The Gift of Presence

 From the December 20, 2023 issue of the Transformational Times

The Gift of Presence  

Karen Herzog

“Greetings from Milwaukee! It’s the season of miracles, and we have a little one named Kelsey Marie. She views the world through big, blue eyes, and has an Eveready smile. Seven months into her life, we’re still in awe of everything she does. All Kelsey wants for Christmas is to crawl, and we believe she’ll get her wish any day now…” 

– Our Family’s 1995 Christmas letter 

Despite the magical lead-up to our firstborn daughter’s first Christmas, a painful ear infection and high fever made her inconsolable, and left us at wit’s end, on Christmas Eve. We finally did what many parents do when physician offices are closed and there’s no urgent care: We bundled her up in the wee hours of Christmas morning and drove her to the ER of the small hospital in my hometown, where we were visiting my parents. 

Kelsey was the only patient at that hour, and the ER was peaceful before her crying pierced the silence. Thankfully, relief was on the way when a young resident appeared in the examining room. The amoxicillin he prescribed (with a dose of reassurance for her anxious, sleep-deprived parents) was a small Christmas miracle. 

I wish the bleary-eyed resident who crawled out of an on-call room bed at 4 a.m., because of a crying child’s non-emergency ear infection could have seen that tiny patient a few hours later, once the amoxicillin kicked in. There’s nothing sweeter than a sweet baby, cheeks still flushed from fever, staring in awe at the twinkling lights on her grandparents’ Christmas tree, her first Christmas morning. 

Of course, first holidays of life often stand in contrast to last holidays of life. I can’t think about one without the other, as my mom died four days before Christmas four years ago. She was 90. 

The awe I felt at the end of my mom’s life was for the healthcare workers. Their presence was as warm as the Christmas lights that filled her room in a skilled care facility. 

This holiday season, my wish for healthcare workers who make tremendous sacrifices to “be there” for patients in hospitals and skilled care centers is to know their presence is a gift that will hold a special place in the holiday memories of those they touch. 

Karen Herzog is the copy editor of the Transformational Times. In a previous life, she was an education reporter at the Milwaukee Journal-Sentinel.  

Christmas Morning Rounds

From the December 21, 2023 issue of the Transformational Times

Christmas Morning Rounds

Bruce H. Campbell, MD FACS

In the days running up to the Christmas Holiday, the Transformational Times editors offered reflections. Here, we publish an essay by editorial board member, Dr. Bruce Campbell.

Many years ago (even before HIPAA), my family was visiting for the holidays. On several occasions I had tried, without a lot of success, to explain to my father what I did for a living as a head and neck cancer surgeon. On this day, I looked at him and said, "Dad, I have to see a couple of people in the hospital this morning. Do you want to come with me?" He readily agreed.  

A few minutes later, we arrived at the inpatient floor. One of my patients that day was a man in his early 30s who had undergone cancer surgery to remove part of his cheekbone the day before. He had done well overnight and was recovering. I stuck my head in his room.  

“Merry Christmas!” I said. “I know this is unusual, but my father is with me this morning to make rounds. He is not a doctor—actually, he is a retired dime store owner—but he would love to meet you. Do you mind if he comes in with me?”  

“Really?” replied my patient. “Sure! That would be fine.” 

I returned to the hallway and explained that the patient’s face was pretty swollen but that he was otherwise doing fine. My dad nodded and we went in. I introduced them to each other. If my father was surprised by the man’s early post-operative appearance, he did not let on.    

“Good morning!" said my dad. “Nice to meet you! How are you doing today?”  

Despite his swelling, my patient replied, “Actually, I’m doing very well, thanks. Better than I expected.” The young man was lying in bed with one eye nearly shut and his cheek full of packing material. His upper lip was swollen, making conversation a bit of a challenge. Nevertheless, as I checked his surgical sites and looked through the notes in his chart, my dad asked the patient about his cancer, his hometown, and his family. My dad, a distinguished looking gentleman with graying temples, nodded and smiled, absorbing the story.  

The patient asked my dad, “So, how long do you think I will be in the hospital?” My dad smiled and glanced at me.  

“I don’t know what my dad thinks, but I think you’re doing great,” I said. “I predict you’ll be ready to go home the day after tomorrow.”  

“Thanks again, Doc. I’ll let my family know.” We all said goodbye and Dad wished him well. After we finished seeing my other patients, Dad and I headed home for our family’s Christmas meal. 

For years, my father recalled the day we made rounds together. He would remind me what he had seen and would ask how the patients were doing. Those few minutes had given him a glimpse into my life and work that I had never, ever been able to adequately share by trying to tell him what I did. 

A few years ago—and long after my dad had died—I received a holiday card from the patient, marking the anniversary of his hospitalization. “I remember you and your father even came in to see me on Christmas Day! I will never forget that,” he wrote.  

I was surprised by how much that one brief Christmas morning rounds encounter had impacted both my father and the patient. The shared experience had preserved the memory and sharpened our senses. I wrote back to the man, now a long-term cancer survivor, that I was very grateful I had been able to share that moment of insight, healing, and presence, both with him and with my dad.

It is a Christmas present I have always treasured.

