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.

Poppies on the Grave – Symbolism and Memorial Day

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

Perspective

Poppies on the Grave – Symbolism and Memorial Day

By Capt. Tej Ishaan Mehta MD - United States Air Force Medical Corps and Internal Medicine Resident Physician

Dr. Mehta reminds us why Memorial Day is such a unique holiday and how commemorating all fallen military personnel can bring us together as one nation…

One-million, three-hundred and four thousand, six hundred and eighty-four. At the time of writing, that is how many United States military personnel have perished in in the line of duty. How many mothers have wept at the sight of Death Notifiers walking to their door? How many fathers have broken down upon receiving that terrible phone call? How many lives have been ruined by the loss of a loved one in service to our country? How many lives have been saved? This Memorial Day, I urge you to consider these questions.

Memorial Day is unique amongst American holidays. All other major American holidays are marked by celebration, but Memorial Day is marked by mourning, by remembering the fallen. Memorial Day honors and mourns the United States military personnel who died in the performance of their duties. The establishment of Memorial Day is complex and uncertain, but general trends are clear. After the end of the Civil War, citizens across the United States recognized the importance of honoring those who had fallen in combat. With the death of Abraham Lincoln in 1865, commemorations were widespread. The National Cemetery System was established for casualties of war and the practice of Memorial Day became common. Across the North and the South, the fallen from both sides of the war were honored, respected, and remembered, continuing their service even in death by helping to reunite the country.

At any National Cemetery today blooms of scarlet are seen. Red poppy flowers are placed on the graves of many war dead, a tradition that dates to World War One. In 1915, after the Second Battle of Ypres, red poppies grew over the graves of some 120,000 casualties. A sea of red, to cover the blood that had been shed. The poem, “In Flanders Fields” by John McCrae, was written about the battle describing the flowers growing on graves. With it, the practice of placing red poppies on the graves of the fallen became common. The practice holds in many other countries as well, serving as an international symbol to honor the fallen.

During the Vietnam War, another somber Memorial Day tradition developed. To recognize those soldiers who were missing in action or had become prisoners of war, military dining facilities set a Missing Man table. The table is usually set for one, to symbolize their isolation. A slice of lemon is placed on the plate, to represent their bitter fates. Salt is sprinkled on the plate to represent the tears of their families. The drinking glass is inverted, to represent that they cannot partake in the meal. The chair is empty to represent their absence. Lastly, a single candle is lit to represent hope and illuminate their way home. This tradition reminds us that while we may enjoy the freedoms in our lives, those freedoms are earned by the protection and sacrifice of others.

One-million, three-hundred and four thousand, six hundred and eighty-four. As I sit here, tallying the scores of fallen soldiers I am reminded of an apocryphal quote from Josef Stalin, “The death of one man is a tragedy. The death of millions is a statistic.” The point of Memorial Day is to stand in stark contrast to that statement; to make the deaths of millions into one tragedy at a time. Memorial Day has helped mend the wounds of the Civil War, of World War One, of the Vietnam War and of countless other conflicts by bringing disparate sides together in their common loss. This Memorial Day, let us remember the good that so many sacrificed for and in so doing find that which brings us together.

Tej Ishaan Mehta, MD, is an Internal Medicine Resident at MCW and a Captain in the United States Air Force Medical Corps.

Rituals Stir our Memories and Push us toward Transformation

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

Director’s Corner

Rituals Stir our Memories and Push us toward Transformation 

Adina Kalet, MD MPH

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

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

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

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

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

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

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

An evening ritual in New York and beyond

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

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

Medical Education will continue to transform 

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

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

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

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

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

Stand Up for What You Believe In

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

Perspective/Opinion

Stand Up for What You Believe In

Chad Kessler, MD

Dr. Kessler is the National Program Director, Emergency Medicine, Department of Veterans Affairs.  He is also a professor at Duke University and a staff physician at the Durham VAMC. He is the epitome of charismatic and inspiring VA leadership.  Here is an essay that he generously let us share from one of his twice weekly newsletters ...

