But the more he called on me the more comfortable I became. It wasn’t just through discussion that Mr. Ryan pushed me, but also through writing. He gave a free write assignment where we could talk about whatever was on our minds. Instantly I was pouring onto the paper everything in my head. Like finally I could get how I felt out into the world. It felt relieving. 

After 20 minutes writing out my life story, Mr. Ryan said it was time to share and present with the class a short synopsis of what we had written. My heart dropped. Mr. Ryan called on me first and even though I had my mask on, you could see the fear in my eyes. Talking in front of a large audience sent shivers down my spine. At that moment, I was stuttering, struggling to get my overwhelming thoughts together and even saying a cohesive sentence. Mr. Ryan noticed and told me to breathe and take a second to focus. It felt like a spotlight was on me, exposing my anxious vulnerability to the world. 

I focused on my essay, remembering what I had written and poured all my effort into. I had the words right in front of me, I just needed the strength to say it. I took a deep breath and realized if I mess up it’s okay, I just need to try my best. I started speaking and at one point I wasn’t even thinking, the words were just coming out of my mouth. The anxious thoughts that always hoarded me had disappeared just for those few minutes. I wasn’t thinking, I was just doing.

After that day, I started taking more charge in class. As I began raising my hand more, I realized that speaking about the books we read — such as Lord of the Flies — allowed me to engage with language in a new way. I could express thoughts that were locked behind my anxiety, and sharing them felt empowering. This allowed me to gradually gain the confidence to start conversing with the people around me about the classwork. It didn’t go anywhere the first few times, but I just needed it to work once. This period marked significant growth in my life. Despite the initial discomfort and isolation, I began to understand how language could be a tool to overcome my internal discord. 

In English class through our discussions I was able to put myself out there more and more. Through the books we read I was able to find characters that related to how I felt. Piggy, one of the characters in the Lord of the Flies, was ignored and never felt included in the larger group. Serena Joy, from The Handmaid’s Tale, always felt alone in the beginning because she never had anyone to talk to about what she was going through. I found solace within the stories I read, as if I wasn’t the only one going through this. 

In the end, Mr. Ryan’s English class wasn’t just about speaking up, buct learning how language could help me overcome my fears. Through reading, writing, and discussion, I found the confidence to express my thoughts and push my anxiety to the side. The uncomfortability was what led to my growth. Looking back I have changed so much as a person since then. I have continued journaling in my notes app and my ability to be social increased drastically. The anxiousness hasn’t disappeared, I don’t think it ever will, but I have the courage now to push past it and show my true self to others. 

Cover Letter 

In this peer profile on Peter Semaans narrative, I decided to take a different direction with the format of my writing. When I interviewed Peter I had asked him to pretend like I am from the New Yorker magazine. This allowed me to format my peer profile as an editorial that would be in the New Yorker. I wanted it to seem as similar to a real life interview piece as possible. I put five important questions that could give a reader an overall understanding of Peter Semaan as an author and some background into his published text. Then I analyzed his story by trying to get a deeper understanding of why he wrote the text the way he did and the rhetorical strategies he used. 

The format of my peer profile as an editorial in the New Yorker focuses on an audience of young adults that are 25 to 35 years old. I wanted this age group as my audience because I feel that they would be more likely to take a chance and actually go out of their way to read Peter’s writing after seeing this editorial piece. Young adults reading the New Yorker would be  more likely to read in their free time. The peer profile helps Peter’s personality shine and shows how relatable his writing is which could be the push an average New Yorker reader needs to give Peter’s text a chance. 

Even though I wrote this for the New Yorker magazine and a young adult age group, Peter’s core idea is something many people go through of all age groups. In a perfect world, I would publish this editorial in the New Yorker in hopes that it gains enough popularity from young adults that English teachers would make it a reading in their classes. This would allow this writing to reach teens who could be struggling with balancing language and literacy. 

