Thanksgiving is a Time for Gratitude and a Commitment

From the 11/20/2020 newsletter

 

 

Director’s Corner

 

 

 Thanksgiving is a Time for Gratitude and a Commitment to Making a Difference 

 

By Adina Kalet, MD MPH

 

 

Inspired by virtually attending the AAMC meeting this week, Dr. Kalet reflects on how the medical profession is embracing this transformative moment and why, after expressing thanks and gratitude, it’s time to roll up our sleeves up and do the hard and meaningful work ahead …

 

 

 

It is gratefulness that makes the soul great. 

-Abraham Joshua Heshel

 

How do we endure what we witness? 

-Anne Curry 

 

• Health disparities are a manifestation of structural racism which we must address to save lives and enhance human dignity and flourishing for us all.

• Without Black and Brown physicians, Black and Brown people will not receive the best medical care. 

• There are structural barriers to increasing the number of physicians of color. We must address these immediately.

• The strategies to creating supportive, nurturing academic environments for students of color seeking to become physicians are well known, as Historically Black Universities and Colleges (HBUCs) have educated 50% of all Black physician.

• MCAT scores reflect privilege in access to enriched education, “gap” year experiences, and expensive test preparation. These advantages are not available to all and therefore should not be used to limit access to medical education. European models of access to medical education are instructive here.  

• Zero sum thinking is keeping us from recognizing that investment in diversifying our profession will “float all boats.” Power is not a scarce resource; it is unlimited. 

• For our culture to “bend toward justice,” we must all be actively engaged. 

• Acknowledge the reality of privilege and its impact on maintaining white and wealth supremacy

• Seek expertise outside of the walls of the profession to help us address these issues  Bring our students to the table and listen to them 

• Communicate often and with authenticity and sincerity 

• “Get proximate” to the people we hope to serve and seek to see people as individuals with basic humanity

• Set audacious goals for change and get and maintain accurate data to guide change toward those goals

 

Thanksgiving 2020 will be unprecedented. Traditionally, Americans mark Thanksgiving with deep family connections, too much food, football, and moments of gratitude. This year, though, hospitals will be overwhelmed, and health care professionals will be working harder and under harsher circumstances than ever before. We will all be socially isolated. The adjustments will be difficult and promise to worsen. Because our residents are working incredibly hard, we want them to know how grateful we are for them. In collaboration with MCWAH, the Kern Institute will be providing “to-go” meals for our trainees on Thanksgiving. Oh, and we will be providing those amazing Kern Cookies, as well. 

 

There are many things for which we are grateful. In my family, we will replace the usual West Coast trip to see the in-laws with Zoom games and remote pie baking lessons. I am grateful for the opportunity to avoid airports on Thanksgiving! I might even start my “gratitude journal” because positive emotion is important when the days get short and cold. Expressing gratitude is associated with personal happiness and is, in part, necessary to create human flourishing (eudemonia in Greek), which Aristotle, philosophers, theologians, and psychologists considered the ultimate goal of a good life and a healthy society. 

 

 

I have also been grateful for and astonished by this week’s virtual Association of American Medical Colleges (AAMC) annual meeting, the largest gathering of medical educators in the world. Over the years, I had become disappointed by the diffuse and frankly self-absorbed nature of the meeting. But in this special year, under the leadership of President David Skorton and Chairman of the Board, our own Joseph Kerschner, the AAMC has found its soul! When needed more than any other time in history, there is a movement afoot for a powerful transformation in American medical education.

 

 

AAMC addresses COVID-19 and structural racism

 

Compared with the usual AAMC meeting – thousands of medical educators from around the world in enormous, Jumbotron-enhanced ballrooms listening to leaders and topflight “inspirational” speakers – the virtual version is intimate and stirring. I sit in my living room while “Rock Stars” NIH Director Francis Collins, NIAID Director Anthony Fauci, and  CDC Principal Deputy Director Anne Schuchat remind us that COVID-19 is  far from over. The pandemic is terrible and getting worse. Thankfully, effective treatments are emerging and effective vaccines are in sight. I am grateful that there are world-class scientists and thought leaders at the helm, collecting valid data and communicating simply and honestly. I am grateful to be reminded that our role right now is to be trustworthy, courageous, risk taking leaders. 

