We Belong to One Another: A Lesson from Dr. Martin Luther King, Jr.

From the January 21, 2022 issue of the Transformational Times (Urban and Community Helath)

We Belong to One Another: A Lesson from Dr. Martin Luther King, Jr.

Cassie Ferguson, MD

In his letter he wrote from a Birmingham jail—the letter that began in the margins of a smuggled newspaper and on found scraps of paper—Dr. Martin Luther King, Jr. shared this:

“Whatever affects one directly affects all indirectly. For some strange reason I can never be what I ought to be until you are what you ought to be. And you can never be what you ought to be until I am what I ought to be—this is the interrelatedness of life.”

The very same stardust

Dr. King suggests that if we would see how inextricably connected we are to one another—if we would see that we belong to one another not only by virtue of being born on the same planet, but also by virtue of the scientific and spiritual reality that we were made from the very same stardust—that then all of us could see how the systems that uphold and protect racism, health and wealth disparities, educational inequalities, and residential segregation dehumanize us all.

That if we understood our interdependence, we would move beyond empathy for those who are suffering the most under the weight of these systems and know in our hearts that when one teenager is murdered, we are all killed. That when a pregnant woman delivers a stillborn baby because her health concerns are dismissed, that we all lose a child. That when one of our students must repeat their first year of medical school because of inequities in medical education and in our learning environment that disproportionately impact students underrepresented in medicine (URiM), that we all fail.

Dangerous unselfishness

This kind of radical compassion is not for the faint of heart. Dr. King understood this. In his very last speech delivered in support of the striking sanitation workers in Memphis, Tennessee, Dr. King rallied the crowd declaring, “either we go up together, or we go down together. Let us develop a kind of dangerous unselfishness.”

At the Kern Institute, our mission has been to inspire and support this kind of unselfishness and this kind of compassion in our learners and educators, such that we might transform the system of medical education to ensure that every one of our patients feels seen and deeply cared for; such that every one of our patients is given the opportunity to flourish. This kind of systemic transformation requires tremendous courage, sacrifice, and love. It demands that we understand compassion not “as a relationship between the healer and the wounded…but as a relationship between equals.” (Pema Chödrön).

Despite these challenges, there are examples of how the MCW community is “showing up.” Here is one example. In the spring of 2020, student doctors British Fields, Jamal Jarrett, Morgan Lockhart, Enrique Avila, and Adriana Perez learned that the Apprenticeship in Medicine (AIM) enrichment program they had been chosen to lead that summer would not be funded because of the pandemic. Led by the incomparable Jean Mallet and supported by the Kern Institute, these students advocated for their program, pivoted, and in three weeks designed and stood up the Virtual Health Sciences (VHS) program. Over Zoom, they provided forty Milwaukee-area high school students from backgrounds historically underrepresented in medicine a meaningful and engaging look at careers in health care and showed them that there is a place in the profession of medicine for them. Our student doctors saw themselves in these high school students and this motivated and empowered them to take direct action.

“The Path of Joy is Connection”

What I have come to realize as a physician and, as someone who teaches medical students about well-being, is that when we become aware of our interrelatedness, we not only wake up to how we might design and redesign systems that assume the humanity of all peoples, but we also feel less alone, less fragile, less anxious; and, like these student doctors, we are empowered to become our best and truest selves. As the late South African anti-apartheid leader and Nobel Peace Prize Laureate Archbishop Desmond Tutu reminded us frequently, the path of sorrow is separation, and the path of joy is connection.

This week, as we celebrate the Reverend Dr. Martin Luther King, Jr., may we cultivate the awareness of our interrelatedness in our hearts, and find the courage to unselfishly redesign our world such that all of us may flourish. 

Catherine (Cassie) Ferguson, MD, is an Associate Professor in the  Department of Pediatrics (Emergency Medicine) at MCW. She is the innovator of the REACH Curriculum, and the Associate Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

The Mission of the SCU: The Saturday Clinic for the Uninsured

From the January 21, 2022 issue of the Transformational Times (Urban and Community Health)

The Mission of the SCU: The Saturday Clinic for the Uninsured

Thomas Ritter, MD

Dr. Ritter wrote this essay when he was a fourth-year medical student at MCW.