Bruce H. Campbell, MD FACS is a retired professor in the Department of Otolaryngology and Communication Sciences at MCW. He has been on the Transformational Times editorial board since March 2020. www.BruceCampbellMD.com 

'Twas the Night Before Christmas: Love, Grief, and Snowflakes

From the December 21, 2023 issue of the Transformational Times

'Twas the Night Before Christmas: Love, Grief, and Snowflakes

Kathlyn Fletcher, MD MA

In the days running up to the Christmas Holiday, the Transformational Times editors offered reflections. Here, we publish an essay by editorial board member, Dr. Kathlyn Fletcher.

My mom loved snow.  When she was alive, she would always call me on the first snow of the year, even when we lived in different states, and it was only snowing where she was.  Having a white Christmas was very special to her--almost sacred--and I wished for snow every year because she loved it so much.  I grew to love it, too.   

One year when I was in high school, we had a stubbornly brown landscape right up to the time that we stepped into the Presbyterian Church on Christmas Eve for the 11:00 PM service.  I loved that church service; we sang favorite Christmas carols and ended with Silent Night by candlelight; magical in its consistent simplicity.   

We left church that night to find that it was snowing beautiful, large flakes, and the streets were already completely blanketed with the quiet, peace of heavy snow.  My mother and both had tears in our eyes as we looked around.  It felt like a small gift meant just for us. 

My mom loved the Christmas season, and writing this remembrance makes me teary that she is gone and grateful that I had her at all.  The holidays will do that to a person.  A few years before she died, she recorded herself reading Twas the Night Before Christmas and gave it to my daughter.  

Every Christmas Eve, we open the book and listen to her voice reading to us as we sit together in our matching Christmas pajamas.   Every year, I feel simultaneous grief and love.  It's a hard place to live, but it's worth it.  Miss you, Mom.    

Kathlyn Fletcher, MD, MA is a professor in the Department of Medicine at MCW and program director of MCW's internal medicine residency. She is a longstanding member of the Transformational Times editorial board. 

 

A Message from the One Who Stays Home while the Resident is Working

 From the December 24, 2021 issue of the Transformational Times

A Message from the One Who Stays Home while the Resident is Working

Clare Xu

Hospitals don't slow down just because the calendar says it is time for a holiday. This essay, originally published in December 2021, shares how the spouse of an internal medicine resident altered her family Christmas plans so that her resident-spouse would also have a special celebration. Remember, this was when COVID-19. vaccines were just becoming available ...

When my husband and I got married in November 2021, our officiant had us make a list of the five things that we love most about the other person. My husband shared that I “live in the moment and celebrate the small things.” Fair enough, though he didn’t mention that I also love to celebrate the big things. By that I mean all the festive holidays: Thanksgiving, Christmas, New Year’s, Valentine’s Day, Easter, and Halloween (plus a few more!).

Christmas is probably my favorite “big thing” to celebrate. Unlike me, my husband didn’t grow up celebrating Christmas. When we got together, he went from living without a single Christmas decoration adorning his dwelling to a home popping with red, green, gold, and silver. He now enjoys our felt garlands hung across the mantle, snowmen, reindeer, and whatever else I bring home. I introduced him to many other Christmas traditions enjoyed by my family, including Christmas crackers, blintzes, and The Muppets Christmas Carol. It brought me joy to share my family Christmas traditions with my husband.

Last Christmas, Zhu was scheduled to work on Christmas Day. I started planning early, considering ways that I could include him in the festivities. My goal was to maximize my participation in my family Christmas celebration while still preserving a special bit of the Christmas magic for Zhu. After conferring with my family on the matter, we opted to have two Christmas celebrations: one on Christmas Day with everyone except Zhu, and one in early January with Zhu as the guest of honor.

On Christmas Day, after celebrating with my family, I dashed back home, through the snow with our two dogs sitting in the back of the car, determined to be there to greet Zhu when got home. My husband never wants anyone to make a fuss over him. He said that he wouldn’t have been bothered if I had chosen to stay on at my parents’ house for Christmas dinner, and I am sure that he was sincere. I explained to him that above all, Christmas is about giving; not just presents and food and all of the other trappings, but of ourselves. He’d spent his Christmas giving to his patients who, on this special day, deserved the utmost care and compassion. By being there for him, at home, on Christmas Day, I was able to show him how much I love and value him.

For our January-Christmas, I arranged with my parents to leave all of the gifts for and from Zhu unopened, and the holiday decorations up exactly as they were on Christmas Day. This day was for Zhu. Of course, the attention made him feel a little shy, but we all knew how much he appreciated the gesture and the opportunity of joining in the festivities.

I believe that preserving celebrations and tailoring them to Zhu’s work schedule helps him to focus on his patients. He doesn’t have to feel that he is missing out and give into feelings of loneliness. He might not be able to celebrate with his loved ones on Christmas Day, but he is helping people who are struggling on Christmas Day. This might be the worst day of their lives and their families. They’re scared and maybe in pain. I like to think that the staff who are taking care of the patients will be able to bring joy and healing, even on holidays.

This essay was written while Zhuchen Xu, MD was completing his internal medicine residency. Dr. Xu is now on the MCW faculty. 

Human Flourishing: Judaism, Medicine, and a Life Well-Lived

From the December 16, 2022 issue of the Transformational Times

Human Flourishing: Judaism, Medicine, and a Life Well-Lived

Sarah Root

The Kern Institute believes that human flourishing is central to the health of physicians, caregivers, patients, and society. In this essay, initially published one year ago in the Transformational Times, medical student Sarah Root shares some family stories that highlight her thoughts on faith, flourishing, and the practice of medicine from the perspective of Judaism ...

