Being a Parent and a Pediatrician

Originally published in the October 22, 2021 Transformational Times newsletter

Being a Parent and a Pediatrician

Cassie Ferguson, MD

Every weekday morning, I am confronted with my failure as a parent. Instead of filling my three kids’ lunchboxes with a colorful array of washed and cut, 100% organic, GMO-free fruits and veggies and a lean protein-packed sandwich cut into a dinosaur shape, I am typically frantically grabbing for a Dole fruit cup, an unnaturally colored yogurt tube, and a bag of Fritos. Guilt inevitably washes over me every time I shove a PB&J made with Skippy and grape jelly on white bread into their lunch boxes, and I cringe thinking about the teachers seeing what I knowingly

feed my children.

What you are to be, you are now becoming

–Carl Rogers

I don’t know if I feel this guilt more acutely as a pediatrician—as someone who spent nearly a decade learning about how to keep kids healthy and should “know better”—because I don’t have a different perspective to which I might compare. My first son, Ben, arrived two weeks after I graduated from pediatric residency. Will arrived as I finished my pediatric emergency. medicine fellowship, and Nick three years after I became an attending in the emergency department (ED) at Children’s. I became a mother as I learned to become a pediatrician.

While the guilt may be sharper, there were advantages to my training when it came to caring for my kids when they were little. The nurses in the well-baby nursery taught me how to swaddle a baby so that they couldn’t free their tiny little arms. I knew that 100°F was not a real fever. And I could assure my husband (and myself) that our child would eventually learn to pee in the potty.

There were distinct disadvantages, as well. I also learned about the randomness with which a four-year-old is struck with leukemia. About what it sounds like to hear a mother’s heart shatter when she learns her sixteen-year-old has died in the car crash. The health and safety ofmy own kids can feel so fragile; regularly witnessing the suffering of kids and their families makes it difficult to believe that my own kids would be spared, no matter the real odds.

Every system is perfectly designed to get the results it gets

–Arthur Jones

Most of the suffering that we witness as pediatricians, however, is not a result of random chance. Disparities in the utilization of health care services and in overall health spending, structural racism, and residential segregation that limits access to good schools, jobs, healthy food choices and green spaces for the majority of Black and Latino or Hispanic Americans directly translates to poor health outcomes for the families for which we care. Kids dying from gunshot wounds, physical abuse, asthma exacerbations, drug exposures; these deaths are not random. They are a result of the systems we have purposefully built in America and continue to support with our inaction.

A friend once described having a child as forever walking around with your heart on the outside of your body. As a mom and a pediatrician, I’ve discovered that my heart can be broken not only when my own child falls and breaks their arm, or is bullied at school, but by anything that harms children anywhere. I have come to see this as our superpower—this tenderness and vulnerability spurs my colleagues to fight courageously for the radical redesign of our systems.

We are called to disrupt the cycle of interpersonal violence in our communities, to address food insecurity in our ED, to protest the attempt to ban books about racism from our schools, and to ensure that the way we treat acute pain is equitable.

Hope is the thing with feathers

–Emily Dickinson

This calling can feel overwhelming, particularly when I am in the ED managing twenty very sick patients and a full waiting room, and then receiving a page heralding the imminent arrival of yet another child with a gunshot wound. On those nights nothing we do feels like enough; it feels as if we are digging a hole in the sand as the walls are caving in around us.

On those nights, I come home defeated, or angry, or fearful; overwhelmed with the perspective on how dangerous the world can be for our most vulnerable citizens and feeling powerless to protect both my patients and my own kids.On those nights I come home to my kids and peer into their dark bedrooms, staring at their sleeping forms from the door, surprised at how easy and regular their breath comes. I renew

my vow to do what I can to make them feel safe and loved and find grace in the belief that this love is perhaps more communal than I realize.

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

The Transformational Times is Taking a Sabbatical (although the blog will continue)

From the September 29, 2023 issue of the Transformational Times

Take Our Survey

The Transformational Times is Taking a Sabbatical

Adina Kalet, MD, MPH

Born on the fly to keep our medical community thoughtfully connected through the pandemic, the Transformational Times--like the rest of the world--is establishing its “new normal.” To do this, we are pausing weekly publication to gather reader input and intentionally consider how best to serve our community while continuing to reflect the transformational work at the Medical College of Wisconsin around character and caring alongside clinical excellence. Dr. Kalet shares what will happen behind the scenes, and invites readers to help shape the future of this thoughtful, medical education publication by participating in our survey ...

