Reflecting on My Journey to Women’s Health Care a Year After Dobbs

From the July 14, 2023 issue of the Transformational Times - One Year post Dobbs

Reflecting on My Journey to Women’s Health Care a Year After Dobbs

Amy H Farkas, MD, MS

Dr. Farkas shares her longtime passion and perspective on the advances and freedoms in women’s health care, both locally and globally, as the nation marks one year since the Supreme Court ruling on Dobbs v. Jackson Women’s Health Organization ended the constitutional right to abortion...

My path to women’s health care began in 9th grade world geography class. Mr. Nickels required us to report on a current world event each week, which meant I often found myself reading the world news section of the Kansas City Star. One day, as I read a story about the treatment of women by the Taliban in Afghanistan, I found myself wishing I could do more to help women around the world. Recognizing that I would not be traveling to Kabul any time soon, I decided to call my local Planned Parenthood to volunteer. I honestly can’t remember if I even knew what Planned Parenthood did, other than I had a vague understanding they were active in women’s health care and were a lot closer than Afghanistan.

My first job as a volunteer was to learn about local anti-abortion groups, specifically the Army of God, an organization known for acts of violence against abortion facilities and clinicians. I was shown pictures of known members in hopes that I could pick them out from the mostly peaceful protestors. Within a few weeks, I was the Saturday morning clinic escort. My main job was to stand opposite the protesters who showed up each Saturday and be a friendly face to women who were coming for care. Most Saturdays it was just me and the security guard standing across from five to fifteen protestors who were yelling and holding signs.

My time as a clinic escort was mostly uneventful. The police would frequently drive by and sometimes park across the street until everyone had gone home. But there were incidents of violence, real and threatened. One day, the clinic had to close when all its windows were shot out. Another day, it closed when someone committed suicide in the parking lot in protest. My fellow escort had a rock thrown at her head. Most staff at the facility had their pictures published on the internet by anti-abortion groups, and my picture might have been out there, too.

I remained a volunteer for Planned Parenthood throughout high school. In college, I founded a chapter of Planned Parenthood’s student advocacy organization. While I entered college as an international studies major, my time with the student advocacy organization grew my passion for women’s health care and specifically, reproductive care. It inspired me to pursue medicine.

I was fortunate in medical school to meet another educator, Dr. Melissa McNeil, a general internist, and leader in women’s health, who became my mentor. Throughout medical school, residency, and fellowship, she helped foster my knowledge and skills in clinical women’s health and the practice of academic medicine. She also connected me to the VA.

Since I began working at the VA in 2018, I have become convinced there is no other healthcare organization in the US more committed to serving women’s health care needs. You may find this surprising, given the military and VA's reputation for being male dominated.

Yet, women Veterans represent the fasting growing demographic group within VA, and the VA invests in their care across all its missions. It supports women’s health fellowships for physicians, researchers, psychologists, and nurses. This, in turn, helps grow the next generation leaders in academic medicine and women’s health. It funds research in contraception, maternal mortality, intimate partner violence, and breast cancer. It offers targeted educational programs for primary care teams, including physicians, APPs, and nurses to ensure they have the skills necessary to provide comprehensive, gender-specific care.

And in the post-Roe v. Wade world, the VA committed to ensuring women Veterans have access to the full range of reproductive health, including access to abortion care to “promote,preserve, or restore the health” of Veterans.

To achieve this goal, educators will be key to success. Educators will be the ones who translate government policy into clinical practice. They will teach clinicians who likely have never engaged in pregnancy options counseling and certainly not abortion care to provide compassionate and comprehensive reproductive health care. This change at VA will take time, and there are many pieces left to be figured out. But the VA's commitment to women’s health gives me hope that in the post-Roe world, medicine will not allow six justices to define health care.

The VA’s commitment to all aspects of women’s health care takes me back to my early passion to serve women’s health, both locally and globally. Thankfully, American women have far more options than were allowed to their counterparts living under the Taliban, both then and now. I am reminded that the advances and freedoms in women’s health remain only when we fight for them.

As a physician and educator, I can do my part in my clinic with my patients and in the classroom with students by helping to ensure the next generation of physicians have the necessary skills to provide comprehensive care to women. I’m grateful to have the VA as an ally in my own work to ensure health freedom for women.

Amy H Farkas, MD, MS, is an associate professor of Medicine at the Medical College of Wisconsin and works clinically as a women’s health primary care physician at the Milwaukee VA Medical Center. She also serves as faculty at the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, where she is Director of the KICS program and part of the GME Pillar.

He Did his Job. It Took a Toll on Him and His Family.

From the May 26, 2023 issue of the Transformational Times - Memorial Day

Guest essay

“He Did his Job. It Took a Toll on Him and His Family.”