How can one do the most to help others and uplift the world?

 

Unlike in many religions, Judaism does not generally concern itself with what happens spiritually after death. As a seventeen-year-old reeling from the loss of her grandmother to cancer, this was a surprising comfort to me. From my dad’s eulogy where he reminisced about some of her best traits (the dedication of her life in support of the arts) and her most eye-rolling (her unwavering belief that Melba toast and cream cheese represented a complete breakfast), to the shiva services in which family, friends, and extended community gathered to share anecdotes, quirks, and fond memories (and of course, food), the focus was not on grief. 

That’s not to say that there weren’t tears, but they were intermixed with laughter as we sat there together, eating bagels and lox in celebration of a life well-lived. This emphasis on life is not unique to the Jewish mourning process, but is a central tenet in Jewish philosophy as a whole. Moreso than simple recognition, Judaism holds the preservation of life as one of its highest values. By Jewish law, the pursuit of saving a life supersedes all but four of the 613 mitzvot, or G-d’s commandments, in the Torah. It is this regard that exempts the sick from fasting on Yom Kippur (the Day of Atonement), permits Jews who might go hungry otherwise to break kashrut (the dietary laws), and allows abortions to save the life of the mother. But the simple concept of preserving life is meaningless without a Jewish concept of what it means to live, and perhaps even flourish.

In the Pirkei Avot (teachings by rabbis throughout the ages), Shimon the Righteous coined the idea of al shlosha d’varim, or the three principles on which the world stands: studying Torah, performing avodah, and practicing gemilut hasadim (Pirkei Avot 1:2). To study Torah is to read the fundamental Jewish religious text and learn how to live an honorable life. Historically, avodah referred to sacrificial rites performed in the temple. Throughout the centuries its religious meaning expanded more broadly to worship and divine service, while in modern Hebrew, avodah simply translates to work. Finally, gemilut hasadim are acts of loving kindness, a spiritual calling for Jewish people to help others.

There is interplay between the concept of an individual’s actions in following the al shlosha d’varim and the flourishing of broader society. In Jewish teachings, it is clear that the personal and the community are intrinsically linked concepts, and that one cannot find meaning without the other. From the Torah, we Jews learn the mitzvot and the stories of our people, providing an ethical framework and bringing us closer to our communities, our history, and to G-d. This is the fundamental basis for the Jewish concept of l’dor v’dor, a phrase which translates to “from generation to generation,” and encompasses the sharing of traditions, stories, and values between generations. In participating in l’dor v’dor, we enrich both our own lives and those of our communities by building bonds of love and respect.

In practicing avodah, we Jews find spiritual fulfillment, which may seem personal at first. However, communal worship is a requirement in religious Judaism. For public prayer, a minimum of ten people (historically men) must participate in order for the obligation to be met. 

But I would also like to point out that avodah means more than just worship; it also refers to divine service and work. These two concepts remind me of a story that my rabbi used to tell, in which every week a man would bring a loaf of bread as an offering to G-d and leave it in the ark, where the Torah scrolls are kept. And every week, another man would come pray to G-d, asking for food to feed his family. When he would open the ark, the bread would be there, his prayers answered. When the two discovered each other, both were initially upset; the first because G-d was not receiving his offerings and the second because G-d was not answering him. But their rabbi simply laughed. G-d, he said, was listening to their prayers. By offering the bread, the first man was acting as the hand of G-d to fulfill the prayers of the second.

The story illustrates that divine service is not passive, and that true prayer is not just holy words, but actions that emulate the divine. This understanding is fundamental to the third pillar of al shlosha d’varim: gemilut hasadim, or acts of loving kindness. The scope of this is broad, encompassing anything from caring for the sick, to volunteering at a food bank, to waking up to drive your brother to school at 6:00 AM so he doesn’t have to bike in the rain. Gemilut hasadim is about dedicating your actions to uplifting your community in a way that is personal. 

Gemilut hasadim is notably separate from tzedakah, generally translated as charity, one of the most important mitzvot. It is explicitly commanded in in the Torah to “open your hand to the poor and needy kin in your land” (Deuteronomy 15:11). But in modern translations, tzedakah means more than just charity. The root of the word is tzedek, meaning justice and righteousness. Giving charity can thus be seen as a facet of restoring justice to the world. With this interpretation, tzedakah has extended to not just mean giving money, but also giving time, reiterating the importance of actions in Judaism. This concept underlies Jewish support for many social movements: if we ourselves are to flourish, then we must ensure that everyone can flourish.

The concepts of al shlosha d’varim, l’dor v’dor, and tzedakah come together in turn to form the spiritual foundation for tikkun olam, the Jewish imperative to repair the world. In Kabbalistic Judaism, this moral mandate is explained through the shattering of the vessels, a revision of the creation myth. In this story, when G-d is creating the world, he puts his divine light into several vessels. These vessels were intended to be spread throughout the universe and make it perfect.

But the vessels were unable to contain G-d’s divinity and they shattered, sending sparks far and wide. Tikkun olam, Kabbalistic Judaism states, is the process of finding the sparks and gathering them, by acting as the hands of G-d in helping others. When enough of these sparks are gathered, the vessels can be restored, and the world can once again be made whole. Tikkun olam, in essence, is a directive for how to live a meaningful life. The concept of human flourishing in Judaism then becomes a simple question: how can one do the most to help others and uplift the world?