The most meaningful insight I have gained from this peer profile regarding language and literacy is that your home environment has a huge impact on the way you are able to speak. Interviewing Peter I saw that because the language spoken at home was so different from what you use at school it made learning proper grammar so difficult. The English courses in elementary school weren’t enough to help teach us English properly. This is something many immigrant children go through and highlights something that should be improved in our education system. America is a place with a high immigrant population so shouldn’t there be more assistance for learning English properly at a young age. Personally, I also spoke a different language at home so my English was really bad. In elementary school they put me in ESL, English as Second Language, but that wasn’t enough to improve my grammar. It wasn’t until high school that I was able to eventually get better. This entire peer profile shows that a lot of people struggle with language and literacy and there should be more assistance provided in this area. 

In this peer profile I believe text impacted my learning and writing practices the most. The way I wrote my text was really informal compared to the traditional essay format. I really wanted this peer profile to be different to anything I have written before by putting it in the format of an editorial that would be in the New Yorker. This allowed me to be very creative and push my writing style in a very different way. By putting direct quotes and then analyzing the narrative piece right after similar to how an editorial may do it. 

This assignment in phase 2 has helped me develop and engage in the collaborative and social aspects of writing processes. I was able to get to know Peter Semaan better through the interview process. I was also able to add some creativeness to it by making it seem like I am from the New Yorker magazine. I learned a lot about Peter that I didn’t know before, such as his personal struggles and how he has grown from it. Currently we are dorming together and this interview has made me even closer to him. This assignment also allowed me to really get into my creative writing which really made me enjoy it even more. 

New Yorker Magazines Editorial of Peter Semaan “The road to a new narrative”

In this new edition of the New Yorker magazine, I have had the pleasure of interviewing Peter Semaan, a recent publisher of his short text “The road to a new narrative.” I was able to have the first ever interview with Peter Semaan, an upcoming writer that everyone has their eyes on. This is his first published text and he has already won accolades from critics from the TIMES Magazine and New York Times. This article will focus on our interview and a look into his life as a writer. 

This interview was the first time I ever had the pleasure of meeting Peter Semaan. As soon as he entered the room for our interview he had this gentle smile and warm glow. It only excited my intrigue to get to know Peter better. Throughout our interview I could tell he was a jolly guy, excited to be on the show and share his story about language and writing. I hope this editorial on Peter Semaan intrigues you just as much as it intrigued me. 

Interview Highlights

Question 1: Peter, how long have you been a writer for?

“Most of my life I had been writing for school assignments and never really took the time to write for my own pleasure. It wasn’t until I started journaling about my daily life and writing in my little notebook that I started to enjoy writing outside of school. Writing felt like a way of getting my thoughts out and became very therapeutic.” — Peter Semaan 

Peter’s story felt very relatable because many people only write for the purposes of school. His branching out to writing on his own time revealed how much he actually enjoyed writing, which was the initial spark he needed to eventually publish this short text. 

Question 2: Peter, is there any reason you specifically chose this text  to write about and publish to the world?

“This text talked a lot about my struggles with multiple languages as a child from a multilingual family. I feel that many people relate to these struggles and wanted to publish something that showed people they weren’t alone. Dealing with multiple languages was also a big part of my life and has made me who I am today so it felt like the right topic for my first published text.”— Peter Semaan 

In his text Peter talks a lot about the English language he had to learn for school, the Arabic language spoken at home, and the Coptic alphabet he needed to learn for church. A specific anecdote he uses is how easily confused he got with the Coptic and English alphabet. Due to him learning Coptic as a pre-teen he began to confuse his letters. Pain in Coptic looked like rain in English  and the Arabic spoken at home was nothing like what he spoke at school. This led to struggles with grasping the differences between the languages and gave some backstory to how dealing with three different languages hurt his ability to grasp grammar and syntax, impacting his writing skills in school. 

Question 3: Can you talk more about the impact Mr. G had on you?