Billie Kubly

Two close friends and MCW/Marquette School of Medicine alumni were drafted to serve their country during the Vietnam War. Orthopaedic surgeon Michael Kubly, MD, was sent to Vietnam. Fuller McBride, MD, an OB/Gyn, was assigned to a stateside military hospital. 

Billie Kubly, the widow of Mike Kubly, MD, remembers the experience of her husband being sent overseas and how his time working in the war zone changed him...

Our family holds Veterans in high regard. My father was in World War I, and my three brothers-in-law served in World War II. My husband, Mike Kubly, was drafted for the Vietnam War in January of 1966. 

Mike had just started his first year of orthopaedic surgery residency in Milwaukee working with Drs. Walter P. Blount and Albert C. Schmidt; one of the best programs in the country. At the time, we had four children. The youngest was two; the oldest was seven. We had just moved back from Atlanta, where Mike had completed his internship.

Being drafted and sent to Vietnam

I opened his orders when they came to our house. I read San Francisco and was so excited. When Mike read them, he said, “No, Billie. I am flying out from SF for VN (Vietnam).” He had to resign from his orthopaedics residency and worked in an emergency department until June, when he reported for duty as a Captain in the Army.

We went to San Antonio for six weeks of basic training, then drove back to Wisconsin. My father-in-law wanted me to move back to Monroe, where both of us were from. My mother had lots of medical problems. Her doctors thought my four children might be too much for her, so I moved in with my in-laws.

We met the McBrides in Chicago for two last nights on the town before our guys reported to duty.

I remember Mike telling me that it was hard getting used to prioritizing treatment on the wounded Soldiers that had the best chance of making it. It was just the opposite of working in the ER at the County Hospital, as he had done in medical school. 

Returning home

When I met Mike in Chicago upon his return, I did not see a change in him until we moved to Fort Gordon in Augusta, GA for his second year in the Army. At Fort Gordon, he saw many of the patients he had treated in Vietnam, since that was one of the Army Ortho hospitals.

Mike felt the anger of the public; being spat upon, the lack of support and respect. That was such a disappointment after giving his all for our Soldiers and seeing what our Soldiers sacrificed. Performing so many amputations took a toll on him.

After the service, we returned to Milwaukee for Mike to finish his residency. He was recruited by the two best offices in town, Blount and Schmidt. He chose Schmidt. And so, we settled in, and Mike gave his all to Medicine with anger still lurking behind his outgoing, funny personality. 

Mike and I both loved reading about World War II, but not Vietnam. It was too painful for him. The pain and anger were there underneath the surface for all those years. He talked about the experience often with our friends who had never served, and they appreciated that. But he never discussed it with our children.

Returning to Vietnam decades later

When we were in our 70s, we travelled to Vietnam. We visited where he had been stationed but, by then, the town had grown so much that he had a hard time finding the streets that he had once known so well. He had also taken care of a leper colony that had been run by the French nuns. He had loved the meals they cooked for the doctors. While we were there, they told us that the last of the nuns had died, and the government had taken it over. 

He was nervous that the Vietnamese people would not like us, but that wasn’t the case. He was happy to see how prosperous the country was with beautiful resorts springing up, which many Europeans were enjoying. 

We travelled from Hanoi south to Saigon (now known as Ho Chi Minh City). The guide on the bus in Saigon kept telling us that they were “the good Communists. Not like Cuba.” The Museum was painful to go through with the pictures of those who had helped Americans hanging on to the American planes as they took off for the US. That had been their only hope of freedom at the time. 

Seeing the country and knowing that they did not hate Americans made Mike more comfortable. He lost lots of his anger after that, but never could decide if America should have gone to war. He did his job. It took its toll on him and on his family.

The summer before he died at 82, I said to him, “Mike, I think you had PTSD, undiagnosed.” 

And he responded, “I think you might be right.”

Michael and Billie Kubly received honorary doctorates from the Medical College of Wisconsin in 2016 for their philanthropic work. In addition to their private donations in support of mental health-related projects and research at MCW, Marquette University, and Rogers Behavioral Health, the couple founded the Charles E. Kubly Foundation, a public charity committed to suicide prevention and improving the lives of those affected by depression, after their youngest son, Charlie, died from suicide at age 28 following a lengthy battle with depression. Through the generous support of donors, the foundation funds quality mental health projects that aim to reduce suicide and the stigma associated with depression and provides education and resource information.

Veteran’s Day Reflections as a Service Member and Medical Student

 From the 11/13/2020 newsletter

Student perspective/opinion

  

Veteran’s Day Reflections as a Service Member and Medical Student

 

 

Corey McKenzie – MCW-Milwaukee medical student and Ensign in the Medical Corps of the United States Navy.

  

Mr. McKenzie reminds us of the sacrifice and the commitment to service expected by service members. He also points out the parallels between military and medical service ...

