Nisus steps forth.

Meanings that Roman authors gave to nisus (NYsus), a word chiefly used in poetry, ranged from the pedestrian (a step or tread) to the celestial (the course of the stars). Cicero, Horace, Vergil, and others used nisus to convey striving, endeavor, ascent, flight, and the pain of giving birth.1,2 In this issue of Neurology, a new feature, Nisus, steps forth, to link neurology and neurologists with philosophy and literature—areas of learning concerned with thought and human relations—and with the arts. In Nisus, readers will find poems, short fiction, and creative nonfiction replete with illustration, imagery, scenes, and dialogue. There will be essays that draw upon the personal history of the writer and memoirs that provide personal insight concerning important topics. There will be a focus on neurologic themes in the broader context of medicine and society. We urge you, our readers, to help us in various ways: to send us your own creative writing for publication, to encourage contributions from qualified writers both within and outside the AAN, to volunteer to perform peer review under my supervision as Nisus Editor, and to share your comments and opinions concerning this new direction for the journal. Your participation will determine its success. In 2000 and again this year, the American Academy of Neurology (AAN) awarded a $2,000 prize for Creative Expression of Human Values in Neurology: $500 to the winner and $1,500 to a charity of the winner’s choice. The award recognizes creative writing that inspires understanding of and compassion for those suffering from neurologic disorders. Each year, approximately 30 AAN members submitted either short fiction or poetry that was judged for its focus on human values in the doctor–patient relationship, its originality and creativity, its potential to change for the better the way neurology is practiced and the outcome of care for neurologic patients, its artistry and skill of presentation, and its ability to communicate to the reader. The judges—all of them published writers—were either physicians or persons with neurologic conditions. Michael A. LaCombe, who edits “On Being a Doctor” for Annals of Internal Medicine, and I judged both competitions. John Stone, dean, cardiologist, and distinguished poet, judged the contest in 2000. Floyd Skloot, who judged both this year and last, has been able to continue a career as a writer of awardwinning novels and poetry despite contending for more than a decade with serious consequences of encephalitis. Many of his poems have appeared in the Journal of the American Medical Association. June Price, who became a judge this year, founded and until recently edited Living SMArt, a newsletter by and for adults with spinal muscular atrophy, a condition she has had since infancy. She has also written a book to help disabled individuals live independently. Her insights are worth the time of neurologists, even those of us who may have thought we knew all about caring for severely weak patients. The winner of the 2000 competition was Dr. Peter B. Kang, who was then a resident in pediatric neurology at the University of Pennsylvania. His story, “Playing Hooky,” about a routine office visit and what did and did not happen on that day, is an appropriate introduction to Nisus.3 In forthcoming issues, we will publish this year’s winning story, other notable contributions to the contest, and material newly submitted to Nisus. Some new submissions may be guided by the precepts of the Human Values award. Many, we hope, will take new directions. No line separates fact from fiction. Everyone’s fiction is someone’s fact and tomorrow’s fact is today’s fiction. Nonetheless, the uses of fact and fiction are distinct and, if possible, a distinction should be made. In 1988, an anonymous account of giving a lethal dose of morphine to a dying patient appeared in the Journal of the American Medical Association.4 The story, which became notorious, was not verified and may or may not be true. That uncertainty is important: there is a difference between reporting one’s personal act of euthanasia—performed, however misguidedly, out of compassion for suffering— and contriving a polemic against euthanasia in the guise of a case report that is actually false. Nisus intends to avoid such ambiguous situations: authors will publish under their own names and will be asked to label their prose submissions as fiction,