“Mr. G helped me realize what I was really missing in my writing, but also helped me through a lot of personal growth. He made me realize that comparing myself to others wasn’t going to get me anywhere and will only put me in a bad mindset.”— Peter Semaan 

Mr. G was Peter’s sophomore high school English teacher who was in Peter’s words, “an interesting individual”, always ending class by singing a song on his guitar. This teacher became a role model to Peter; Mr. G helped improve his writing skills and eventually overcome his issues with grammar. 

Question 4: Peter, why did you use these specific rhetorical strategies within your writing?

“I chose anecdotes because it made it easier for me to refer to in my writing. I wanted to create a text where people could see themselves in my shoes. Where they could understand what I was going through and see it in my perspective. It would make it easier for them to relate their own experiences to my anecdotes” — Peter Semaan

The reference to anecdotes really helped deepen the emotional connection to Peter’s text. Every anecdote felt relatable such as when he was dealing with the frustration of the bad grade on the essay. I personally have had countless times where I have just been disappointed with my performance, but Peter shows how you have to just push through and try your best to improve. 

Question 5: Are there any other texts or books currently in the making that readers should be keeping a look out for Peter?

“Right now nothing is really in the works, but I am brainstorming some ideas currently and hope to get it to my readers soon.”— Peter Semaan 

Sadly we couldn’t get an inside scoop on any new writing that Peter is working on, but that is okay because when we hear something our readers will be the first to know!

Text Analysis 

These five questions helped showcase the main points of my interview with Peter. The use of rhetorical strategies really drove his essay forward. The use of personal anecdotes such as his experience with Mr. G showed a pivotal moment in his life. We see so much of Peter’s growth from before he had written his paper to after through his relationship with Mr. G. These relatable anecdotes helped illustrate how Peter progressed in his writing skills and self confidence. He was always comparing himself to others and wondering why he couldn’t do as well when it came to essays. The buildup of his confidence through the improvement of his writing helped show an amazing connection that couldn’t have been possible without Mr. G. 

A main point in the anecdotes was the importance of a role model in a person’s life. To readers of this editorial, is there someone in your life that you look up to? Someone who has had a great impact on your growth? Having a role model can push someone to make great changes in their life due to the inspiration they bring. 

This role model helped Peter with his self confidence, which seemed to have sprung from his earlier struggles with grammar and writing. Peter’s usages of compare and contrast helps the reader see the tension he feels. The thoughts of not being good enough or being behind everyone else. 

This has a heavy appeal to pathos because of the emotional vulnerability Peter shows, especially after receiving so many corrections on his essay. His initial comparison to his peers only made his mindset worse and increased his frustrations. The role of Mr. G helped lead to a transformation from insecurity to confidence creating a very uplifting story. It leaves the reader with a sense of hope and motivation to think that anything is possible as long as you put in the work. 

Peter wraps up the text beautifully by showing his personal growth as a writer and in his self confidence. He began tutoring younger students and trying to help them with the same problems that he had faced. The grammar errors and frustration that he originally felt with writing were all problems he understood. This understanding allows Peter to be a better teacher to younger generations and help them face these problems. In the same way Mr. G was a role model to Peter, Peter became a role model to his younger students. 

As you can see, Peter began this text highlighting his struggles with languages, writing, and self confidence. But through the rhetorical strategies showcased how he was able to master writing with the help of Mr. G. Through his own first person perspective we got a look into his thoughts and frustration, but as the text went on the tone was very reflective and encouraging. Peter was always listening to the critics of Mr. G and learning life long lessons that left a huge mark on him. These lessons helped him come full circle as he mastered writing and then became a tutor so that he could also help others who struggle with the same issues. 

Peter showed his vulnerability, kindness, and grit in this phenomenal text. Readers will find a lot of relatable moments that can make them think of their own experiences. As a fellow reader, I really enjoyed this text and would recommend it to all. It is the story of how Peter turned his weakness into a strength and learned valuable lessons along the way. 