 

 

Many emotions and thoughts flood my conscience when I think about Veterans Day. Why? I am a service member; I have many service members (retired and still serving) in my immediate social circle and family. I know veterans who never made it home. I know veterans who made it home, only to meet their maker while fighting the continued conflict in their mind. 

 

The best way for me to describe all of my emotions and thoughts surrounding Veteran’s Day is to tell you about my in-laws – two people that gave more for this country than most can fathom, but who would never take the limelight or sing their own praises. As you will find, most veterans are humble about their service. Almost all of them will tell you, “I miss it.” My father-in-law is certainly of this opinion.

 

Imagine a trajectory where all who join – no matter their ethnicity, culture, economic background, gender, history – are melded together, trained on a level field, and prepared for a future determined by one metric – and one metric only – Service. That’s the “military way.” If you sign the dotted line, you’re welcomed into a group that will forever have your back and forever demand the most of your character. My father-in-law joined this group and served for twenty-one years. He retired at the second highest rank of an enlisted sailor. For twenty-one years, he sacrificed his freedoms for ours.

 

 My mother-in-law also sacrificed. During deployments, imagine going through birthdays, graduations, holidays, weddings, funerals, and every life event by yourself with six kids and on a tiny budget. Most enlisted sailors live near the poverty line and are eligible for WIC and food stamps. When sailors deploy, the budget is cut in two, financial straps pull more tightly, and both adults must have enough money to live on.

 

Very few people understand this true sacrifice. Here’s the most fantastic part: Veterans don’t need you to. Their service is their burden to bear alone and they never ask other people to share. Heroes walk amongst us. 

 

Veteran’s Day fills me with pride and gratitude. As Americans, we are so lucky. We rarely must contemplate our freedoms. But, when we do, and if there are grounds to get better, we have the freedom to voice our concerns. Daily, the quality of life of every American is challenged. Our society questions the fairness of everything. We live in a country where social justice movements are possible. This is a freedom made possible by those who protect our rights. Not everyone agrees with one another, but we live in a country where we get to have the conversation. Our military members make these conversations and social changes possible. 

To use a metaphor, if the USA is a house and the people who live in it need to either remodel or tear it down to build something better, our service members keep the foundation strong and ready for whatever is next. This is a day where we tip our hats to these silent heroes and preservers of our freedoms. 

 

Veteran’s Day also fills me with disdain and frustration. Our veterans are largely forgotten and not treated with the gratitude they deserve. They signed the dotted line and risked everything. Their healthcare, both mental and physical, is not where it should be after they retire. Twenty-two veterans a day succumb to suicide. I joined the military to pay for medical school, but my eyes have been opened to the health care gaps our military, and especially veterans, receive. I plan to use my education to change this. I can think of no population I would rather serve than those that served so selflessly. Honor, courage, and commitment are military ideals, but don’t they also apply to medicine, as well?

 

 

Interestingly, there are many parallels between military service and medical service. We both give up large parts of our lives in the service of others. We are constantly volunteering to care for others’ needs before our own. Our society, by in large, is more stable and free because of our service. We each have alarming suicide rates, and we struggle – Boy, oh boy! Do we struggle! – to face that reality. Neither group requires praise. Each strives to hone its craft and make processes better. Probably most important, both are vital threads in the fabric of society. Even if the idea of military service is completely foreign to you as a medical professional, I hope you can see how similar and relatable your own life can be to military service. My hope is that someone reading this might change the way they think about our veterans and their sacrifice.

 

 

This Veteran’s Day, I hope each of us takes a moment to feel the weight of the sacrifice our veterans gave. If you know a veteran, reach out to them. While they will not expect praise, their day may be just a bit brighter by a simple, “Thanks.” Don’t worry about what you say; if it comes from the heart, it will be well received. Most are warriors on the outside and big teddy bears on the inside. Never forget, they serve for you! I leave you with the first article of the Code of Conduct. Hooyah!

 

I am an American, fighting in the forces which guard my country and our way of life. I am prepared to give my life in their defense.

 

 

 

 Corey McKenzie is a member of the Class of 2023 on the MCW-Milwaukee campus. 

 

The views expressed are those of the author and do not reflect the official policy or position of the US Navy, the Department of Defense, or the US Government.

 

 

If you or someone you know is struggling with thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255 or reach the Crisis Text Line by texting HOME to 741741. 

 

Associate Editor: Anna Visser

Meaningful Careers in the VA

 From the 11/13/2020 newsletter

Perspective
 
 
Meaningful Careers in the VA
 
 
Kayt Havens, MD
 
 
Dr. Havens describes the myriad, rewarding career opportunities the VA has to offer …
 
 

Twelve years ago, I received a call from Dr. Ann Nattinger asking if I would accept a position at the Zablocki VAMC as Director of the Women's Clinic.  I am grateful every day that I said, “Yes.”  My work there powerfully influenced my identity as an educator-physician and design learner. When I told colleagues and friends that I worked at the VA, their faces often registered disbelief. Little did they know that the VA has the history of being the most innovative health care system in this country. 
 