So, I was sweating through my Thomas Pink button down shirt this late Friday afternoon and eon or two ago.  I was still in the hospital at 6:00 that day, stewing in this tiny, windowless room…not only because of the jungle like temperature, but the unfamiliar and frankly unnerving environment. As a young chief, this was all very new to me, and having to sit with these top leaders was terrifying, and only intensified by the news I had to share. We were short on coverage, I felt that we were teetering on unsafe care in our Emergency Department, and I needed to advocate for staff in a miserable budget year.  That word…I didn’t realize how much power was in that single word.  I literally remember the second when the Boss stopped the meeting in mid-sentence, and said, “Kessler, did you say we have an ‘unsafe’ environment?” Like I had uttered a profanity in Temple or put ketchup on a hot dog.  I looked around, realized everyone was staring at me, and said prophetically, in my best Homer Simpson voice, “uh…yes.”  I’ll be honest, I don’t remember much after that, except feeling like I said or did something wrong (even though I knew I wasn’t wrong), that people were mad at me, and that I truly may get fired…but I got home, gave my wife a hug, the kiddos jumped into my arms, grabbed myself a two liter chai and thought in my head, I did the right thing, right?     

 

Here’s the moral of my tale…Stand up for what you believe in, even if you’re standing alone! It may be pressure from your boss to not open your mouth, it may be your team telling you everything is fine or it may be that little voice (you know, the easier wrong voice) whispering to you how much you really like your job...and don’t really feel like updating your CV.  But whatever it is, make sure you’re doing what is right in your mind.  It’s your name on that memo, on that patient chart, it’s your voice they will hear, and it’s your conscious you will live with for years to come.  So, make sure you do the right thing, take the harder right, and stand up for what you believe in…even if you’re standing alone.

 

Just for closure sake, we did end up getting that additional coverage for the ED, and I did not get fired.  In fact, I specifically remember one of the senior leaders coming up to me later that week, telling me how brave that was…and was indeed the right thing for patient care. If only he was standing with me during that meeting…but nonetheless, alone or together, we need to stand strong for what we believe in.

Dr. Kessler curates an amazing series called “C20” or Covid in 20, which currently has over 100 informative episodes on a variety of topics from “COVID and the law (Episode 63) to COVID and delirium (Episode 28).  Some are VA specific, but many are not.  Click here to check them out. 

The Marquette University School of Medicine Aids America in the Time of War

From the 5/28/2021 newsletter

Medical School History 

 

The Marquette University School of Medicine Aids America in the Time of War

 

Richard Katschke, MA

 

In this excerpt from his book, Knowledge Changing Life: A History of the Medical College of Wisconsin, 1893-2019, MCW Chief Historian Richard N. Katschke explains how MCW’s predecessor institution, the Marquette University School of Medicine, responded to the national call to action during World War II …

 

As Europe was embroiled in conflict in the late 1930s, the possibility of the United States’ participation in the war effort impacted the Marquette University School of Medicine and other medical schools nationwide. Beginning in 1940, the Marquette medical school responded to a request from U.S. Surgeon General James C. Magee to sponsor an army surgical hospital. Eben J. Carey, MD, PhD, dean of the medical school, appointed twenty Marquette medical school faculty and staff members to provide administrative and technical assistance to Surgical Hospital #42, based at Fort Campbell, Kentucky. Also, in 1940, Marquette University – including the medical school – was one of twelve colleges nationwide selected to sponsor a Naval Reserve Officer Training Corps.

Following the attack at Pearl Harbor, the United States declared war against Japan on December 8, 1941. Four days later, Germany and the United States went to war. The world conflict triggered significant changes at the medical school. Beginning in July 1942, all teaching activities at the Marquette medical school were accelerated so that medical students could become physicians more quickly and provide medical care on the front lines. Vacations were shortened or suspended. Courses were abbreviated, and electives were dropped. Walter Zeit, PhD, ’39, recalled, “There were several instances where one academic year ended on a Friday and the next one started the following Monday.” Graduation ceremonies were conducted in May and November. Because of the demand for physicians during wartime, the medical school – unlike many other academic programs at Marquette – maintained a strong enrollment.