The highlight of my medical school experience has undoubtedly been working at the Saturday Clinic for the Uninsured (SCU). SCU is a student-run free clinic for patients without health insurance that operates at the intersection of North and Humboldt on, you guessed it, Saturdays. In addition to a name that is quite “on the nose," SCU has been a staple of the Milwaukee community for over twenty years. Our mission is to provide comprehensive, patient-centered, and equitable care to Milwaukee’s uninsured population.

Goal One: Provide high quality care

Uninsured patients in Milwaukee face an array of challenges to access healthcare and we have shaped SCU to meet the needs of our community. We have grown to become a long-term home for our patients to receive healthcare by marshalling resources at MCW and Milwaukee hospitals to provide access to lab work, mammograms, and specialists including ophthalmology, dermatology, and rheumatology. We offer an in-house dispensary of medications at no cost to our patients and have established a partnership with Seton Pharmacy at Ascension Columbia St. Mary’s to provide any medication we don’t have for a low-cost rate. We evaluate and address the social determinants of health for all of our patients, including food insecurity, legal assistance, and housing instability.

Goal Two: Improve cultural humility and clinical competence

In addition to its mission to provide comprehensive, patient-centered, and equitable care, SCU also aims to enrich the cultural humility and clinical competencies of its student volunteers. This second mission has certainly been achieved in my personal and professional life. Early in medical school, I was an eager learner of anatomy, pharmacology, and pathophysiology. While I certainly remain interested in these subjects of medicine, my experience at SCU has revealed to me the broader picture of medicine—to identify and critically examine the ways in which our patients, insured or not, encounter obstacles to receiving care. Whether the obstacle lies outside of healthcare, such as access to affordable transportation, or is an internal obstacle, such as racism in medicine, truly comprehensive care requires intervention on both a personal and societal level. 

SCU has taught me that providing patient-centered care requires grace to meet patients where they are, see the world through their eyes, and act accordingly. Providing equitable care necessitates intentional introspection and the evaluation of my own biases on a daily basis.

I believe SCU’s contribution to the Milwaukee community is difficult to truly measure. While direct patient care can be quantified by the number of patients seen or referrals sent, the impression SCU makes on its volunteers who go out and serve in their own way after graduating, although intangible, cannot be overlooked. I am becoming a family medicine physician because of my time at SCU, and I am only one of many volunteers in SCU’s long history who enter healthcare with a heart for service and dedication for justice. I am grateful to have worked at SCU and encourage all who are interested to volunteer there as well.

To learn more about the Saturday Clinic for the Uninsured, check out the website here.

Thomas Ritter, MD was a member of the MCW-Milwaukee Class of 2022. He followed his heart as is currently a resident in the MCW Family Medicine program at Columbia St. Mary's Hospital in Milwaukee.

Opening the Gate for Student Mental Health Needs

From the September 15, 2023 issue of the Transformational Times

Opening the Gate for Student Mental Health Needs

Kevin Bozymski, PharmD, BCPS, BCPP

Dr. Bozymski, a board-certified psychiatric pharmacist, discusses the mental health stressors faced by health care students, and shares his journey of training future pharmacists to become mental health “gatekeepers” for their peers (and themselves) …

Expanding beyond algorithms

When people ask me what I do for a living, it’s not as straightforward as saying teacher or pharmacist—or even the phrase, mental health pharmacist. It usually involves a back-and-forth dialogue, with me imperfectly describing my winding path as the audience inquires, prompts and clarifies. Upon reflection, the emphasis on one-on-one connections is what got me on my path. 

While healthcare practitioners and researchers value the scientific method (me included), I’ve often found algorithms too restrictive. That’s why psychiatry resonated with me as a student pharmacist, where the right pharmacologic choice cannot be made without considering an individual’s preferences, values, and environment.

It’s also why academia called to me as a resident pharmacist, where a “one-size- fits-all” teaching approach does not meet every learner’s preference, needs, and background. 