Last week we celebrated Veterans Day. I am taking this opportunity to also honor the physicians and care teams who have committed some or all of their lives to the improvement of health care for veterans. I've asked some of our MCW Zablocki VAMC faculty why they chose to work in the VA. I'm including some of their comments below.
 
Dr. Jerome VanRuiswyk says, “I do consider it a privilege to care for all types of veterans. Many veterans paid the ultimate price for freedom and didn't return; the rest were willing to pay that price and, you and I have the privilege to serve them. Other things that have drawn me to a career at the VA is the fact that the vast majority of veterans are truly grateful for the care they receive. The system focuses on caring for these unique patients no matter their socioeconomic status including their wide range of comorbidities, some which resulted from their service.  Veterans are best served by the VA's multidisciplinary care teams who have a biopsychosocial approach to care.”
 
 Dr. Jeffrey Whittle, who has spent most of his career working throughout VA hospitals wrote, “I think that working in the VA has been a privilege because so many of the employees are mission driven. They truly view the opportunity to serve veterans as an important reason to come to work.”  As patients receive care regardless of their ability to pay has “allowed me to get to know people from across the socioeconomic spectrum on a personal level and has helped me recognize the nobility that is present.” Dr. Whittle also states that “history means more to me now.” He has worked with and taken care of the “ordinary people who have made that history,” having seen prisoners of war, a member of the Tuskegee Airmen, veterans of Pearl Harbor, the Omaha Beach landing on D-Day, and the Battle of the Bulge in his practice.  These veterans and those of the Vietnam War and current conflicts have added to his sense of commitment.
 
Dr. Amy Farkas joined our VA two years ago after completing a women’s health fellowship at the Pittsburg VA.  “Caring for veterans is one of the many things I find rewarding.”  There are a host of professional reasons that make a VA career appealing to her. “I’m lucky enough to be involved locally and nationally with the VA.” As faculty, I spend 1/3 of my time developing Women's Health education programming for the national VA where there is this amazing network of women health leaders.  This has been a huge benefit for my career. “The VA also provides great resources for medical education and scholarship including research projects. I have access to immense amounts of data and powerful tools for utilizing it.” 
 
Dr.  Margaret Holmes adds another dimension to her work at the VA. Her grandfather served in the trenches during World War I. Her beloved stepfather was a veteran of World War II, Korea, and Vietnam and her great-great-grandfather fought in the battle of Shiloh during the Civil War. Therefore, her work at the VA has a personal meaning as well.  She notes that she cares for a much sicker, poorer population. She has the “addition of terrific teams including a nurse, LPN and MSA who are all smart and capable.” A dietitian, social worker and pharmacist are also housed in her clinic. She experiences  fewer barriers to care  as “social workers slay the psychosocial dragons enabling us to see the patients more easily and get them access to services which are part of living a healthful life … I never have to say your insurance doesn't cover that and medications are cheap or free for everyone.” Dr. Holmes loves that she has time to do her job properly as there are no RVU’s, she has thirty minutes with each returning patient, sixty minutes for a new patient, and “no one fusses if it takes longer to complete a visit.”  Her collaboration with specialists is easy, and they're attentive to the needs of her patients.
 
For myself, my last five years at the VA included national work with the VA Innovators Network. As such, I traveled to thirty-two VA sites across the country and witnessed firsthand the commitment and dedication of frontline workers including nurses, occupational therapists, physical therapists, etc. through this network. Over $3,000,000 a year was awarded to frontline employees who identified and solved problems encountered by veterans using human centered design as part of understanding the problem.  3D printing programs were established across these thirty-two hospitals to create everything from a personalized spoon for a stroke victim, to improving a poor prosthesis fit.  A young woman whose leg was blown off in Afghanistan requested a prosthetic so she could wear a high heel for her wedding which was proudly presented to her.  The Minneapolis VA critically created a wheelchair which a user could crank up to a standing position; imagine being able to roll yourself down an airplane aisle. One multidisciplinary team of occupational therapists, designer and engineers created a hamburger helper device for two veterans allowing them to eat a full hamburger at Red Robin.  Previously the “claw” would destroy the burger half eaten. These projects were designed with veterans for veterans. I stand proudly with the veterans that my colleagues and I have served and those who have served me. 
 
Students who want to know more can sign up for the Military Academic Enrichment Elective that will be offered in January 2021. Michael Nagy, PharmD and his team of medical and pharmacy students worked with students, faculty and veterans. This will be the third year this class is offered to medical students and represents innovative curriculum development.
Chase LaRue, an MCW-Milwaukee Class of 2023 medical student and member of the US Naval Reserves, shares the following information about the elective: 
 

The military academic enrichment elective provides students a unique opportunity to learn specifically about veteran health care issues and considerations unique to this population. They explore the health care providers role in adapting their care to better suit the needs of those who served. The course consists of a weekly didactic given by lecturers experienced in advocating for veteran wellbeing combined with a portion of the class that allows for group discussion. Topics span a variety of subjects from experiences veteran populations may have faced during service to techniques that medical and pharmacy students may use to better connect with veteran patients. This class helps students develop a strong sense of trust with veterans. 
 
