Loving Each Other Through the Darkness

From the 12/11/2020 newsletter

Perspective

 

 

“Loving Each Other Through the Darkness”

 

 

Alicia Pilarski, DO & Cassie Ferguson, MD

 

 

“My patient was talking with me a few minutes ago and then he just coded…we tried everything we could. Breaking the news to his family over the phone was awful.”

 

“I just can’t unsee what happened to my patient. She was so badly abused and injured and I can’t imagine what she went through…”

 

“I made a mistake. I thought our patient was suffering from congestive heart failure, but it was sepsis. I never gave antibiotics and caused further damage from giving diuretics. I’m not sure how I can go back to work tomorrow.”

 

As physicians and learners, we see people suffer with protracted and difficult illnesses. We see lives instantly devastated by a new diagnosis or injury. We are asked to bear witness to the death of patients too sick to be surrounded by their own family. And then we kneel alone, face in our hands, before rising quickly to take care of the next patient. We are not taught or given the space to process these tragedies aloud.

Death, loss, and errors are inherent to the practice of medicine, yet a false sense of separation keeps us from reaching out to one another when their impact becomes too much to struggle with on our own. This sense of separation exists for many reasons, but is certainly driven by the isolating medical hierarchy, our unforgiving culture of blame and shame, and our own sense of exceptionalism; this erroneous belief that we are inherently different from one another, that we are the only one that has struggled in this way, that others have somehow handled it by themselves. Our current social situation exacerbates these issues, offering less opportunity to be physically present with our work family and making resources harder to recognize.

These obstacles to connection fuel our unwellness. They prevent us from seeing that our suffering is not exceptional; it is universal. We hope you know that we see you behind that mask and know that patient’s death made you think of your own mortality and wonder if someone in your family is next. We see you on that Zoom call stretching every ounce of your energy and patience in order to be a mom, a teacher, a researcher, a physician. And we see you sitting six feet away from us in the break room struggling with that last case that shook you to your core.

 

We see you. We are you.

 

We also know that connection is a remarkable force and have witnessed its power in our own lives. Talking openly about our struggles with one another reminds us of our humanity and wakes us up to the reality that we are not so different from one another. It is also a powerful force for healing; sharing our anxiety, grief, anger, and fear with someone who will listen empathically strips these emotions of the shame and paralysis that are often attached. And in turn, your story of how you overcame what you experienced can become “someone else’s survival guide.” (Brené Brown).

We encourage you to ask how you might tap into and add to the incredible power of our community and draw on the collective compassion of your colleagues. We want to be your first line of defense when what you’ve seen saturates your coping mechanisms. We want to be there for you like someone was there for us.

Dr. Rana Awdish phrased it most beautifully in her book, In Shock:

 

“How we care for each other during life is the true restoration—the definition of agency…Our ability to be present with each other through our suffering is what we are meant to do. It is what feeds us when the darkness inevitably looms. We cannot avoid the darkness, just as we cannot evade suffering. Loving each other through the darkness is the thing to look for and to mark. It’s there, in the shadows, where we find meaning and purpose.”

 

Resources for providers, trainees, learners, and staff:

 

·   Our institution has several resources and opportunities to reach out for support, both for peer support and more advanced support.

 

• For a list of the current Froedtert & MCW Supporting our Staff (SOS) Peer Support team, please visit our website: https://infoscope.mcw.edu/MCP-Medical-College-Physicians/Practice-Initiatives/Peer-Support-Program.htm
• If you need immediate support, please page the SOS Team (414-314-1763) or email Dr. Alicia Pilarski (apilarski@mcw.edu) or Dr. Timothy Klatt (tklatt@mcw.edu).

 

 

Alicia Pilarski, DO is a Associate Professor in the Department of Emergency Medicine at MCW. She serves as the Graduate Medical Education Patient Safety and Quality Officer. She is the Associate Chief Medical Officer at Froedtert Hospital. She is actively involved in Wellness in the Kern Institute, MCWAH, MCW, and the hospitals.