It is this cultural mindset that encourages many Jews, such as me, to pursue a career in medicine and informs our perspective on providing care. Medical practice inherently encompasses many critical Jewish values, namely an ultimate respect for life and acts of loving kindness. Healthcare workers dedicate their time, on nights, holidays, and weekends, to ensure that the ill can continue to receive life-saving care. Medical education is itself l’dor v’dor, as knowledge, passion, and ritual are passed down from each generation of physician to incoming medical trainees. And the medical field is a community intended to uplift patients, families, and healthcare workers, a direct extension to the communities that we as Jews are morally called to participate in.

The Jewish physicians that I know flourish when their patients flourish, but only so much can be done by the bedside. Thus, the concept of tzedek teaches us that as physicians we have a responsibility to ensure that patients are being treated with justice, both in the clinic and in the broader world. This is ever more important in a society where the cost of care continues to increase, and people are threatened with lack of access. We must strive for tikkun olam, to repair the parts of the system that are broken and advocate on a broader level as a community.

This past Thanksgiving, my grandfather pulled me aside to give me some words of wisdom as a lifelong physician himself. Remember, he said, that medicine is not just a practice, but a privilege. In this, I see a redefinition of the word avodah. Perhaps the distinction between worship, divine service, and mundane work is far smaller than one might initially imagine. When the work is serving others, is that not a form of worship in its own right? I hold all of these Jewish principles close when learning to provide care, when advocating for my patients, and when approaching difficult situations with respect and an appreciation for life. In becoming a medical practitioner, I am laying the groundwork for my own Jewish flourishing.

Sarah Root is an MD/PhD student at the Pritzker School of Medicine at the University of Chicago; she was in her second year of the program when this essay was published in December 2022. She is a graduate of the University of Pennsylvania and is passionate about the intersection of Judaism and ethics. Email: sroot@uchicago.edu

Who Are We? Beyond Earth at the Intersection of Bioscience and Religion

From the December 16, 2022 issue of the Transformational Times

Who Are We? Beyond Earth at the Intersection of Bioscience and Religion

Annie Friedrich, PhD and Ryan Spellecy, PhD

In December 2022, the Medical College of Wisconsin, Marquette University, and Viterbo University hosted its first seminar on ‘Big Questions’ at the intersection of bioscience and religion. A perhaps unlikely pairing of a theologian and an astronomer explored what it means for humans to be unique in the vastness of the universe…

A theologian and an astronomer walk into a room…while this may sound like the beginning of a joke, this was the scene on December 5, 2022, for the inaugural session of a new seminar series called "Big Questions," which explores the intersection between bioscience and religion. Moderated by MCW’s Aasim Padela, MD, this series aims to foster interdisciplinary humble and fruitful dialogue, build bridges of understanding, and spark curiosity at the juncture of religion and science. The series seeks to replace the question of science or religion with “where do science and religion find common ground?”

More than 50 MCW faculty, staff, medical students, and community members heard from Astronomer Jennifer Wiseman, PhD and theologian Jonathan Crane, PhD, MPhil, MA. Dr. Wiseman is the Emeritus Director of the Dialogue on Science, Ethics, and Religion at the American Association for the Advancement of Science. Dr Crane is the Raymond F. Schinazi Scholar of Bioethics and Jewish Thought at the Ethics Center, and Professor of Medicine and Religion at Emory University.

The question that began this series is a simple one: if there is life on other planets, what does that mean for human significance? Dr. Wiseman explored this question in light of astronomical discoveries, while Dr. Crane offered a Jewish perspective on the question of human uniqueness in the context of life beyond earth. While these perspectives may seem to be at odds, Drs. Wiseman and Crane had more in common than one might think, which is perhaps the point of interdisciplinary dialogues such as these.

In the vastness of the universe, are humans significant?

As Dr. Wiseman approached the podium, the lights were dimmed as a breathtaking photo of thousands of stars filled the screen. Thanks to technology like the Hubble Telescope, stars are no longer just small pinpricks of light; the image on the screen showed bright flashes of red, blue, and yellow. According to Dr. Wiseman, there are more than 200 billion stars in our Milky Way galaxy alone, which may lead one to feel small and insignificant.

Astronomer Carl Sagan may sum up this feeling of insignificance: “Who are we? We find that we live on an insignificant planet of a humdrum star lost in a galaxy tucked away in some forgotten corner of a universe in which there are far more galaxies than people.” And yet, Dr. Wiseman did not find this insignificance or smallness deterministic or fatalistic. Rather, she saw this as an opportunity to be inspired. Space exploration provides an invitation to explore what we don’t yet know or have not yet encountered, and Dr. Wiseman accepts that invitation gladly.

Betzelem Elohim: A Jewish perspective on human uniqueness

At the end of her remarks, Dr. Wiseman offered a counter to Dr. Sagan’s quote in Psalm 8:3-4 which says, “When I look at your heavens, the work of your fingers, the moon and the stars, which you have set in place, what is the man that you are mindful of him, and the son of man that you care for him?” Dr. Crane picked up the Psalms, as well, acknowledging that Jewish tradition recognizes that things outside of this earth are significant because God created them.

