Rituals Stir our Memories and Push us toward Transformation

 From the 5/28/2021 - Memorial Day - newsletter

Director’s Corner

Rituals Stir our Memories and Push us toward Transformation 

Adina Kalet, MD MPH

In this week’s Director’s Corner, Dr. Kalet asks us to both attend to our need for commemoration of the very difficult time with rest and reconnection while we also work to sustain hard won transformative gains …

Memorial Day weekend is especially poignant this year. As a nation, we are exhausted. We have collectively experienced fourteen months of a frightening, isolating, unpredictable pandemic, an eye-opening year since the murder of George Floyd, widespread calls for social justice, and a nail-biting presidential election. We have been irrevocably changed and are emerging - in fits and starts - into a new post pandemic reality. Now that many of us have been vaccinated against SARS-CoV-2, we are eager for the summer season to kick off.

In many ways, the past months have forced us to innovate, create, and find new ways to conduct our lives. It is not yet clear which of these changes are good or sustainable, but we are different now than we were then.

Rituals and gratitude are important as we honor those who have served

In this Transformational Times issue, Capt. Tej Ishaan Mehta MD, who is an Internal Medicine resident at MCW, movingly recounts how Memorial Day came to be after the Civil War, when our deeply divided nation emerged from that awful, bloody conflict. He writes, “Across the North and the South, the fallen from both sides of the war were honored, respected, and remembered, continuing their service even in death by helping to reunite the country.”  He reminds us that ritual and symbolism have the power to bridge our gaping chasms and heal our festering wounds. 

This issue also features a fascinating excerpt from Richard N. Katchske’s new book, Knowledge Changing Life: A History of the Medical College of Wisconsin, 1893-2019. Mr. Katschke, MCW’s Chief Historian, describes our medical school’s mobilization during World War II.  Our faculty and students served the nation by embracing a dramatically accelerated curriculum to ensure a supply of physicians prepared to go to war. And go to war they did. Many served with great distinction, and one made the ultimate sacrifice. I plan to read Katschke’s entire book (I will share some highlights) and recommit to a favorite pastime of studying the class portraits that line the hallways on the main floor of the medical school building. I will inspect the faces and uniforms, knowing that many served overseas or at home in a war effort. How many were impacted by WWI, WWII, Korea, Vietnam, Iraq, and Afghanistan? Who went on to have careers touched by the influenza pandemic of 1918, by HIV/AIDS, or by other national challenges?  I will wonder. 

On this day, we honor the individual soldiers who made the ultimate sacrifice to protect and defend our many precious freedoms.  It is important to commemorate them, and we must support their grieving families and the loved ones who were left behind. It is a somber but awesome opportunity to take time to honor their losses, recognize their sacrifices, consider what they have taught us, and pledge to make a difference in the world they shaped. 

An evening ritual in New York and beyond

The response to COVID-19 inspired its own rituals. Starting mid-March 2020, at 7:00 p.m., everyone on my block in Brooklyn, NY came out on their stoops to make “noise” (some had musical instruments) for a good twenty minutes to celebrate the health care and essential workers who went to work every day at the hospital around the corner. This nightly ritual, which was occurring at 7:00 p.m. all over the globe, continued daily for many months, and evolved into a means for neighbors to check in with each other and socialize. It was so joyous and silly, that I found that I missed it when it petered out. 

Although not a part of our national Memorial Day commemoration, those of us in health care, and those whose families have been touched, also remember relatives and friends who died from COVID-19. The rituals to honor front line health care workers and first responders remind us that, as a society, we must address the unconscionable health disparities and social ills that put so many, particularly our Black and Brown citizens, at outsized risk.  As of yesterday, an estimated 3,511,748 worldwide have died of COVID-19, and it isn’t over yet. In many parts of the world, hospitals resources are overwhelmed, oxygen is not available, and vaccine supplies and infrastructure are inadequate. Despite the circumstances and at enormous personal risk, our international health care colleagues face the pandemic and do their duty with character and compassion. Heroes are everywhere. Perhaps someday soon, there will be a COVID-19 Remembrance Day.

Medical Education will continue to transform 

How will we remember these pandemic times? Will they change our work when things return to something resembling “normal”? I suspect that there will be many tell-tale signs stamped on our educational practices. We have new levels of savvy with technology-enabled education, admissions processes, international conferences, and performance-based assessments. We have narrowed the “digital divide” between us and our applicants and students to address issues of equitable access. Even if a significant proportion of medical education remains remote, we will be better at enhancing face-to-face sessions with meaningful, integrative faculty-led small group experiences. While fancy equipment and simulators might be irreplaceable for some types of teaching, expanded use of low-cost virtual reality devices and mobile apps offer areas of untapped potential. As we harness new educational practices, what we discover will become endlessly scalable. 

Emerging from the pandemic will also help us re-commit to preparing our trainees to practice in, and influence, health care systems. How do we help our students and trainees see the “big picture” of medicine in society? How do we enable our trainees to provide outstanding, equitable health care to the marginalized? How do we prepare for future pandemic and health crises? Can we embrace technology, yet keep medicine humane? We will need to integrate the transformational goals of the Kern Institute into a constantly evolving medical education landscape.

Wars and pandemics have lead to unspeakable, senseless horror. Both, however, have also resulted in opportunities for innovation. Battlefield medicine during WWII led to life-saving civilian improvements in trauma care, limb salvage, reconstruction, and antibiotic use. The pandemic offers opportunities, as well and, as we commemorate the many losses of the past year, we will fiercely embrace the future. 

Too many have died both in battle and from preventable, treatable disease. We insist that they did not die in vain, and pledge to learn something good and important in their honor. 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.