Unfortunately, it’s easy to fall into the algorithm trap as a teacher when discussing student mental health, especially when we aren’t taking care of our own mental health. We look back in our own life to how we handled stress as a learner, assuming our experience will translate well to another’s. We worry about finding time to dialogue, looking toward rating scales used in clinic appointments as a model for triaging student concerns. This solutions-first mindset shows in our health care learners, as a recent scoping review of medical student literature found fears of decreased career opportunities, nonconfidentiality and personal stigma as the top individual barriers to care.

Before walking in someone else’s shoes, it’s worth asking about their journey so far and how they find themselves now. 

From stress to burnout to on fire 

As the psychiatric pharmacist on faculty within Medical College of Wisconsin School of Pharmacy, I am invited to give perspective about student mental health on many interdisciplinary councils, committees and workgroups. The most impactful discussions, though, come in one-on-one discussions with my student pharmacist mentees. 

These quarterly meetings have a brief agenda,  and are open-ended for me to actively listen and ask: How is your quarterly session going? What has been a surprise since we last spoke? Where do you want your shoes to take you, and how can I help them do so?

It's no secret that the MCW PharmD curriculum is stressful, with students completing four years of traditional coursework in just three. And while it’s unclear to what extent stress correlates to burnout and mental health concerns, published U.S. student pharmacist surveys identify positive response rates of 19% to 40% for clinical depression (via PHQ-9) and 21% to 41% for clinical anxiety (via GAD-7). (see references 2-5)

Furthermore, the American Academy of Colleges of Pharmacy has released a statement encouraging pharmacy schools to proactively promote overall wellness and stress management techniques.

There’s no easy algorithm to determine who develops clinically significant concerns, but it is near-impossible to do so unless a student is connected enough to their academic community to be asked.

Who’s at the gate for mental health care?

Access and stigma are two driving barriers in psychiatry, and certainly student mental health is no exception. Therefore, gatekeeper training—programs teaching how to identify warning signs of mental crises and connect people to needed services—have been spreading across the globe. Such programs are not just for healthcare practitioners, but for anyone with a desire to improve mental health in their area. Thanks to funding from the Kern Institute, the MCW Pharmacy School, and Advancing a Healthier Wisconsin endowment, I’ve had the honor as a certified Mental Health First Aid instructor of teaching 60 first-year PharmD students (so far) how to open the gate for their peers, their communities, and themselves.

While students over the years have commented on its benefits, one anonymous comment from a course evaluation struck me the most:

“These skills were amazing to learn. It has helped with not only my family and friends but also has been used in practice with my peers. To have the ability to learn about what people go through and how to be able to approach and talk to people about a mental health crisis is something everyone should learn.”

If we cannot break down every systematic gate standing between an individual and mental health resources, we can at least ensure the keepers know how to help passersby. And even if my student pharmacist self from over a decade ago does not fully understand the unique stressors of this generation, I can at least dedicate myself to learning from and conversing with them in a non-algorithmic way - using the information gained to better appreciate, reassure, and connect.

After all, with mental health, an imperfect response is better than no response at all.

Take action:

Interested in becoming trained as a MHFA instructor (or just completing MHFA certification yourself)? Please contact Dr. Kevin Bozymski or Dr. Himanshu Agrawal for more information. 

For further reading:

1. Berliant M et al. Barriers faced by medical students in seeking mental healthcare: a scoping review. MedEdPublish (2016). 2022; 12:70.

2. Koutsimani P et al. The relationship between burnout, depression, and anxiety: a systematic review and meta-analysis. Front Psychol. 2019; 10:284.

3. Fischbein R et al. Pharmacy and medical students’ mental health symptoms, experiences, attitudes, and help-seeking behaviors. Am J Pharm Educ. 2019;83(10):7558.

4. DeHart RM et al. Prevalence of depression and anxiety among student pharmacists. Int J Med Pharm. 2020;8(2):1-8.

5. Shangraw AM et al. Prevalence of anxiety and depressive symptoms among pharmacy students. Am J Pharm Educ. 2021;85(2):8166.

6. American Colleges of Clinical Pharmacy. AACP Statement on Commitment to Clinician Well-Being and Resilience. Accessed https://www.aacp.org/article/commitment-clinician-well-being-and-resilience on September 5, 2023.