Yet, their significance is not a threat to our own. Humans are particularly unique, according to Dr. Crane, because humans are betzelem Elohim, made in the image of God. But what if other beings who are also “made in the image of God” are discovered? Would human uniqueness and superiority fail? We may not be the exclusive owners of betzelem Elohim, but we were given revelation, and Dr. Crane notes that this dialogue with God is what matters.

The significance of human significance

While questions of human uniqueness and significance are surely important questions worthy of exploration for their own sake, one might well be skeptical of the importance of these questions when our pediatric hospital is at—or over—capacity due to a triple threat of COVID, RSV, and influenza. When pressing deadlines or clinical responsibilities overwhelm, taking time for philosophical reflection may seem trivial at best or irresponsible at worst.

But, as Dr. Crane argued, being “made in the image of God” provides a certain comfort that allows us to “take risks” about science, healthcare, and the pursuit of knowledge. Reflecting on human significance—whether from a religious or scientific perspective—encourages us to push forward in our research endeavors and to take risks in our teaching as we develop a new curriculum and employ teaching techniques and modalities that may stretch us. As we seek to transform medical education, surely, we could all use comfort and the permission to take risks, as transformation does not come without challenges and risks.

Perhaps some of us are already confident of human significance. When a learner comes to us for help, overwhelmed by the subject matter or stresses of life, we take time to listen because we know they are unique and significant. If we did not believe in human significance and the intrinsic value of human beings, perhaps we would not have chosen this field in the first place.

Yet this affirmation of human significance, whether from a scientific or religious perspective, reminds us to approach our work with a spirit of service and compassion that can transform the practice of medicine, medical education, and the biomedical sciences.

Annie Friedrich, PhD, HEC-C is an Assistant Professor of Bioethics and Medical Humanities in the Institute for Health and Equity at MCW.

Ryan Spellecy, PhD, is the Ursula von der Ruhr Chair in Bioethics and Professor of Bioethics and Medical Humanities, and Psychiatry and Behavioral Health, at MCW.

Remembering the Earliest Days of the Pandemic: The Institute Responds to Times of Transition

From the April 24, 2020 issue of the Transformational Times

Remembering the Earliest Days of the Pandemic: The Institute Responds to Times of Transition

Adina Kalet, MD, MPH

This April 2020 essay was originally published six weeks after classes shut down at MCW. Despite the unknown risks, our physicians, nurses, and front line workers stayed on the job. 

During the very earliest days of the COVID-19 pandemic, we were all scared for our lives; the danger was very, very real and the future was uncertain. Despite this, the Kern Institute's leaders and educators shifted the Institute's focus to make certain students were supported and prepared. As you read, recall those days when we worried about the transitions and the future. 

In the coming months, the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education will transition again. Those of us associated with the Institute hope that whatever iteration emerges will continue to provide a sustained, innovative, and character-driven platform that influences the future of health sciences education. 

 

The COVID-19 pandemic has hit our economy hard. On our own campuses, saving and protecting lives has caused unprecedented revenue shortfalls within our community, to our hospitals, and to the Medical College of Wisconsin. Ironically, just when health care provision, education, and research are needed most, our work is threatened. Those on the “front line” of the pandemic deserve hazard pay for taking on risks for the rest of us, yet our staff is facing salary reductions and furloughs. 

Along with many of our peer institutions, MCW is implementing a financial austerity plan. We have hit a very rough patch and more changes are coming. Our futures are uncertain. People are scared. In this context, the Kern Institute is working to be good citizens by aligning emerging needs with our resources.

There can be opportunity in adversity

Historians point out that even devastating crises offer opportunities to societies. We have already seen unprecedented innovations in the face of immediate problems. Unable to deliver required clinical rotations, faculty and students are co-creating ways to fill curricular gaps through telehealth and service learning. New levels of collaboration and cooperation among medical schools and with accreditors have broken-down traditional silos, suddenly changing systems and shifting long-held policies. 

We must leverage these transformative opportunities for the better. If we work together to retain our senses of mission, purpose, and meaning, we will increase our individual and organizational well-being and resiliency. 

Pivoting what we do, yet remaining thoughtful

In our pre COVID-19 lives, the Kern Institute had been working to clarify our philosophy of medical education transformation. We referred to this as our “topology of transformation,” seeking to best understand why we are doing what we are doing. By thinking, dialoging, reading, and writing, we wrestled with uncovering which experiences are essential as a student transforms into the “good physician.” Then, and only then, would we allow ourselves to talk about the instructional or pedagogical evidence that drives the design and implementation of programs that achieve this transformation. For most of us, especially impatient physicians, it takes discipline not to jump into the “doing” too soon.

Suddenly, COVID-19 accelerated our work

Plato is credited with the phrase, “Necessity is the mother of invention,” sometimes translated more literally as, “Our need will be the real creator." While I prefer the more feminine flourish, now is the time when innovation is needed most. Over the past few weeks, Kern has pivoted to assist MCW’s rapidly transforming educational programs in response to immediate needs and we are designing ways to streamline and sustain the best of these changes. 

We are collaborating with partners in Academic Affairs and Student Affairs to support well-being, prepare students to meet their graduation requirements, provide meaningful clinical experiences, sustain and strengthen MCW’s long-term investments in diversity and inclusion, and speed the design and implementation of a dynamic, state of-the-art fully virtual curriculum.