 

Thankfully, AAMC also provided us with a conference chock-full of the “Rock Stars” of the national conscience.  Journalists Nikole Hannah-Jones and Ann Curry, educators and historians Ibram X. Kendi and Secretary of the Smithsonian Institute Lonnie Bunch, III, each in her or his own way challenged us to face reality head on and then act, every day in every way, to make concrete changes. 

 

But what to do to create change? Where do we engage?

 

 

If we think of racism as Stage 4 cancer, we would know what to do 

 

When educator and historian Ibram X. Kendi, was 37-years-old and writing his now iconic book, How to be an Antiracist(MCW’s Common Read this year), he was diagnosed with and battling Stage 4, widely metastatic colon cancer. 

 

Kendi is not only a national intellectual treasure, but a human face of race-based health disparities. Black Americans are 20% more likely to be diagnosed with cancer. Luckily, he is now disease-free, unlike Black Panther actor Chadwick Boseman, who died at 43 in August 2020 of  the same disease.  When compared to whites, Black men have a 40% higher death rate from this disease. Professor Kendi formulated the compelling analogy that racism in America is a Stage 4 metastatic cancer, sapping us of our vitality, threatening our lives, and stealing from us the future contributions of our greatest intellectuals and artists. But here is the silver lining: By widely sharing the particulars of his personal story, as well as his life’s work, Kendi allows us to imagine routing racism out of society for good.  

 

We in medicine know how to attack an aggressive disease, how to throw everything we have at it, to declare war on it. We know we must serve up the full commitment of intellectual, scientific, spiritual, and financial resources to prolong life and enhance quality of life while we search for a cure. This is important work, worth engaging in.  

 

But the cancer analogy doesn’t stop there. Kendi also provides guidance on how to create the “good life.” In an essay in The Atlantic, Kendi describes how the act of writing his book literally reduced his suffering and allowed him to put the physical and existential drama of his cancer battle in perspective. Work created a profound experience of well-being even during severe stress. This deep engagement with the act of work, what psychologist Mihaly Csikszentmihalyi calls “flow,” is a characteristic of “optimal” performance and profound well-being. In medicine, when we have such experiences, our work is purposeful and meaningful. 

 

 

Back to the AAMC

 

The meeting has been loaded with meaningful and important moments. Among the realities and takeaways: 

 

 

To make concrete, corrective, and transformative changes in medical education, we must:

 

 

Gratitude and commitment

 

I am now committed to a few, specific actions. This year, we must address equity in the medical school admissions process and we must redouble our efforts to transform the curriculum to both prepare future physicians for the challenges ahead and address the profound challenges to the well-being among our own. This will be hard work and we must face the realities and roadblocks head-on. If, we take on these challenges – in community – we will be rewarded with a sense of pride and thanksgiving for our courage to engage, take risks, and accomplish things that matter.

 

Many among us are profoundly fatigued from the pandemic and hope to feel a whisper of relief at this time of Thanksgiving. Let us take this time to be grateful for what we do have and for each other. Give thanks for and support to our colleagues who are engaged in the hard, hard work of patient care these days. Be grateful for the opportunities we have to change the future of medical education. 

 

Gratitude – and the opportunity to do meaningful, healing, and important work – is good for us all. Happy Thanksgiving.