Due to the COVID-19 pandemic, the course will only involve medical students in 2021, but we look forward to continuing more programs in the future. The logistics regarding this year's virtual sign up will be available as we approach January. Given that virtually all MCW Milwaukee medical students will spend at least some portion of their rotations at the Zablocki VA Medical Center, taking the time to understand this perspective and diversity of issues surrounding these patients is important to help us serve there better and maximize the quality of care we are able to provide.
 

 
 
Kathryn (Kayt) Havens, MD is an Associate Professor of Medicine (General Internal Medicine) at MCW. She is a member of the Culture and Systems Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, bringing expertise in human-centered design methodology.
 
 

My Dad was a Veteran

From the 11/6/2020 newsletter

Editor’s Corner

 

 

My Dad was a Veteran

 

 

Bruce H. Campbell, MD FACS – Editor-in-Chief of the Transformational Times

 

 

In this Veteran’s Day issue of the Transformational Times, you will meet several people who have offered their time and talents in service of country. Some, in the earliest stages of their careers, share their motivations; others, who have retired, offer their reflections. All have taken the oath, just as my father once did, to “support and defend the Constitution of the United States against all enemies, foreign and domestic.” Like our newsletter contributors today, my father inspired me.

 

 

My dad was a veteran. He spent over three years on a light cruiser, the USS Santa Fe CL-60, during World War II. His ship earned thirteen battle stars, seeing action from the Aleutians to the Philippines. I have no idea what that experience was like.

 

Similar to many other citizen-soldiers of his era, Dad never planned to be in the military. He grew up on a Missouri farm during and after the Depression, knowing only that he wanted a different kind of life. He worked his way through college and graduate school by scraping together enough money to, as he said, “keep body and soul together.” Like everyone else, his life was upended on December 7, 1941. 

 

He enlisted in the Navy shortly after the attack on Pearl Harbor. His mother, back on the farm, bemoaned his choice. “Why didn’t you join the Army like your brother?” she cried. “Navy boys all drown like rats!” 

 

After ninety days of Officer’s Candidate School, newly commissioned Ensign Ray W. Campbell, USNR was on his way to the Pacific. He served in many capacities on the ship from gunnery officer to officer of the deck. He occasionally assisted the ship’s doctor (who had trained as a gynecologist) in surgery. He helped direct rescuers after the attack on the USS Franklin, and was nearly killed when a kamikaze plane barely missed the gun turret where he was standing. He played the ship’s small portable organ to accompany Catholic, Protestant, and Jewish services. He wrote letters to parents of sailors who died. His ship became part of the occupation fleet after the attacks on Hiroshima and Nagasaki ended the war. He returned home to a different world.

 

My dad was twenty-three when he enlisted and twenty-seven when the war ended in 1945. For perspective, I never lived more than a hundred miles from where I was born until I was thirty. Between twenty-three and twenty-seven, I was finishing medical school, starting residency, and trying to figure out what I wanted to do with my life. At the age when he was fulfilling his service as part of the Greatest Generation, I was exploring the depths of imposter syndrome. 

 

My dad spoke very little about his experiences. At home, we looked occasionally at a book he had helped compile about his ship’s campaigns. There were a few mementos around the house. He called a shipmate once in a while. He didn’t march in parades or join the VFW. I wish I had asked him why but, now, it is too late. 

 

Because my dad spent little time talking about his Navy service, I am encouraged that there are VA-based programs that help veterans to tell their stories. I count myself fortunate to have met many veterans throughout my career at the Zablocki VAMC. 

 

I have the utmost respect and admiration for the veterans for whom I have cared and for this week’s Transformational Times contributors. I hope you will pause and sit for a while with each of the essays. Please listen to their stories and then take time to honor the veterans in your life. 

 

 

 

Bruce H. Campbell, MD FACS is a Professor in the Department of Otolaryngology and Communication Sciences at MCW. He is on the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

 

 

 

 

Take 3: In the Service of Fellow Veterans

 From the 11/6/2020 newsletter

Take 3: In the Service of Fellow Veterans

Dr. Jeffrey Jackson shares his insights about being a retired Army officer and serving veterans at the Clement J Zablocki VA Medical Center in Milwaukee.
 

Jeffry L. Jackson, MD MPH 

 

 

1. Some people have observed that there is an esprit de corps within the VA, especially between the patients.  How do you explain that?