Cover Letter 

The audience I focused my narrative on is for two different groups of people. The first group are people who also deal with anxiety and want to read about the growth of someone who has gotten better at overcoming it in stressful situations. Throughout the essay I talk about my own inner thoughts as a way for a fellow anxious person to find it relatable. My narrative outlines the way I slowly began accepting the uncomfortability of my situations which helped me improve by becoming more accustomed to them. The more you put yourself in uncomfortable situations the more comfortable those situations slowly become. Obviously this takes time and that’s why it is scary. But hopefully if someone reads this and they deal with anxiety it can give them hope that Mr. Ryan gave me to try to overcome it. The second group that this narrative is meant for are those who don’t deal with anxiety as often or already have processes in places to overcome anxiety. Everyone has anxiety, but some people experience it more often and with greater effect than others. My narrative allows someone who doesn’t deal with anxiety as often to get to see into my world and the way I think. 

The most meaningful insight I have gained is that the people around you have a huge impact on your language and literacy. If it wasn’t for Mr. Ryan I wouldn’t have pushed myself as much to actually try to overcome my anxiety and be social. It was Mr. Ryan who would constantly force me to participate in the beginning, and the person who I could talk to about my anxiety. He put me in the uncomfortable situations that I needed in order to improve. Then after that I began putting myself in those uncomfortable situations by choice. During the beginning of the year I was scared to talk to my classmates, but by the end I was able to ask the person next to me to be my partner in the Shark Tank project. For me that was a huge milestone because I was taking things into my own hands. The introduction to literature in English class such as Lord of the Flies and The Handmaid’s Tale was really important because of how I was able to relate to the characters. It made me feel less alone and helped me see how they themselves tried to overcome the terrible situations they were in through courage. Personally I never have read books by choice, so I never would have tried reading literature in order to find something in my life that felt like it understood me.

Purpose has definitely impacted my learning and my writing practices the most. The purpose of this narrative is to show the story arc of someone overcoming anxiety by confronting uncomfortability. Knowing the purpose of my narrative allows me to base a story around it in an easier way. This isn’t only apparent in writing the narrative, but also in life. Knowing your “why” allows you to have a guiding line of what your goal is. That’s what they always say when you’re on the journey to becoming a doctor: remember your why? The purpose served as a guiding line for the narrative and helped me draw on a moment in my life where I dealt with a lot of anxiety, which was when I moved to a new high school in 10th grade. 

This phase has helped me achieve exploring and analyzing in my own and other’s writing a variety of genres and rhetorical situations. During the peer review session where we shared our narratives within our group, I saw two really interesting and different narratives. Areej discussed the ongoing Palestinian-Israel conflict and how it has impacted her life. She discussed her own connection to her homeland and how that connection pushes her to advocate for Palestine through protests. In order to improve her ability to advocate she improved her language skills. This was so different compared to what I wrote as she used many different techniques to convey the passion she feels about ending this conflict, such as through her tone throughout the essay. In Ryka’s essay she discussed the relationship between her and her grandmother, which pushed both of them to explore each other’s cultures and languages. Ryka tried to be more into Indian culture while her grandmother tried to improve her English speaking abilities through apps such as Duolingo. The story really resonated as Ryka conveyed how much her grandmother was trying and how much she cared through the repetition of the quote “I am grandma.” This phase introduced me to two very different genres of writing that each have their own story and twist on how languages/literacy impacted them. 

Using the advice from my peers and Mr. Garfinkel, I went deeper into the key moments that helped me overcome my anxiety. I explained how Mr. Ryan was a role model to me because of how we both dealt with anxiety in our lives. This helped me in my journey to being able to overcome my anxious thoughts, which comes together in my Shark Tank presentation where my growth throughout the year is shown. A clear contrast is shown between how I felt in the beginning of the school year and how I felt by the end, displaying my growth. 