Some things are the same in both 2020 and 2024

These are historic times globally and locally. As we adapt our educational work to the new reality, we will study the outcomes, learn from our successes and shortcomings, and look for the new topology of transformation. 

The essay was originally published on April 24, 2020 as, "Transforming Educational Strategies on a Dime."

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.

MCW's Seventh MedMoth Storytelling Evening

  

MCW's Seventh MedMoth Storytelling Evening

MCW MedMoth, a student-initiated and student-led storytelling event, was held on November 30, 2023. Over 100 appreciateive listeners came to support the ten storytellers as they shared tales on everything from the lifelong scars left after shoplifting to lessons learned from running a food pantry program to a death in the ICU. 

Some of the stories will soon be featured on the Medical Education Matters podcast. 

Thanks to the Kern Institute, the Kern Family Foundation, and the Charles E. Kubly Foundation for support of MCW MedMoth over the past four years. These events reflect human centered design principles and character. MedMoth supports students, staff, faculty, and health care professionals in human flourishing and resilience.

Big props to the MedMoth team: MCW students Meg Summerside, Linda Nwumeh, Amber Bo, Meghan Schilthuis, Corey Briska, and Maya Martin, and to Kern faculty/staff Shannon Majewski, Devarati Syam, Adina Kalet, Bruce Campbell, and Cassie Ferguson. 

Look for the next MCW MedMoth evening in Spring 2024!

My Night in the ED: Treating My Community During a Mass Casualty Incident

 From the December 17, 2021 issue of the Transformational Times

My Night in the ED: Treating My Community During a Mass Casualty Incident

On November 21, 2021, Evan Gibson was a third-year medical student at the MCW-Milwaukee campus. He was working a shift in the ED that evening when Froedtert Hospital and Children’s Wisconsin ran a mass casualty incident in response to the Waukesha Parade Tragedy. 

In this "Take 3" exchange published two weeks after the event, he answered three questions on his experience working a mass casualty event from his perspective as a medical student…

Transformational Times: What emotions did you experience hearing about the incident/treating the patients?

Evan Gibson: Fear was the first emotion that I experienced, which surprised me as I worked in EMS for multiple years and experienced challenging situations. I think that framed the seriousness of the incident for me. I have fortunately never been a part of a mass casualty incident and wasn’t sure what experiences were going to come in the following hours.

As I’m from Southeastern Wisconsin, I was also fearful that I might know a patient that came in. There is quite a difference between a friend texting you to ask what they should take for their cold vs. treating them (or their family) for a life-threatening injury.

Transformational Times: How did you harness your fear in the moment? What advice did you receive from fellow students or physicians prior to the arrival of the patients?

Evan Gibson: Fortunately, Dr. Jason Liu, who is an expert in Disaster Management, came to the ED after hearing of the event and helped lead the response. He reminded us that “the pathology is the same,” and this was a calming message for me. It reminded me that these individuals would be no different than the previous patients that have presented to the trauma bay and helped ground me.

Transformational Times: Did you notice any characteristics or traits that the Froedtert Hospital/Children’s Wisconsin-Milwaukee Hospital workforce demonstrated that stood out to you?

The dedication of everyone stood out most to me. There were multiple nurses, techs, and physicians that came to the ED or called in asking how they could help even though they were not scheduled. Everyone wanted to help their community in any way they could. The swiftness and preparedness of the nursing staff stood out to me as well. They quickly moved patients to the floor and made sure that there were plenty of rooms available within the ED. Everyone appeared prepared and eager to run a smooth mass casualty

Evan Gibson, MD, graduated from MCW in 2023. He is currently a PGY1 in Emergency Medicine at the Medical College of Wisconsin.

Gratitude: A Practical Application

 From the November 18, 2022 issue of the Transformational Times (Gratitude)

Gratitude: A Practical Application

Kathlyn E. Fletcher, MD, MA

Dr. Fletcher and Luke make a discovery together.

Me: “What are you grateful for today?”

My 12-year-old son, Luke: “That everyone was here today. My basketball games. And making tortillas with you.”

This is the nightly ritual that we have observed almost without fail since mid-winter 2021. I think it turned his life around; but let me take you back to the preceding months and you can judge for yourself.

We had endured most of the first year of COVID, like everyone else in the world. There was talk in the media of how the pandemic was impacting children, making them more anxious and worsening behavior. Maybe that was the explanation, but honestly, this storm had been brewing before COVID: My beautiful 10-year-old boy had become completely negative. He was certain that every activity on the horizon would be terrible, even the ones that he always objectively enjoyed (e.g., baseball practice). Every conversation we had was about his discontent. Nothing would placate him. Nothing brought him happiness. School was terrible. He didn’t like his teacher. His friends were never available. The list was endless and bleak.

On February 2, 2021, I took the day off to visit my sister in Lake Forest, IL. We had a lovely day. She made me a beautiful and delicious lunch, and we went shopping. 

As I drove home in the dark, it was freezing outside. Tiny snow flurries dusted the windshield on the lonely stretch of the interstate between the Wisconsin-Illinois border and the south Milwaukee suburbs. I turned on a podcast to pass the time. I don’t listen to a lot of podcasts, and I had never listened to Oprah’s before. I don’t know why I chose to listen to Oprah’s Super Soul episode called Grace and Gratitude, but something drew me to it that night.