Norman Engbring, MD, ’51, noted in his book An Anchor forthe Future that the accelerated wartime curriculum placed an additional financial stress on the medical students. In 1942, the W.K. Kellogg Foundation provided $15,000 to the medical school to create a student loan fund. The Kellogg Foundation awarded similar grants to other medical schools nationwide.

Another change that occurred in September 1942 was that the fifth year of medical school - the internship year - was abolished. The requirement had been in place since 1920. Dr. Engbring explained that the fifth year was dropped so that junior medical students could qualify for federal loans that placed a four-year limit on the number of years a student could remain in school. By the end of 1942, only nine of the nation’s sixty-seven medical schools still required the completion of an internship year before medical school graduation. The Army and Navy gave medical students provisional commissions which enabled the students to avoid the draft and stay in school. For example, the Army Student Training Corps and the Navy’s V-12 program were organized, and medical student recruits received a base pay of $50 per month from the military.

“Khaki is now in evidence in the Schools of Medicine and Dentistry as 320 members of the Army Enlisted Reserve Corps in these schools were recently called to active duty by the order of the War Department,” reported the Marquette Tribune on July 15, 1943. “Within the last weeks these Meds and Dents were sent to Camp Grant, Illinois, where they were inducted, issued uniforms, and immediately ordered back to Marquette to continue their education. Roll call at 7:45 am either on the parade grounds or for senior medics, at the hospital, begins the day of the trainees.” Anthony Pisciotta, MD, ’44, recalled that the Army students were organized into the 3665^th service corps under the command of Major Joseph Plodowski, who was based at the medical school. The medical student soldiers became known as “Plodowski’s Raiders” and the “Fighting 3665^th.”

The Marquette Tribune reported that of the 334 male students enrolled in the medical school, 176 were commissioned as 2^nd lieutenants in the army, 104 received navy commissions, thirty-six had applications pending, and eighteen were ineligible for commissions because they were either non-citizens or had a medical disability. Earl Thayer wrote in Seeking to Serve: A History of the Medical Society of Milwaukee County, that nearly fifty faculty members saw active service, as well as a large percentage of alumni.

One alumnus, Lt. William Henry Millmann, MD, ’43, was killed on February 21, 1945, while caring for war casualties in Italy. The Millmann Award, the Medical College of Wisconsin’s highest honor for graduating medical students, was named in his memory. The first recipient of this award was Marjorie E. Tweedt Brown in 1948. John Erbes, MD, who joined the medical school’s surgical faculty in the late 1940s, was the most highly decorated U.S. physician in World War II. As a battalion surgeon, he saw front-line duty in Morocco, Tunisia, Sicily, Normandy, Belgium, and Germany.

 _____

Excerpted from Knowledge Changing Life: A History of the Medical College of Wisconsin, 1893-2019, by MCW Chief Historian Richard N. Katschke, MA. The book is available for online purchase here.

 

 

Richard N. Katschke, MA is the Chief Historian of the Medical College of Wisconsin. He joined MCW as Director of Public Affairs in 1985 and served as the Senior Associate Vice President for Communications. He received MCW’s Distinguished Service Award in 2015 and was awarded an honorary Doctor of Humane Letters degree by MCW at the 2021 commencement ceremony.

Discussing the Grandkids: If RBG and Antonin Scalia can Find Common Ground, Then so can We

From the 1/22/2021 newsletter 

Director’s Corner

 

 

Discussing the Grandkids: If RBG and Antonin Scalia can Find Common Ground, Then so can We 

 

 

By Adina Kalet, MD MPH and Kathlyn Fletcher, MD MA

 

 

This week Drs. Fletcher and Kalet team up to argue that there are ways in which nurturing a patient-physician relationship resembles the healing our society needs today …

 

 

As clinicians, we learn to build rapport quickly. Most of the time this is easy. After all, people come to physicians and other health professionals seeking help or advice and are predisposed to trust us. Under most circumstances, we use our verbal and nonverbal skills to put the individual at ease and make an opening invitation, something along the lines of, “Tell me, what is going on?” or, “How can I help?” to get the patient telling their story. Evidence suggests that establishing a narrative thread, by encouraging the patient to speak uninterrupted and actively listenining  is the most efficient way to get to the “heart of the matter.” It provides information  for clinical reasoning and also establishes the therapeutic alliance needed to ensure shared decision making and a workable plan to address the issues that need tending to. And it usually takes under two minutes for the patient to come to the end of their story.  