 

Dear Readers,

September is a time for renewal. Kids are back in school, the summer has come to an end, and in my faith, we gather to celebrate the birth of the world through our “high holy days.” At the Kern Institute we have been taking time to reflect and plan. We spent a day in retreat a couple of weeks ago, to contemplate where we have been and consider where are going next. In that spirit, the Transformational Times team is taking a short sabbatical to refresh our processes, update our vision and begin again.

 

The Transformational Times was born during the first days of the COVID-19 pandemic in March 2020, when the Medical College of Wisconsin (MCW) sent all of the students and many faculty and staff members home. As I have recounted before, we decided to transition our existing quarterly newsletter into a weekly offering, and rename it the Transformational Times. We hoped this would keep our work alive and support our medical education community.

 

As those early weeks turned into months then years, we kept up our pace, publishing 178 weekly issues of the Transformational Times and two curated books. We have taken only a handful of holiday weeks “off.” We are proud we have helped people share personal stories about their work and worlds. The tagline to be “delivering stories of hope, community, caring and resilience to our community,” has largely been honored.

 

The Transformational Times has been a success in many ways. We have grown our readership both inside and outside of MCW and received a great deal of supportive feedback and a few critical comments; we take all of our feedback very seriously. Through these efforts, we have hosted a hardy, broad conversation around the transformation of medical education and accelerated the expansive acceptance at MCW and beyond of new models for educating physicians that embody the character and caring essential to health and health care. This is the mission of the Kern Institute.

 

What to expect in the future

With the pandemic largely in the rear-view mirror, we are taking a break to reimagine the Transformational Times. Over the next few weeks, under the leadership of our new Co-Editors-in-Chief Wendy Peltier, MD and Himanshu Agrawal, MD, we will seek input from our readers. Our Editorial Board will ensure we continue to prioritize creating community and encouraging storytelling that promotes the ideas and discourse at the heart of health professions education.

 

Drs. Peltier and Agrawal will do this work along with our multidisciplinary editorial board which includes Bruce Campbell, MD (founding Editor-in-Chief); Kathlyn Fletcher, MD; Adina Kalet, MD, MPH; Karen Herzog (Milwaukee-based journalist); Justine Espisito, (Kern Institute staff); Joy Wick, (Kern Institute Communications Consultant); William Graft. Jr., MD (Resident, Internal Medicine/Psychiatry); and medical students Julia Bosco, Linda Nwumeh, Wolf Pulsiano, Sophie Voss and Emelyn Zaworski.

 

Our immediate goals are to work with Kern Institute members and the MCW leadership to:

• Refine our processes, policies, and submission guidelines
• Publish regular, theme-based issues that engage broad swaths of our community
• Leverage our Philosophies of Medical Education Transformation Lab (PMETaL) to build a civil discourse framework that enables diverse and profound conversations about our professions
• Have our editing team, including two former journalists, actively assist and encourage writers of all comfort levels
• Explore more flexible publishing platforms (video, audio, social formats, etc.)
• Integrate our work with the Kern Institute Podcast Network

 

We plan to continue and expand popular features of the Transformational Times, including:

• Themed issues for special days (e.g., Veteran’s Day, Valentine’s Day, Thanksgiving) and events in the medical education year (e.g., The White Coat Ceremony, Match Day, Graduation)
• Programmatic reports from the Institute, including The Learner Continuum Hub, Educator Development Hub, and the Medical Education Data Science, Human Centered Design, and the Philosophies of Medical Education Transformation labs
• Project reports from the Transformational Innovations (TI2), KINETIC3, and the MCWFusion curriculum, including Learning Communities, The Good Doctor Course, the Character and Professionalism Thread, and Learning Dashboards
• Works-in-progress on medical school to residency transitions, character measurement, and professional identity formation
• Summaries of Qualitative Research Methods, the Kern Institute Collaboration Scholarship (KICS) group journal clubs and collaborations, the Medical Education Matters Podcast, and our Medical Education Transformation book series
• Collaboration reports with Academic Affairs, the MCW Affiliated Hospitals (MCWAH) GME programs, MCW-Central Wisconsin, MCW-Green Bay, Thrive on King, the School of Pharmacy, the Physician Assistants Program, Genetic Counselling, Anesthesia Assistant Program, and the Graduate School
• Reflection on and coverage of the emerging issues of our times

Please Provide Input

While we won’t be publishing for a few weeks, we will be accepting submissions, and we encourage you to reach out to us with your ideas.