At some point in the podcast, they discussed the study that showed that by writing down what you are grateful for every night, one can move from being pessimistic to mildly optimistic in three weeks. Right then and there, I made a Groundhog’s Day resolution: Luke and I were going to each say three things that we were grateful for every night for three weeks and then I would re-evaluate. 

It was a little rough at first. 

Luke: “Can’t you just tell me what to say?”

Me: “No.”

Some nights, the only things he was grateful for were breakfast, lunch, and dinner. But at least he was saying something. After a week or so, he asked me if I wanted to say a prayer after our gratitudes. Hmmm. That seemed promising. We persevered through three weeks, and then it was a habit.

I am not sure exactly when things changed, but after a month or so, he wasn’t actively resisting all new activities. A few weeks later, he would remind me if we hadn’t said our gratitudes before we started to read a new chapter in the Chip Hilton book we were sharing. Now, he still doesn’t like school, but we don’t discuss it every day. He walks into new situations with (mild) optimism. He has found a way to be comfortable in his skin and happy in his life.

A lot of other things have gotten easier as the early COVID restrictions have lifted but, again, this change in his outlook predated that one. It’s not scientific, but life is better, and gratitude was the major change. While I was open to the idea before, I am now a complete believer. 

In May 2022, a year and a half into the experiment, Luke got COVID. Isolated in his room, we couldn’t do our usual ritual, so he FaceTimed me at bedtime. “Can we do our gratitudes, Mom?” 

#winningthegame

Kathlyn Fletcher, MD, MA, is a Professor in the Department of Medicine at MCW. She is the program director for the Internal Medicine residency program and the co-director of the GME pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. She is an editor of the Kern Transformational Times.

Happy Thanksgiving from the MedEd Blog!

 

Coaching is Vital to Preventing Burnout in Physicians

From the May 14, 2021 issue of the Transformational Times (Suicide prevention issue) 

Coaching is Vital to Preventing Burnout in Physicians

Brett Linzer, MD

My internal medicine/pediatrics friend, Alex Djuricich, MD, killed himself a few years ago. He was one of my resident partners and eventually became the internal medicine/pediatrics program director at the Indiana University School of Medicine. He was a mentor to many internal medicine/pediatrics physicians and a father of two teenage daughters. When he died, I promised myself that I would do what I could to help other physicians...

It has taken me a long time but, with some of the work I am doing, I feel as though I am making good on that promise. I spent years trying to figure out why doctors hurt themselves. I am not sure if I have figured out much, but I have learned a lot along the way.

One of the most important things I have learned is that I do not have all the answers to my life. But I found a lot of the answers through coaching.

Why is coaching important?

The idea that we, as physicians, can figure everything out on our own and not rely on others to help us is, at best, a poor strategy for success and, at worst, a dangerous myth. Physicians are highly trained and skilled in certain areas but may lack mastery in relationships and communication. After residency, there is little emphasis on personal growth and especially emotional development. Coaching can bring wide-ranging benefits to any organization. Most experts agree the cost of replacing one physician, including lost revenue, can be around $1M. A well-coached physician is more likely to stay in their current position and, therefore, save the cost of recruiting a replacement. In addition, there is less physician burnout, improved mental health, more effective physician leadership, and more balanced and engaged physicians. When physicians are at their best, everyone wins.

The struggles hit close to home

During my training, I was no stranger to suicide. A medical school classmate killed himself. Then, an international graduate with two children and a family in China hanged himself during the second week of our internship. We all knew he was struggling but had not known what to do. We were treading water ourselves. 

The next morning, the residency program director brought our group of ten interns into a room and talked to us. "This is bad,” he said. “We care about you. Here is the card for the psychologist. Call if you need help." I looked around the room at the other confused faces and honestly thought, what does he mean by “need help”? I said to myself, Look Brett, screw your head on straight. You are on call and have a busy service. You need to get back to work. 

Two years later, my chief resident shot himself. I thought he had all the answers. He was a smart guy and had a desirable GI fellowship lined up. At the funeral, I went up to people I knew. Do you understand this? Can you explain this to me? Can you please tell me he had some label or diagnosis or something that I do not have? Chronic depression, alcohol abuse, or schizophrenia? Something? Anything? How do I know I am not next in line? There is always a line. 

On average, one physician commits suicide every day in America. Every day! 

But I was not next in line. Next in line was my friend Alex. He was considered by many to be the ideal internal medicine/pediatrics academic physician. I went to his wedding. He met his wife when she was a fellow intern with me and Alex was our resident. He had a family. He even looked like me. How are they different than me? How close was I to where they were? Look Brett, I said to myself. Screw your head on right. You have a lot of … wait … it is not working. You cannot figure it out. Who's next in line? 

Then, one of my best friends and close partners left our organization. I had difficulty understanding why he left and felt the effects even more acutely when I had to absorb a number of his patients. This was the height of the opiate epidemic and some of the patients were very difficult. I did not know how to manage them well. In addition, I had an unmotivated, depressed medical assistant working with me and I did not know how to communicate with her. The triage nurse in our small clinic was not motivated to do her job. I was not comfortable with conflict, so I avoided her and did extra triage work. The clinic manager was too scared to confront the problems. The administration was well-meaning but not helpful. 

I felt like I was playing a new game and I did not know how to play it well. I did not even know how to tell if I was successful. Press Ganey surveys did not do it for me. 