 

Cassie Ferguson, MD is an Associate Professor of Pediatrics (Emergency Medicine) at MCW. She leads the MCW M1 and M2 REACH curriculum focused on promoting wellness. She is the director of the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

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Global Engagement Elicits the 3Cs

From the 12/4/2020 newsletter
 

Perspective 
 
 
Global Engagement Elicits the 3Cs
 
 
Stephen Hargarten, MD, MPH and Tifany Frazer, MPH – MCW Office of Global Health
 
 

In this essay, Dr. Hargarten and Ms. Frazer share how the missions of MCW, the Kern Institute, and the Office of Global Health overlap, and celebrate how students – taken outside of their normal cultural contexts to experience medical care in low- and middle-income countries – return with new appreciations for the value of competence, character, and caring in medicine …  
 
 
A MCW medical student recently reflected on a positive experience with a mentor: 
 

“We can easily forget we are treating a person and not just the disease. Despite feeling like we know best, we sometimes forget to include patients in the decision-making process. The doctor and patient collaborated to help develop their own healing systems outside from dependency on medications. Medications for chronic pain were replaced with relationships.”

As we celebrate MCW’s 10^th Annual Global Health Week, we are reminded that global engagement opportunities expose our students to new healthcare practices, build their character by challenging their personal beliefs, and stimulates the development of innovative solutions for patient care. As one trainee reflected, after observing that access to technology is restricted in low resourced settings, “You have to use and rely on your clinical skills and judgment. You likely become a better steward of resources, and arguably a better clinician.”
 
A report by the Lancet Global Independent Commission on “The Education of Health Professionals for the 21st Century” asked academic institutions to rethink professional education reforms in our century. It stated “the extraordinary pace of global change is stretching the knowledge, skills, and values of all health professionals.” The Commission called for “more agile and rapid adaptation of core competencies based on transnational, multi-professional perspectives to serve the needs of individuals and populations” and sought transformative education to develop leaders for the 21st century. 
 
The transformational gift of Robert D. and Patricia E. Kern validates the belief that the healthcare environment of the 21^st century is a global one, encompassing everything from engaging with researchers worldwide to providing clinical care in culturally diverse local communities. MCW trainees’ reflections following their global health research and clinical rotations are reviewed and demonstrate the following themes: perspective, awareness, ambivalence, and practice. A trainee reflected: 
 

"The list of health disparities I witnessed ultimately would take me hours to describe. As a physician, this experience forced me to alter my expectations and become more flexible in regards to medication compliance, progression of disease processes, and utilization of diagnostics and treatments given these limitations in resources." 

This student experience parallels the Kern Institute’s national movement and vision to transform medical education along the continuum. Engagement with diverse communities, whether local or international, reflects the current and future common realities of healthcare and humanity and what type of doctor is needed for the future. Another trainee reflected, 

 
“I am certain I have been impacted in more ways than I can truly describe. I know that as a physician and even more so as a human being I have been undeniably transformed."

 
Similar to the Kern Institute’s advancement of the Triple Aim of Health Care through its “Triple Aim for Medical Education,” faculty and staff active in global health efforts facilitate stronger connections to become caring, competent, and compassionate physician leaders committed to improving population health and enhancing patient outcomes, locally and globally. Our trainees benefit from experiences in low, middle, and high resourced settings, that compare and contrast health and health care in a variety of complex socioeconomic, political, and cultural environments. As the Kern Institute seeks to develop innovative models to optimize health system performance, physicians who are more comfortable “using a truly globalized approach (integrating therapies and treatment from a variety of resourced settings and cultures)” are more likely to improve health through enhanced care at a better value. 
 
Immersion in clinically and culturally diverse settings allows medical students and faculty to examine their preconceived notions of medicine and their roles as healers. The AAMC posted a story on their website indicating that “global health curriculum and electives provide lessons in patient advocacy, health equity, and humility.” A medical student quoted in the article reflected on a global health rotation in a low resource environment, “Working in this environment requires self-awareness, strength, and humility to accept and then overcome challenges to one’s way of being, thinking, and perceiving the world.” This parallels the Kern Institute’s expected outcome to cultivate physicians with the attributes of “fairness, honesty, kindness, leadership, and teamwork.”  
 