7. Suicide Prevention Resource Center. Choosing A Suicide Prevention Gatekeeper Training Program: A Comparison Table. Accessed https://sprc.org/wp-content/uploads/2022/12/GatekeeperMatrix6-21-18_0.pdf on September 5, 2023.

8. National Council for Mental Wellbeing. About MHFA: What is Mental Health First Aid? Accessed https://www.mentalhealthfirstaid.org/about on September 5, 2023.

Dr. Kevin Bozymski, PharmD, is an Assistant Professor with appointments in the MCW Pharmacy School Department of Clinical Sciences and the School of Medicine Department of Psychiatry & Behavioral Medicine. He is a certified Mental Health First Aid instructor, providing training through an Advancing a Healthier Wisconsin endowment. He also provides clinical services at both the MCW Tosa Health Center and Froedtert Hospital Complex Intervention Unit.

Professionalism Lapses in GME: Oops, Can’t, and Won’t

From the August 4, 2023 issue of the Transformational Times

Professionalism Lapses in Graduate Medical Education: Oops, Can’t, and Won’t 

Chad Carlson, MD, FAAN 

Program Director Carlson shares takeaways about remediation in residency training: Intent is important. In broad terms, the categories of “oops,” “can’t,” and “won’t,” divide learners into those who have a lapse in behavior they know and understand, those who currently lack or cannot access a set of skills or tools, and those who choose not to do something, despite having access to and knowledge of the appropriate path forward... 

Anyone involved in medical education, regardless of the level of learners, can relate to issues of professionalism in situations needing to be addressed.  If you are like me, this is followed by a pit in the stomach and concerns about the best next steps: Can I fix this? How do I help? Is this even a “fixable” problem?

These thoughts are often compounded by a feeling of relative isolation; while we all help learners address these issues, we often feel like we are doing so in a relative vacuum. Often, our own experiences and feelings complicate remediation and lead to the belief that these sorts of problems cannot be fixed.  

The concerns and limitations program directors face in addressing issues of professionalism prompted us to focus on this topic at the Medical College of Wisconsin Affiliated Hospitals (MCWAH) Program Directors retreat. A presentation and discussion session led by invited speakers Betsy Williams, PhD, MPH, FSACME (Clinical Director of the Professional Renewal Center) and Karen Warburton, MD, FASN, FACP (Associate Professor of Medicine and Director of GME Advancement and Clinician Wellness Program at the University of Virginia Health System) outlined several key features and highlighted some common themes. The retreat also focused on the potentially daunting topic of remediation of professionalism issues in graduate medical education through interactive and case-based talks. 

Key takeaway: Professionalism issues are not inherently irremediable.

The process of remediation itself can be broken down into: Identification, Assessment, Active Coaching, and Ongoing Evaluation

Identification has already occurred if you have a pit in your stomach about what comes next with a resident. But most medical educators can recall situations where, if they had better documentation or more feedback or input, they would have better understood both the scope and nature of issues with a learner. The earlier that identification occurs, the less likely it will negatively impact the timing of training for a learner. Dr. Williams lamented the frequent occurrence of hearing about a struggling learner in April or May of their final year of training when there is little time to implement an effective coaching plan.  

Within the realm of assessment, intent is important. The difference between an “oops,” “can’t,” and “won’t,” is an important distinction.  

In broad terms, these categories divide learners into those who have a lapse in behavior they know and understand, those who currently lack or cannot access a set of skills or tools, and those who choose not to do something, despite having access to and knowledge of the appropriate path forward. 

A comprehensive assessment also includes looking for potential mental health contributors. Evidence supports that about a third of struggling learners have an underlying mental health concern such as anxiety, depression, and cognitive or learning disorders. It is no surprise these underlying conditions often contribute to a “can’t.” 

The results of the assessment should drive the approach to coaching (or discipline). 

While a program or course director’s approach is often to take the lead on remediation or other issues to spare busy faculty colleagues and team members, in these settings, the program director may not be the best person to do the coaching. 

Involve someone not part of the Clinical Competency Committee (or recuse that person from discussions in the Clinical Competency Committee if this is unavoidable).  

Planning the intervention

In planning the type of intervention, the concept of intent is important. 