About this time, Epic came online, and I struggled with efficiency. My wife had chronic debilitating migraines and we had three teenagers at home with no family support. I had extended family challenges. I was cut off from my emotions and I unknowingly built walls to contain them, not knowing I was cutting off my good emotions as well. 

A turning point and finding help

In 2014, my survival skills were not serving me. Life was closing in. I was tired, frustrated, angry, irritable, confused, fearful, and more. I took care of depressed patients and I prescribed SSRIs for them. Would an SSRI help me? I did not even have a doctor. Maybe counseling would help, but I did not know where to turn. I did not have the time.

I was too scared. During one particularly rough patch, I asked myself if I was suicidal.

One night, I was sitting at home and finishing Epic charts. My wife handed me a card that said, "I think you need some help." 

I looked at the card that suggested I contact Dike Drummond, MD from the burnout prevention program, www.TheHappyMD.com I said to her, “Don’t worry. I just need more time. I can figure this out on my own. I just need to work harder.” My wife had heard me say this before. She was losing patience and my words were not as convincing to me as they had been before.

I asked myself, “Am I depressed?”

I called Dike and set up a discovery session. This is a free one-hour “get to know you” session with the burnout counselor. At that point, I still did not trust him or anyone else. More than once, I almost cancelled the call. I thought, he does not know me. I am a very private, introverted person with my special problems.

The next week, I completed the call and was shocked to discover within twenty minutes that he could see right through my walls and defenses. He saw the scared kid behind the walls. He saw and knew my patterns of behavior and thought. He knew where that place was because he had been there. I broke down and agreed to work with him.

Dike explained that many of my patterns of behavior and emotion were not unique to me. There are patterns that are unique to physicians and emerge from our training. Many of these are survival adaptations. This stunned me and was so reassuring. He told me I was not broken. There were patterns I could learn about and then modify. Here are some of the typical patterns and misconceptions that Dr. Drummond described that physicians adopt that lead to burnout:

• If I just work harder, things will work out.
• I am a smart guy/girl, so I will figure it out.
• I need to do it all by myself.
• I do not want to deal with this difficult patient, nurse, etc.
• Compassion is important for other people but not for me.
• My emotions are not safe. I need to protect myself.
• I feel like an impostor.

My work with Dike centered around twice-a-month one-hour coaching calls where we worked on emotional and skill development. We started every call with five minutes of gratitude and appreciation. What would I like to congratulate myself for? What did I do right? This was actually hard for me because I was more in the habit of beating myself up for what I had done wrong. I could easily list all the negatives, but I had trouble seeing the positives. 

After that, we would complete the work for the day. Some of the emotional work involved processing difficult emotions like shame, fear, anger. I realized I had a lot of shame. For example, we discussed:

• How to gain better access to my emotions and feelings. How to trust myself and others.
• How to have more self-compassion and more compassion for others.
• How to absorb positive feedback and not deflect it away.
• How to have a soft front and a strong back.

The area of skill development was wide-ranging. Communication skills were huge. I realized if I could be a better communicator, I could save a lot of time and prevent a lot of negative emotions. As I became better, I noticed how ninety-minute disagreements could turn into fifteen minutes. Three meetings could be one if I was more effective. Three-day arguments could be resolved in thirty minutes with deep listening and full presence. We did in-depth personality testing and self-awareness, and I learned how to interact with different personality types more effectively. I learned how to deal with difficult people like the nurses and patients. We did role-play and scripting.

I realized that as I took more responsibility for the interactions, I developed new skills and the nurses changed their behaviors. In the past, I had believed that my role was to give the right answers, but I learned it was more important to develop the art of asking the right questions. I discovered how to run an effective meeting. What is the goal? How do we know if we achieved the goal? Can we stop after thirty minutes and consider it a success if we reached our goal? 

I mastered Epic documentation techniques, created succinct, appropriate notes, learned stress management breathing techniques, mastered time management and batching approaches, practiced delegation, adopted marriage skills, enhanced my communications, and made firm dates on the calendar. I had been transformed.

Emerging from the other side

Coaching has changed me. When physicians are at their best everyone wins. As physicians, we need to trust, ask for help, and be supported along the way. We need good leadership that makes coaching easily accessible, affordable, and encouraged. We could spend one-tenth the amount it takes to replace one physician and invest it in the few hundred we already have. It is critical to understand that coaching programs are not just for impaired or problem physicians. These approaches are for growth minded, striving physicians who want to improvetheir lives and the lives around them. Highly achieving people in many fields have coaches. Every sports superstar has a coach. Most high-level business leaders have coaches. Every coach I know has a coach of their own. And the people at the top - the ones who train the other coaches - have networks of support and growth systems around the country.

It starts with each of us

Here is what you can do. It all starts with you. Take care of yourself and trust that others may be able to help you. Realize that you may not have all the answers to your life. Reach out to others for connection and for mutual support. Consider coaching for yourselves. 

Brett Linzer, MD, is board-certified in both internal medicine and pediatrics. He has been in practice with ProHealth Care for over twenty years. He has been a part of the Medical College of Wisconsin for 18 years as a preceptor and mentor to fourth-year students in his ambulatory clinic in Oconomowoc. He is the recipient of the Marvin Wagner Preceptor Award, ACP Wisconsin Community Physician and mentor award and the Milwaukee Academy of Medicine award for excellence in teaching. He can be reached at balinzer@phci.org