 

The VA purposefully instills a strong sense of mission.  Ask nearly any VA employee and they can recite the mission statement, “to care for those who shall have borne the battle,” initially uttered by Abraham Lincoln.  From the initial orientation to daily meetings, VA employees are constantly reminded of their duty to serve veterans.  

 
This esprit de corps is also present among veterans.  The purpose of boot camp in the military is to indoctrinate a sense of belonging, that the person standing beside you is responsible for keeping you alive in combat, an obligation that is mutual.  A significant portion of veterans have seen combat in WWII, Korea, Vietnam and now in the Middle East.  Nothing creates a sense of comradeship like going into harm’s way. Unfortunately, nearly everyone who deployed into a combat theatre saw a friend die or be severely injured.  This strong sense of purpose and sacrifice leaves an indelible mark.

 

 

2. What is the best advice you could give to students and residents who provide care for veterans?  What key insights could make their care for veterans better?

 

Veterans are no different than nonveterans in what they want from their providers.  If the patient believes you have their welfare at heart, if they trust that you are motivated to do your best for them, they will respond to you. Communication is at the heart.  Be open and honest and human. Admit when you don’t know something. Seek out their underlying motivation for the visit, and as best you can, honestly deal with it.  Do not judge veterans, many have physical and psychological scars, and some have made bad choices.  Listen to their stories.
 

 
3. Tell us about a moment during your service in the Army that you are most proud of (or that contributed to your development as a caring physician)?

 

I spent most of my military career at Walter Reed Army Medical Center.  I was a senior resident and was working in the ER when we gathered around the television to hear George Bush announce that the United States was going to repel Iraq’s invasion of Kuwait.  The United States he said, but he really meant the United States’ military forces - young men and women.  Nearly all the military casualties made their way back to Walter Reed. I witnessed the impact of combat on soldiers and their families; a family at the bedside of a soldier with a horrific brain injury, clinging desperately to hope and misinterpreting every minimal sign of responsiveness.  I avoided elevator bank 4 because that’s where the amputees would gather in their wheelchairs, coming back from our amputee center.  It broke my heart to see so many being pushed by their mothers or their 18-year-old girlfriends.  They barely looked old enough to shave. 

Old men make the decision to go to war, young men and women pay the price.  

I once made the trip out to Dover to watch the dead being returned home.  Each flag-draped coffin was moved from the plane to the mortuary, solemnly accompanied by an honor detail.  On my visit, family members and several high-ranking officials were in attendance.  I only made the trip once and cannot imagine the resilience it must take to be assigned this duty.  I attended several funerals at Arlington Cemetery.   On one occasion, President Bush was in attendance.  I was proud to serve a Commander in Chief who was openly weeping. 

I spent 21 years in the Army.  What I am most proud of was the sense of purpose, honor and sacrifice that I witnessed.

 
 

Jeffrey Jackson, MD MPH is a Professor in the Department of Medicine at MCW. His practice is at the Zablocki VA Medical Center. 

 

Editor: Kathleen Fletcher, MD MA

 

Veteran’s Day Reflection

 From the 11/6/2020 newsletter

Perspective 
 
Veteran’s Day Reflection
 
 
Kenneth Lee, MD – Department of Physical Medicine and Rehabilitation
 
 
Dr. Lee, a retired Army Colonel, shares his perspective on how we all learn to serve our military veterans …
 
 

“Thank you for taking care of my patients.”  These words meant something to me when I addressed nurses, therapists, dieticians, pharmacists, and many other disciplines at the Zablocki Veterans Affairs Medical Center (VAMC), especially when Veteran’s Day came around. 
 
 But now, I no longer say these words.  Why?  Let’s see……
 
I have been a physician in the VA system since 1997 and my whole medical career has been at the VAMC. I retired from the military after twenty-seven years of service in 2013.  I spent 27 years in the National Guard with one active duty deployment. Now, I am a retired military veteran. I have seen leaderships change, colleagues move around, and viewpoints challenged and accepted over the years.  The one thing that has stayed consistent in my life: The veterans.  
 
I interact with different generations of veterans on a daily basis.  Some are sick.  Some are healthy. Some are disabled.  Some are athletes.  And, some are just friends.  They are all serviced by the VA.  So how are we doing on that front?
 
Some time ago, a second-year medical student approached me to help create an introductory curriculum on veteran care to be taken BEFORE medical students start their rotations at the VA.  Without much thought, I agreed to be her mentor.  Three years later, this is a fully formed, elective inter-professional educational curriculum created in partnership between MCW’s schools of medicine and pharmacy. This curriculum covers the life of military service member during peacetime and war, the structures of the DOD and VA systems, the development of interviewing skills with veterans, and much more.  You can see the eagerness of the students in the classroom as they absorb the information the teachers and veterans share with them.
 