 

 

 

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

“No Words Can Describe this Experience”

From the 11/13/2020 newsletter

Perspective

  

Michelle Minikel, MD – Bellin Health

  

“No Words Can Describe this Experience”

 

Dr. Michelle Minikel works as a primary care physician in Green Bay, WI, a COVID-19 hotbed. In this essay, she shares some of what she has experienced over the past nine months …

  

Over the past few months I’ve been asked to be interviewed and to serve on a panel discussion and to give a lecture and to write a piece about what it was like to care for a “disadvantaged” population during a major COVID outbreak in Green Bay.   I want to say “yes,” but it’s hard.  I don’t usually feel up for the task.  I don’t know if I can really put to words what this pandemic has been like. 

 

How can I convey the frustration…

Of seeing the first positive SARS-CoV-2 test result of a patient of mine who works at the JBS meat-packing plant?  The very same patient who had asked me a couple of weeks prior for an excusal from work, due to her high-risk conditions? She later informed me she was denied.  Having toured the plant and seen the working environment, how can I ever describe what it was like to know, just know, that COVID was going to tear through that plant like a tornado?  It wasn’t a surprise; we had already seen it happen in multiple plants.  But the public health department was powerless to close the plant.  I will never know if there is more that I could have done to close it, even if for just a couple of weeks.  A couple of weeks that could have perhaps saved a couple of lives. 
 

 How can I convey the heart ache…

Of what it was like to see a once hospitalized COVID-survivor, back to see me in the clinic, whos husband didn’t make it, who didn’t survive the infection she brought home from work?  

Or to see the patient who also blew whistles at her meat packing plant in early March and whose requests to wear a mask were denied?  “We matter less to them than the cows,” she told me.  

 Or what it was like to see two of my pediatric patients in clinic and finally meet their premature newborn baby sister, taken from her mom’s womb as she died at age 30 of COVID?  
 

 How can I convey the anger…

That the meat packing plants wouldn’t close down and instead let the fire rage for days, stoked with bonuses for the employees who did not miss work?  Are our hamburgers really that essential? 

 Or of hearing people decry the springtime Green Bay outbreak as stemming from a lack of education among the Hispanics?  Day after day in clinic, I heard about their fears of continuing to work and the sacrifices they were making to protect themselves, and answered their questions about how to best prevent the virus.  All while watching hydroxychloroquine be given to them in the hospital, in many cases, even weeks after the CDC stopped recommending it. 

 Or of watching people in Green Bay, even now, shop without masks and continue go out to restaurants and bars, while our children aren’t able to attend school?
 No words can describe this experience. 
 

 

 

Michelle Minikel, MD is board-certified in Family Medicine and practices through Bellin Health in Green Bay WI. She leads the Clínica Hispana.

 

Her Hospital is Now my School - A poem

From the 11/13/2020 newsletter

Her Hospital is Now my School

Sarah Steffen

September comes to a close, and October creeps in.

My body feels it before I even realize it.

Exhaustion.

Grief rising to the surface.

I drive to school in the same direction.

In the same dark dreariness.

Rainy and cold. Bone-chilling.

Just as it was when we bundled up in her room watching the rain come down.

Sitting vigil. Keeping watch throughout the night.

Waiting.

Waiting for an end that was coming.

Now on breaks we stroll through the hospital.

So casually.

So loudly.

Almost too joyfully.

As if it’s forgotten that this is still a hospital and not just our school.

Past the surgical waiting room, where families hold their breath.

Past the cafeteria where my family spent so much time.

Waiting. Resting. Breathing.

I see her room from here and am transported back in time.

I can’t be here. Not this week. Not this time of year.

It’s too tangible.

Too real.

Every day I walk into school,

into the same building.

The same building where my grandmother worked for so many years

to take care of and welcome new, little babies into the world.

And it was here.

Here in the place where she loved to work so much

that she took her last breath.

I am distinctly aware of this.

Every day.

But especially this day.

Her hospital is now my school.

My home too.

And in my heart, I know

this is just how she would want it to be.

Sarah Steffen is a medical student in the MCW-Central Wisconsin Class of 2022. 

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