• Support with little formal coaching is likely adequate for an “oops." 
• Formal coaching is typically necessary for a “can’t.” 
• In the case of a “won’t,” rapid escalation beyond coaching to formal disciplinary measures may be necessary. 

In thinking about a “can’t,” we need to consider both the realm of teaching about professional norms and recognize when there are barriers (personal or systemic) to following them. 

As educational leaders, we need to look at individual professionalism violations and consider whether the issues represent a broader systemic issue or are related to individual factors alone. 

Ongoing systemic monitoring and intervention is critical 

Importantly, whatever the remediation methods, one cannot think of this as a single episode or course of treatment; a systemic approach for regular monitoring and evaluation must be in place to identify potential lapses in professionalism, prior to them rising to the level of a problem.   

The systematic approach to thinking about issues of professionalism was a welcome discussion during the retreat. But perhaps more important was the recognition that these are challenging, but not insurmountable problems with which we, as educators, all struggle. 

The desire to help our students, residents, and fellows succeed is--and should be--strong. But the frustration and disappointment when those expectations are not met is very real for all involved. This can be particularly true in graduate medical education, where we work closely with small classes of trainees, typically for multiple years. These personal bonds can be both a strength and a liability when professionalism is challenged.   

Our community of educators is our greatest resource

Our community of educators committed to improving learner well-being is, undoubtedly, our greatest resource; learners struggling with professionalism issues are not unique to any one campus, course, or program. We can, and should, make use of the depth of expertise across the institution instead of staying in silos in our individual departments and programs.   

Drs. Warburton and Williams made it clear through their experience and work on this topic that learners who encounter these issues can, in most cases, be helped and put back on a path to success. 

Proper diagnosis and management, just like in patient care, is the key to success. 

Chad Carlson, MD, FAAN, is a Professor in the Department of Neurology at Medical College of Wisconsin and serves as the Program Director for the Adult Neurology Residency, Associate Program Director for the Clinical Neurophysiology and Epilepsy Fellowships, and Vice Chair of Education.  

Whoosh! Goes My Heart

From the December 21, 2023 issue of the Transformational Times

Whoosh! Goes My Heart  

Himanshu ‘Tinu’ Agrawal, MD, DF-APA 

Dr. Agrwawal shared this story from his childhood in the holiday issue of the Transformational Times. You can read other stories by Transformational Times team members, Kathlyn Fletcher, Bruce Campbell, and Karen Herzog.  

From ages six until nine, I lived in London. My mother worked in the Indian embassy there, and one day she brought home a chocolate-filled Santa, sitting on a plastic sleigh. 

“Oh my God!” I squealed. ”Is it from Santa Claus?” I couldn’t believe it; it was finally happening. After hearing so much about the big guy from kids at school, I was finally getting a gift from him!  

"No, it’s from Mrs. Malhotra, she works on the desk next to me, you’ve met her,” my mother responded. 

“No! It’s from Santa Claus. You’re teasing me aren’t you, Mom?” I smiled. I could see through her attempts to trick me. 

“I told you. It’s from Mrs. Malhotra,” she repeated. 

“No! It’s from Santa!” I insisted. 

“No! It’s from Mrs. Malhotra!” she snapped back. My mom wanted to make sure poor Mrs. Malhotra received the credit she deserved. 

“You’re lying, Mom! Why are you lying?!” I yelled. I wanted so much to believe Santa had finally read my letters. 

A slap on my face ended any further arguments, as it usually did back in those days.  

Whoosh! went my heart.  

A couple of years later, we returned to our apartment in India, where Santa did not make pit stops. 

Now, four decades later, I find myself back in the land of Santa.  

Now, my son is 8 years old, and he writes letters to Santa every year. 

Now, every Christmas Eve, we tuck in, and I read him ‘Twas the Night Before Christmas by Clement C. Moore. 

Whoosh! goes my heart. 

Whoosh! Whoosh! goes Krishna’s heart. 

Whoosh! is the sound that magic makes. 

And you can’t snuff it out with a slap on the face. 

Himanshu Agrawal, MD is an Associate Professor in the Department of Psychiatry and Behavioral Medicine at MCW. He is one of the co-Editors-in-Chief of the Transformational Times. 

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!