During this COVID-19 pandemic, there have been countless gestures by the community, despite the suffering, to provide comfort needed by the veterans. Boxed lunches for VA staff during the height of COVID -19 surge, generous donation of PPEs so we can continue to be safe during the care of the veterans, and many words and notes of encouragement.  
 
 It seems that during the worst of times, the veterans are never forgotten. 
 
What else? You can tell your stories.  You have them.
 
So, why do I no longer say the words, “Thank you for taking care of my patients”?  I always thought of the veterans as my brothers and sisters. I never had second thoughts. But it was just one of those things that was part of the military/veteran culture.  Just accepted it.  But recently, I find myself truly belonging to this family.  So, I now say….
 
“Thank you for taking care of my fellow veterans.”
 
 

Kenneth Lee, MD is an Associate Professor of Physical Medicine and Rehabilitation at MCW who works and teaches at the Zablocki VA Medical Center in Milwaukee. He served as the Commander of the Army’s Company B, 118th Area Support Medical Battalion in Iraq. 
 
You can read more of his personal story and motivation for caring for veterans here.

Preview of presentation by Adam Hill, MD - Author of Long Walk Out of the Woods: A Physician’s Story of Addiction, Depression, Hope, and Recovery

From the 7/31/2020 newsletter

Three Questions for Adam Hill, MD 

Dr. Hill is Chief of Pediatric Palliative Care at Indiana University’s Riley Hospital for Children and author of Long Walk Out of the Woods ~ A Physician’s Story of Addiction, Depression, Hope, and Recovery

He will deliver Kern Institute's Grand Rounds on 8/6/2020 - 9:00 - 10:00 a.m. CDT

REGISTER HERE

  

TRANSFORMATIONAL TIMES: Dr. Hill, you developed and direct a program at Riley Hospital for Children called an "Compassion Rounds." What led you to develop the program and what impact do you see it having?

ADAM HILL, MD: We wanted to create a safe space for human storytelling, where individuals from all walks of life could come, share their experiences in a brave yet vulnerable way and know that they are being loved and supported for their authentic truth. We wanted to cultivate compassion, empathy, understanding and in doing so, breed a culture of human connection within our hospital walls. We intentionally open this space to all people, from EVS workers, cafeteria colleagues, to teachers, therapists, nurses and docs. We don’t focus at all onclinical medical decisions or even clinical encounters but instead about our own human experiences and how those experiences make us who we are today. In doing so, we create connections, friendships, perspectives and pathways for support. So that if an individual is struggling in their own story, they know that they are not alone and have cultivated their own silos and spaces now to reach out for help.

Over and over again we see these connections flourish outside of the meeting spaces. Sparks that turn into brushfires and true connections that develop when we take off our own blindfolds and realize that we are all in the same room together. Walking around with our own insecurities, fears, and anxieties in the same way. And we don’t shy away from the harder conversations like ourmental health, personal trauma, abuse, race, addiction, work trauma, grief/loss, etc.

TT: How do you use empathy to explore the emotions and needs of your patients?

DR. HILL: Having my own story of health conditions allows me to challenge myself to constantly stay open-minded and open-hearted. That we all have our own stories that are deeper than any stereotype or superficial assumptions assigned. That I hope people will get to know me as Adam, a man/husband/father/dog-lover/physician and not merely as someone with a history of addiction or depression. I hope to give my patients and their families the same dignity, a respect of listening to their story with a willingness to be changed.

From my own experience, I know that personal truth is layered under levels of denial, self-preservation, anger, projection, shame, guilt and the external pressures of having to portray some semblance of perfection or a stereotyped ideal of how to live your own life. Getting to the truth of someone’s experience requires patience, presence, trust, respect and a safe enough space where this truth can be explored. I hope to show up in this way for my patients, to build this trust and know that I can’t ever know what their story, life or lived experiences is like – but that I am willing to listen to find out.

 

TT: As a palliative care specialist, how do you manage your own mental well-being while caring for patients, especially during the pandemic or any other crisis?

DR. HILL: Without pretense. Without any expectation of perfection or that I have everything figured out. I am a work in progress and I strive not for perfection but for progress every single day. That I can show up, do my best and provide space for grace that I am a human being in the midst of difficult times and I can only control what I can control. Over almost a decade of recovery, I have learned my own triggers, my own needs, my own limits and where I need to set boundaries in my own life. I’ve developed skills and techniques, and I rely on ongoing counseling to continue to move forward in my own processing of the complexity of the daily work. I’ve learned how to communicate those needs to my family and my colleagues in a way that allows me to continue to do the intimate work every single day.

I also find deep meaning and purpose in the work that I do. Although difficult work, I see this as an incredible opportunity to make a difference in someone’s life during the hardest days of their lives. That I didn’t cause the pain, suffering, sadness or grief. I am not in control of what happens in the world all around, but I do have a role to play in showing up, doing my best and bringing intention into the work. And then, on the back-end, finding healthy ways to integrate that work into the story of my life in a way that allows me to be a father/husband/son as the top priority of my life.