Written Narrative

Anxiety, the feeling of your heart dropping through your chest, while your brain is going a hundred miles per hour. Every thought is filled with “what ifs” and endless possibilities of what could go wrong. These were the only thoughts in my head when I had moved to a new high school in 10th grade. 

I was sitting in the far corner of my English class with my mask on, everyone else conversing about the reading assignment within their groups. “What should I talk about?” “How do I even start a conversation?” “What if they don’t hear me?” “What if I say something stupid.” My head thought of everything that could go wrong if I tried to speak. During this internal discord, my English teacher, Mr. Ryan had approached me, “Do you have anyone to work with?” 

My English teacher Mr. Ryan

My heart felt like it had been stomped on. I could see the pity in his eyes and I hated it. I nodded no and he left me alone. This constant struggle affected me everyday. I hated this anxiety and decided I would avoid it at all costs. In class I focused on getting my work done and at lunch I would just listen to music. But rolling up into a ball and avoiding social interaction only continued to hurt me. Having no one to talk to or anything to look forward to in the school day other than going home. 

I felt all alone, but I wasn’t. In his own little way, Mr. Ryan was trying to help me. For the next few weeks he constantly called on me trying to get me to talk. In discussions he would call on me first and keep asking questions to hear my thoughts. At first I was always terrified, scared of making an idiot of myself — of potentially saying the wrong thing. I was scared of being judged. But the more he called on me the more comfortable I became. It wasn’t just through discussion that Mr. Ryan pushed me, but also through writing. He gave a free write assignment where we could talk about whatever was on our minds. Instantly I was pouring onto the paper everything in my head. Like finally I could get how I felt out into the world. It felt relieving. 

After 20 minutes writing out my life story, Mr. Ryan said it was time to share and present the class a short synopsis of what we had written. My heart dropped. Mr. Ryan called on me first and even though I had my mask on, you could see the fear in my eyes. Talking in front of a large audience sent shivers down my spine. At that moment, I was stuttering, struggling to get my overwhelming thoughts together and even saying a cohesive sentence. Mr. Ryan noticed and told me to breathe and take a second to focus. It felt like a spotlight was on me, exposing my anxious vulnerability to the world. 

I focused on my essay, remembering what I had written and poured all my effort into. I had the words right in front of me, I just needed the strength to say it. I took a deep breath and realized if I mess up it’s okay, I just need to try my best. I started speaking and at one point I wasn’t even thinking, the words were just coming out of my mouth. The anxious thoughts that always hoarded me had disappeared just for those few minutes. I wasn’t thinking, I was just doing.

In English class through our discussions I was able to put myself out there more and more. Through the books we read I was able to find characters that related to how I felt. Piggy, one of the characters in the Lord of the Flies, was ignored and never felt included in the larger group. Serena Joy, from The Handmaid’s Tale, always felt alone in the beginning because she never had anyone to talk to about what she was going through. Both these characters were experiencing loneliness like I was.  I found solace within these two stories because it felt like I wasn’t the only one going through this. 

 After that day, I started taking more charge in class. As I began raising my hand more, I realized that speaking about the books we read — such as Lord of the Flies — allowed me to engage in an easier way. I could express thoughts that were locked behind my anxiety through the topics of the book, and sharing them felt empowering. This allowed me to gradually gain the confidence to start conversing with the people around me about the classwork. It didn’t go anywhere the first few times, but I just needed it to work once. This period marked significant growth in my life. Despite the initial discomfort and isolation, I began to understand how language could be a tool to overcome my internal discord.  

Mr. Ryan was someone that I could talk to about anything. After every class, I would go up to him and just ask him the most randomest questions. He was like a role model to me because he knew what it was like to deal with anxiety. We didn’t talk about it 1 on 1, but he had done a speech in class about dealing with anxiety when he was growing up and how he tries to overcome it everyday. He said that this was his first actual year of teaching and the first day of school he was terrified. He had to talk to an entire class of high schoolers and make sure they were actually learning. 