 

We want to hear from you! Whether this is your first or your 178th time reading the Transformational Times, please provide us feedback by taking our survey. If you have advice, opinions, or critiques, please reach out with your thoughts and feelings during this time. And thank you for reading, sharing, and caring.

 

In the meanwhile, watch this space for announcements of our Kern Institute events and related content.

Take Our Survey

Sincerely,

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.

Building Relationships: MCW-Central Wisconsin and the Lac du Flambeau Ojibwe People

From the September 22, 2023 issue of the Transformational Times

Building Relationships: MCW-Central Wisconsin and the Lac du Flambeau Ojibwe People  

 

Amy Prunuske, PhD and Corina Norrbom, MD  

 

Drs. Amy Prunuske and Corina Norrbom, faculty members at the Medical College of Wisconsin-Central Wisconsin, traveled with a group of colleagues to Lac du Flambeau for a workshop in July. They share some of the moments that moved them and look forward to returning soon … 

 

Above all, we came to “Be Curious” – something branded on Amy’s purple notebook from a recent MCW Kern Institute for the Transformation of Medical Education workshop by its Human Centered Design Lab. 

 

We were excited to meet with tribal members and hear about their experiences. We wanted to explore connections that could be relevant to the MCW-Central Wisconsin Physician in the Community Pathway programming we direct; to build on Amy’s previous work of incorporating Indigenous perspectives into the medical school curriculum (Lewis and Prunuske, 2017). 

 

Brian Jackson, MS, EdD, our host and a new MCW faculty member, assured us we would feel amazing by the end of the visit. 

 

What we send out into the world is what comes back to us, he said. And if the mind is ready, the teacher and teachings will appear, he added. 

 

Brian encouraged us to be proud of who we are and to learn from each other’s truths. 

 

Over the next two days, Brian’s family members shared their stories. We gained a deeper understanding of how the Ojibwe culture and familial relationships could be used to promote healing and strengthen social cohesion. They created a welcoming environment and treated us as “celebrities.” 

 

We rode in the backseat, as Brian and his father, Dr. Sonny Smart, drove us to a boarding school originally used to “civilize” Native Americans — by separating the children from their families and their culture. Now the tribe uses the space to teach Indigenous classes; to “flip the script” and make sure this history is acknowledged. 

 

Considering the far-reaching impact of our actions was among the teachings shared with us over the weekend: 

“What our seventh generation will have is a consequence of our actions today.” 
— Winona LaDuke  

  

One evening, we joined in the dancing and music at a pow-wow. 

 

Dr. Brian Jackson, Melissa Doud, and their two sons

Getting in synch with the people around you makes your relationships better. This was a meaningful opportunity to connect with both the Lac de Flambeau community and our MCW colleagues. It was a chance to feel unconscious inspiration and gratitude. 

 

The next morning, Brian’s wife, Melissa Doud, shared a video that required us to focus on a task of counting ball tosses. Many of us got the correct number of tosses but missed the moonwalking bear in the background. This was an analogy that the Indigenous perspective may be in the room but is often overlooked. 

 

We relearned how to see and were encouraged to take time to build our own awareness of Indigenous Ways of Knowing (Deloria et al. 2018).  

 

Melissa reminded us that when we look at health disparity numbers, we must remember that the numbers represent real people and families. 

 

In the Ojibwe culture, each parting ends not with a “good-bye” but with a “see you later.” There is no beginning or ending; we will just continue.  

 

We look forward to revisiting Lac du Flambeau reservation in November, this time with a group of MCW-Central Wisconsin medical students.  

 

We will pick up where we left off.  

 

For further reading:  

 

Lewis M, Prunuske A. The Development of an Indigenous Health Curriculum for Medical Students. Acad Med 2017 May;92(5):641-648.  doi: 10.1097/ACM.0000000000001482.  

 

Unfolding Futures: Indigenous Ways of Knowing for the Twenty First Century. Daedalus: Journal of the American Academy of Arts & Sciences. Philip J. Deloria, K. Tsianina Lomawaima, Bryan McKinley Jones Brayboy, Mark N. Trahant, Loren Ghiglione, Douglas Medin & Ned Blackhawk, guest editors. 147 (2): 1 – 172. Spring 2018. Link here.   

 

Amy Prunuske, PhD, is an Associate Professor at the MCW-Central Wisconsin campus and director of the new MCW medical school curriculum MCWfusionTM. She is active in the Kern Institute Human Centered Design Lab.  

 

Corina Norrbom, MD, is a Family Physician and Assistant Professor at the MCW-Central Wisconsin campus.  

They co-direct the Physician in the Community Scholarly Pathway.