Dr. Adam B. Hill is the division chief of pediatric palliative care at Riley Hospital for Children at Indiana University Health. His work in palliative care is focused on allowing patients to live the best quality of life possible, in the midst of chronic, life-limiting and/or life-threatening medical conditions. Dr. Hill is passionate about physician wellness and self-care in the context of changing the culture of medicine surrounding mental health conditions and addiction. In 2017, Dr. Hill published a groundbreaking New England Journal of Medicine articled titled “Breaking the Stigma: A Physician’s Perspective on Self- Care and Recovery.” In this article Dr. Hill shares his own story of personal recovery from depression and substance use. As a result, Dr. Hill has become a nationally recognized lecturer on the topic and has also authored a book entitled “Long Walk Out of the Woods: A Physician’s Story of Addiction, Depression, Hope and Recovery”

Excerpt from: Long Walk Out of the Woods ~ A Physician’s Story of Addiction, Depression, Hope, and Recovery

“...Worldwide, evidence continues to show that worsening mental health is an occupational work hazard in the medical field. I know firsthand how one’s mental health can deteriorate during medical training. Studies have shown that 27 percent of medical students are depressed, a rate three times higher than an aged-matched cohort of their peers. The numbers don’t get any better after graduation either as depression rates among medical residents are an estimated 29 percent. In medical schools in the United Kingdom, a multi-school study found 52 percent of medical students reported substantial levels of anxiety. While another study found the proportion of medical interns meeting criteria for depression increased from a baseline of 3.9 percent prior to medical training to a staggering 25.7 percent during medical internship. In the group of individuals reporting their mental health conditions, more than 80 percent did not feel adequately supported in their disclosure.”

The Power of a Letter on Memorial Day Weekend, 2020

From the 5/29/2020 newsletter



The Power of a Letter on Memorial Day Weekend, 2020



Adrienne Klement, MD - Hospital and Palliative Care Medicine




Hours to days. This is the prognosis required to allow a patient up to two visitors in the VA hospital.


It was a Memorial Day to remember. The Wood National Cemetery looked bare without flags marking each tombstone. Instead, a wreath ceremony took place. Celebrations were virtual and the day subdued.


For our veterans and their families, Memorial Day is for celebration and mourning to honor fallen brothers and sisters, family members, and loved ones in service. It is a day to reflect on the price and sacrifice of military duty.


For many of our patients, celebrations took a backseat to the longing for everyday living. For veterans facing difficult decisions ahead, those recovering from a long battle with the coronavirus, those at end-of-life, those living with dementia, or those with hidden injuries like post-traumatic stress disorder, the lack of usual (and necessary) sensory inputs – the warmth of sunlight hitting a cheek, the sound of birds chirping on a spring morning, the sound of a familiar voice, or the touch and scent of a familiar hand – was missed more than ever.


Similarly, the toll on their families and the hospital staff did not go unrecognized. Many found innovative ways to cope and adapt.


Some patients and families bring prior experiences and learned coping skills from their military mindset. Skills – such as managing uncertainty in uncontrollable situations, sending mail to reduce feelings of isolation during wartime, and handling multiple crises at once – seem all too familiar. On the other hand, memories of confinement, past trauma, and lost freedoms resurface, too.


Hours to days. The pressure for prognostic precision feels immense.


The power to grant meaningful touch and physical presence at the expense of fending off the enemy virus feels costly and unnatural. For patients on our palliative care unit at the VA and for veterans admitted whose care needs exceed their caregiver’s abilities at home, bridging the separation with video chats and phone calls feels inadequate during a very vulnerable time. For those with hearing and vision impairments, this medium is exceptionally difficult.


So, on Memorial Day weekend, sparked by memories of our past and past traditions, we asked families and friends to write letters to help bring coveted familiarity to the bedside. Through the extra efforts of our social workers, nursing assistants, nurses, recreational therapists, and restorative aides, we received and delivered more than 25 letters (and counting).


The letters had an impact - not only on the writers and the patients – but also on the staff members who were fortunate to read them. One patient’s wife wrote, “I pray that the Lord will allow me to kiss those lips, hold your hands, and our eyes lock on each other one more time. If He does allow it, I will be happy, if He doesn’t, I will save my kisses for when we meet again this time in heaven.”


On this Memorial Day, as these letters are read, I sit outside counting my blessings. I hug and kiss my husband and kids. As I do so, my mind wanders to all of the families remembering their fallen soldiers and to the families longing to embrace their soldiers confined to the hospital. Some of them have only hours to days before they, too, will be remembered on Memorial Day.



Adrienne Klement, MD is an Assistant Professor in the Department of Medicine (Hospice and Palliative Medicine, Inpatient General Medicine) at MCW. She practices at the Zablocki Veterans Affairs Medical Center.