During the last month of school our final English project was creating an invention and presenting it in front of judges, similar to the show Shark Tank. Unlike the beginning of the year, I decided I wasn’t just going to sit in the corner afraid to talk to anyone. I asked the person next to me, Jake James, who would go on to become one of my closest friends, if he wanted to be partners for the project. We went on to create the Wheelie, a sports drink shaped like a wheel perfect to enhance any athletes or average person’s workout. We presented in front of three judges, one of them being the principal of our school. When Jake and I were called up to present I took a deep breath to calm myself. Don’t get me wrong my heart was still beating insanely fast, but I didn’t let it get to me during the presentation. I was going back and forth with the judges whenever they asked questions, and even made the class chuckle with some jokes (personal win). 

The ad for my Shark Tank invention, Wheelie

After the presentation ended, the judges ruled they would invest in our product. I was so happy with the presentation and how I stayed collected throughout it. After class, Mr. Ryan came up to me and said “You have grown so much this year Roop, I am so happy for you.” These words from Mr. Ryan meant so much to me because he was a role model to me. He knew what it was like to deal with anxiety.  We talked about dealing with anxiety and how he tries to overcome it everyday. It was his first actual year of teaching and during the first day of school he was terrified. He had to talk to an entire class of high schoolers and make sure they were actually learning. The presentations I would do every once in a while, he would do everyday. Even though he was my English teacher, I found it really easy to relate to him and that only lessened my feelings of loneliness. 

In the end, Mr. Ryan’s English class wasn’t just about speaking up, but learning how language could help me overcome my fears. Through reading, writing, and discussion, I found the confidence to express my thoughts and push my anxiety to the side. The uncomfortability was what led to my growth. Looking back I have changed so much as a person since then. I have continued journaling in my notes app and my ability to be social has increased drastically. The anxiousness hasn’t disappeared and I don’t think it ever will. But I have the courage now to push past it and show my true self to others.

Cover Letter

In this essay my audience was focused on people interested in learning more about pacemakers generally, but also alternative procedures being developed to improve on the weaknesses of pacemakers. This led me to organizing my essay in a specific way to attract my reader. By first describing the basics about pacemakers and then going into their impact on elderly patients both physically and mentally. This gives the reader a better grasp on pacemakers and then I provide a new alternative method that is very interesting and shows how much medical innovation is focused on improving things currently in medicine. This researched essay could also be focused on people within the healthcare field who may not have thought about surgery in this way and allows them to see a whole different perspective. 

The most meaningful insight I have gained in this phase regarding language and literacy is how many interesting topics there are out there that haven’t been properly brought to light. For example, I had never heard about this new alternative method to pacemakers that is non-surgical even though it could be revolutionary to the field of medicine. The amount of research articles I read shined a light but also gave me insight to how little I know. What other interesting new experiments or ideas are out there that just haven’t been popularized? Why aren’t they more of a focus?

In this phase I believe purpose impacted my writing practices and learning the most. When I thought about this topic my purpose was that of an innate interest in learning and understanding more about pacemakers. That led to me exploring this topic more and gaining so much information which genuinely interested me. These types of ethical ideas within medicine are very apparent and should be thought about when treating patients. As a future physician, I have gotten an even better understanding that everyone is different and that many factors lead to adjustments of treatment plans. One of these factors is age which changes how you can approach every situation. 

This phase helped me improve in locating research sources in the library’s databases or archives and on the internet and evaluate them for credibility, accuracy, timeliness, and bias. I utilized scholarly websites such as PubMed and JStor at the library to get a better understanding of my topic idea. I have never really used JStor before and the resources available to me through the CCNY library were essential to this research paper.