 

Most of the time, this process works as it should, but occasionally, even seasoned clinicians find themselves struggling to make an initial connection with someone. When that happens, I (KF) pivot to something that I suspect we can connect about.  Given that I practice at the Veterans Affairs Medical Center and that many of my patients are older, my go-to is the grandchildren.  I have found that  when interactions aren’t going well, asking about grandchildren brings a mellowness that descends like magic.  Most people can’t help but smile.  Pretty soon the pictures are out, and we are connecting on a new level, with tenderness, talking about hopes for a better future.  

 

 

Recent events reverberate 

 

We can’t stop thinking about what happened at the US Capitol Building Wednesday, January 6, 2021.  In the days since, we have talked to many colleagues, friends and learners.  We have heard the same words time and again: shock, fear, shame, anger. 

 

Obsessively watching the news and checking newspaper websites has proven unproductive (not surprisingly), although it has been really hard to avoid.  As more details become available, the terrible implications of that day seem to increase, as do our anxiety and sadness.  Talking about the events does not lead to sense-making or understanding, and only reinforces negativity.  As we faced our colleagues and programs, we asked ourselves, How can we move from despondency and anger to action? How can we stop the feeling that we are banging our heads against the wall? 

 

Independent of one’s political views, we suspect that the thought of engaging the “other side” in dialog about the issues seems exhausting and futile.  But what other way is there?  

 

I (KF) found inspiration in an unlikely place, my email inbox! A message from Chad Kessler, National Director for VA Emergency Medicine, provided important advice about talking with  skeptical VA patients reluctant about receiving the COVID-19 vaccine.  He reminded us that, in some cases, providing facts – particularly when so much is still unknown – is not helpful.  For people fearful of the vaccine, trust in their doctors is more important than explaining the results of the randomized controlled clinical trials that led to emergency authorization. So, his advice was to focus on building the trusting relationship rather than trying to convert patients into vaccine believers. Asking about their health beliefs, listening to the answers, letting them know you care about them and their health, understanding their fears and concerns and, well, maybe asking about the grandkids, is time well spent.  

 

Perhaps the way forward isn’t to convince other Americans that they are wrong and that we are right.  Perhaps the way forward is simply expressing caring in different ways, finding ways to hold different views without fracturing relationships, and sharing a commitment to our common future, as embodied in our children and grandchildren. 

 

 

Reaching across

 

The New York Times reported on a nonpartisan project that brought 526 strangers from across the US and  the political spectrum together for a four-day retreat where they talked in small groups  about a wide range of issues that affected their lives.  The description of the project was inspiring.  Participants reported gaining perspective on how political and social policies affect other people’s lives.  It sounds so civil!  What is to stop of us from doing something similar in our own spheres of influence? 

 

 

An unlikely friendship as a beacon of hope

 

On the surface, the famous friendship between Justices Ruth Bader Ginsburg and Antonin Scalia defies comprehension.  And yet, it grew over decades across their tenures at the US Circuit Court of Appeals to the Supreme Court.  These two storied judges certainly did not agree in their work. Scalia regularly attacked the ideas expressed by RBG, but he never attacked her. She regularly and vehemently disagreed with his legal philosophy but had a deep and abiding respect for his, “captivating brilliance, high spirits, and quick wit.” They had a deep, respectful, and caring relationship with each other based on shared loves of  opera, theater and, of course, grandkids, sharing many meals and social outings.   These beautiful relationships which occur despite polarizing differences in politics seem exceedingly rare and precious these days.    

 

 

As physicians, we have the privilege of trustworthiness and the skills needed to find common ground. We routinely must navigate differences in belief systems toward solving a shared common goal. Perhaps we should expand our influence on civic discourse as well.   Asking about the grandkids, actual or only imagined, can focus us on our shared futures.  

 

 

 

 

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

 

Kathlyn E. Fletcher, MD MA is a Professor and Residency Program Director in the Department of Medicine at the Medical College of Wisconsin. She is the co-Director of the Graduate Medical Education Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

 

 

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