Most of the institutions collaborating in the Kern Institute are, with MCW, fellow members in the Consortium of Universities for Global Health (CUGH) including UW-Madison, Mayo, UCSF, Vanderbilt, and Dartmouth. Our connections to these institutions through CUGH would provide a ready-made platform for us to broaden the reach of Kern innovations, testing our ability to sustain and replicate these initiatives through a global health lens. 
 
As a medical student stated,
 

“As a future provider, this experience has expanded my character and ability to care for diverse patients in several ways. Foremost, it re-enforced that the basic principles of medical care are present across all cultures and peoples. Physicians have a responsibility to help alleviate physical and emotion suffering in all those that seek our care, and to do this, we must establish trust, and show empathy."

As the Kern Institute’s leadership continues to seek broad input on what this transformational gift can impact, we know that continued investment in global health-focused educational offerings is necessary for creating compassionate, caring, competent physician leaders with strong resilient character for the 21^st century.
  

Stephen Hargarten, MD MPH is a Professor of Emergency Medicine, Founding Director of the Comprehensive Injury Center, and Associate Dean of Global Health at MCW. 

 
Tifany Frazer, MPH is the Program Manager of the MCW Office of Global Health. 

Words for these times, a pandemic

From the 12/4/2020 issue


Poetry

Words for these times, a pandemic 

Julie Arthur



Could I write words for these times?
Arrange letters in some fashion
To make the distance bridged.
Writing is a powerful weapon, I am humanity’s soldier,
Words are an offering, a salve.


But nothing I write can unbreak my son’s literal broken heart.
Nothing I can write can sooth the figuratively shattered hearts I see on the floor all around me.


We are masked these days whether
we wear them or not,
and those masks hide the smiles
as well as the frowns, the fear
-that doesn’t just emote from the eyes you know-
and the recognition that these days, which are not for always, are at least for now.


I am not young nor old
And feel I should have wisdom to not feel so breathlessly scared every moment.
Steadfastness escapes me at every turn, I’m left chasing it, just as all are chasing answers
As to how things will end, how we’ll all get out
Of this ok.


These times are not for always.


Something I repeat as a hymn or a hum underneath the terror of the currents of my day.
An oar on this lonely lifeboat to white knuckle
And never let go of.
I wish I could give so many things to others,
Hope, or inspiration, or kindnesses,
Things to pack for the singular journeys we seem to all be on together.


Perhaps these words, these letters, can be
The salve then, used when the wounds are fresh,
When it’s night and things overwhelm,
To read and reread and in the silence to know:
I am there with you too.




Julie Arthur is an Education Program Coordinator II at MCW. “I have worked for MCW for almost 12 years, and have been writing poetry and fiction since first grade! I believe as much as medicine heals, words do too.”

Waiting in Lines

 From the 12/4/2020 newsletter

 
 
Waiting in Lines
 
 
Bruce H Campbell, MD – Transformational Times Editor
 
 
In recognition of MCW’s annual Global Health Week, Dr. Campbell shares some of what he has learned from his global humanitarian trips …
 
 

“At its best, medicine is a service much more than a science.”
- Paul Farmer, MD

Long lines form when the global health team show up. In El Salvador, people arrive in the backs of trucks and then wait hours for one of our provider groups to assess their stomach pains, headaches, or dental problems. The men, all in long pants despite the heat, talk while women in bright dresses tend the children. In rural Kenya, women in cotton print Kanga wraps and men in tattered clothes come from all directions by foot, bicycle, or “boda boda” (the ubiquitous motorcycle taxis), waiting on long benches in the equatorial sun. At the medical center in Eldoret, Kenya, the hallways adjacent to the ENT Clinic are packed with people wearing US-donated t-shirts bearing the names of sports teams, universities, and companies – shirts re-sold to them by roadside vendors.
 
There is no way we could ever operate on everyone who shows up. What could we possibly offer to so many people?
 