Life saving or Prolonging Suffering: The Ethical Dilemma of Pacemakers in Geriatric Care

Every heartbeat is a testament to the body’s resilience, yet for millions, that rhythm may falter as they age, putting their lives at risk. For elderly patients, the idea of surgery, especially for something as vital as installing a pacemaker, can be scary due to the possible risks and the physical toll. However, pacemakers — small devices implanted to help regulate the heart’s rhythm — have transformed cardiac care, offering patients a longer life by preventing slow heart rates. While it’s true that surgery can be particularly challenging for elderly patients, the life-enhancing benefits of pacemakers far outweighs the potential consequences of going through this procedure. 

Pacemakers are important devices that help treat bradyarrhythmia, a heart rate beating fewer than 60 beats per minute, which can be due to family history, medication side effects, heart defects, and heart attacks. “All cardiac pacemakers are generally composed of a pulse generator that generates the electrical current required for stimulation of heart musculature and 1 or 2 electrodes, which are responsible for transmitting the electrical activity generated by the pulse generator to the heart musculature” (Lak). The pacemaker essentially sends an electrical current replicating the one a normal heart is supposed to have. It sends the current through these electrodes whenever the heart falls below a certain beats per minute that could be dangerous to the patient. The electrical current gives the heart a shock and allows it to return back to a normal, safer rhythm.  

Living with a pacemaker does require adjustments to daily life. For example, patients must avoid electromagnetic interference by maintaining a safe distance from certain items, such as airport security scanners, MRIs, electric drills, and cell phones (Fogoros). These changes can significantly impact an elderly patient’s day-to-day activities, requiring additional care and awareness. Richard Fogoros’ article, 14 Things You Can’t Do With a Pacemaker, outlines some of these challenges and the necessary lifestyle modifications. While these adjustments might seem restrictive, they are minor compared to the benefits pacemakers provide in improving heart function and extending life. 

The benefits of pacemakers are clear in survival data. “The observed 5-year survival was 45% in our patients aged 85 years or more. It compares well with previous studies on patients > 80 years that showed a survival in the range between 40% and 49%” (Marini). For instance, nearly 90% of 50-year old patients who receive pacemakers can extend their lifespan by 10 years. These findings emphasize the importance of timely intervention, even for elderly patients. Extending life by even a few years can provide precious time for individuals to enjoy with loved ones and pursue meaningful experiences. 

According to Trabosky et al., the later you implant pacemakers the decreased probability of survival as the years go by. In the figure above you can clearly see that when the pacemaker is implanted into a 50 year old, almost 90 percent have their lifespan increased by 10 years. As the age you implant the pacemaker increases the positive impact on the lifespan of the patient decreases. In patients that are 70 years old less than 50 percent have their lifespan increased by 10 years. The graph clearly shows the later you receive the pacemaker the less it will add to your lifespan. This figure shows just how much of an impact pacemakers can make. An elderly patient that is 65 and above can have their lifespan increased by even a couple years is an amazing feat. It means they can have more time to spend with their significant others, their kids, and their grandchildren. Even the extra year a pacemaker can provide is vital to allowing a person to live out their life to the fullest. 

However, opposing sides argue that even with the increased lifespan that pacemakers may provide, how long does it actually take elderly patients to recover from surgery? “In general, the older patient will have a longer recovery time than a younger patient and is expected to have more complications. In short, the elderly surgery patient will require more support than a younger one, from both professional healthcare providers and other individuals” (Whitlock). For elderly patients the path to recovery becomes much different after a surgery. They require more oversight and may even need to be put into a rehabilitation facility to receive proper care. Due to their age, they have increased chances of complications which can increase recovery time even longer. These unknown variables make it an even scarier experience for the elderly. The increased lifespan that pacemakers can provide just becomes used to recover from the surgery and not actually be able to enjoy your life to the fullest. 