 “This is crazy!” I say to one of our hosts. “We’ll never get through them all.” During a typical workday at home, I see several patients, prepare Epic notes, check diagnoses and billing codes, click all of the boxes, and close the charts. If I am lucky, I can get through twenty people.
 
“We told them that the Americans would be here this week, so they showed up.” He shrugs. “No problem.”
 
The ENT Clinic in Eldoret, Kenya is an exercise in controlled bedlam. The handwritten records fall apart as I flip through them. The quality of the scans and ultrasounds remind me of those I saw in my training forty years ago. We jam two or three patients in the same exam room so the Kenyan and US doctors, nurses, and medical students can peer over one another’s shoulders; there is no HIPAA or pretense of privacy. Patients for whom we have something to offer nod and move to the nurse’s desk to schedule surgery. Patients for whom we have nothing nod and head home.
 
At the end of the day, I look down the hallway. There are still several people who have been waiting since early in the morning. “They’ll be back tomorrow,” says my Kenyan colleague. And they are.
 
I wonder how it feels to wait hours for an opportunity – maybe the only opportunity – to see a specialist and then be told to return the next day or, maybe, never at all.
 
My very first humanitarian trip was to El Salvador where we saw dozens of unfailingly gracious patients. At the very end of the final day, there were still many people outside the clinic. My wife, Kathi, who had dusted off her nursing skills for the trip, accompanied an interpreter to talk to those in line. “Lo siento (I’m sorry),” the interpreter said. “We can see no more patients. The doctors and nurses must return to San Salvador before dark and they will not be back until next year.”
 
“That’s all right,” one of the women responded as she shook Kathi’s hand. “Thank you for coming to help us. We will return next year, as well.”
 
The next day, as we waited in Houston for our connecting flight, Kathi told our traveling companions about her encounter with the grateful woman. While she was speaking, the gate agent announced that our flight to Milwaukee would be delayed several hours because of a major storm disrupting air traffic all along the eastern seaboard.  
 
“This is outrageous!” A sunburned man near us angrily strode to the counter and berated the agent. “My family and I are heading back from vacation in Mexico and I must be at work for very important meetings tomorrow morning. I demandthat you re-route us now! We will not wait!”
 
The gate agent, in a remarkable display of self-control, apologized and said there were no options; every airline had been affected by the storm. The man paced the waiting area, yelling into his cell phone and circling back to the counter at intervals to loudly register his displeasure. Finally, he announced that he and his family were heading to a hotel and that the airline had better cover his expenses. “You’ll be hearing from me!” Off he stormed, family in tow.
 
“What a contrast!” Kathi noted. “Imagine if the Salvadorans who waited had reacted that way.” We were not blind to the grinding poverty in El Salvador and had heard stories about the people’s lack of opportunity, safety, services, and health care (a process Paul Farmer terms “structural violence”), but every one of us noted how grateful and gracious the Salvadorans had been during our one-on-one interactions.
 
Later that evening, a plane arrived. It was a long day, but we did sleep in our own beds that night. 
 
As Paul Farmer notes in his book, Pathologies of Power: Health, Human Rights, and the New War on the Poor, 
 

“The voices, the faces, the suffering of the sick and the poor are all around us. Can we see and hear them? Well-defended against troubling incursions of doubt, we the privileged are precisely the people most at risk of remaining oblivious, since this kind of suffering is not central to our own experience.”

Each global health opportunity has allowed me to view life through a brighter, sharper lens. The lines are always long and colorful. My memory is filled with people, each one hoping that they will hear a word of hope and healing when their time of waiting is finally done.
 
 
 
 
Acknowledgement: Thanks to the MCW Moving Pens and to my wife, Kathi, for valuable advice. A previous version of this essay first appeared in my blog, Reflections in a Head Mirror, in 2017.
 
 
Bruce H Campbell, MD FACS is a Professor of in the Department of Otolaryngology & Communication Sciences and in the Institute of Health and Equity (Bioethics and Medical Humanities) at MCW. He is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for Transformation of Medical Education. He serves as Editor of the Transformational Times.