Furthermore, Kenneth Convesky’s research on the cognitive, functional, and psychological effects of surgery raises valid concerns. “Overall, 225 (17 percent) of the patients who underwent major surgery died within a year. Several measures were associated with increased mortality, including activities of daily living, inability to walk several blocks, dementia and depression” (Convesky). These factors highlight the potential risks and the need for a balanced approach when deciding whether surgery is the right choice for elderly patients. The association between increased mortality and difficulties with activities of daily living, mobility limitations, dementia, and depression suggests that these vulnerabilities may compromise a patient’s ability to recover from the physical and psychological stress of surgery. 

With so many possible side effects, researchers are trying to look for non surgical methods to help cure bradyarrhythmia. The article “Harnessing cell reprogramming for Adrian biological pacing” by Chih-Min Lin M.D., director of the division of cardiology at Taipei General Hospital, talks about the potential of biological pacemakers as a natural alternative to conventional electronic pacemakers. Current electronic pacemakers are effective but have many risks such as mechanical failure, infection, and a lack of adaptability. The authors advocate for cell programming as a solution where normal cells are converted into pacemaker cardiomyocytes. These cells mimic the body’s intrinsic rhythm, and they are a more organic reliability solution because you are using the person’s own ordinary cells. This article talks about an alternative to electrical pacemakers that could be safer, reduce reliance on implantation hardware, and reduce the surgery’s needed.

The figure above from the article “Harnessing cell reprogramming for Adrian biological pacing” by Chih-Min Lin, shows the progression of pacemakers throughout time. But the fourth image is the alternative method that these researchers hope will become the new norm. It’s a clear diagram of the heart and shows the placement of the catheter which will place the biological product into the heart and allow the creation of a biological pacemaker. 

Pacemaker implantation in elderly patients presents a complex ethical landscape that necessitates careful consideration of several key principles. Foremost among these is patient autonomy—the right of individuals to make informed decisions about their own healthcare. Ensuring that elderly patients fully understand the benefits, risks, and potential outcomes of pacemaker surgery is essential for honoring this autonomy. This involves transparent communication about the procedure’s impact on quality of life, possible complications, and the realistic expectations for recovery and longevity. Additionally, the principles of beneficence and non-maleficence require healthcare providers to balance the potential benefits of pacemaker implantation against the risks and burdens it may impose. For some elderly patients, especially those with multiple comorbidities or limited life expectancy, the invasiveness of surgery and the subsequent recovery period may outweigh the advantages of the device. Therefore, a thorough, individualized assessment is crucial to determine whether the intervention aligns with the patient’s overall health goals and values.

Furthermore, the decision-making process should involve a multidisciplinary approach, incorporating insights from cardiologists, geriatricians, ethicists, and, importantly, the patients and their families. This collaborative strategy ensures that all aspects of the patient’s health—physical, cognitive, and emotional—are considered. It also facilitates discussions about alternative treatments, including less invasive options or palliative care, when appropriate. By engaging in shared decision-making, healthcare providers can respect the patient’s autonomy while also fulfilling their ethical obligation to act in the patient’s best interest. Ultimately, the goal is to arrive at a decision that reflects the patient’s preferences and values, ensuring that the chosen course of action promotes their well-being and dignity.

This new innovative research highlights a different approach to treating bradyarrhythmia in a non surgical way. Patients could just come in and have a catheter that will turn a person’s normal cells into tiny pacemakers. It would be non invasive, no recovery time needed, and would provide the same benefits that pacemakers already provide just with less risk. More research is definitely needed, but this showcases how there is so much more to be done within medicine. So many areas where we can improve outcomes and the general quality of life for our patients. 

Pacemakers have already revolutionized the treatment of bradyarrhythmia, and their impact on cardiac care continues to grow. Despite the challenges of surgery and recovery, their ability to extend life and improve heart function makes them an invaluable option for many elderly patients. There are still improvements to be made that can remove the recovery time of surgery. Alternatives like biological pacemakers promise to further enhance care, ensuring that patients can live longer, healthier lives with minimal disruption to their daily routines. This progress underscores the endless possibilities within medicine to improve outcomes and quality of life for all patients.