A Story About Maryam

 From the January 27, 2023 issue of the Transformational Times

Associate Director's Column

A Story About Maryam 

By Cassie C. Ferguson, MD 

 Dr. Ferguson, who is a reknowned mentor and educator at MCW, tells the story of one student who came to her when on the edge of academic despair ...

The most rewarding mentoring relationship I’ve had with a medical student began the day she came to see me in my office to tell me about her experiences on academic leave. Maryam* had heard that I started a task force to learn about our school’s remediation process and wanted to share her story with me. I now know her to be a fierce, determined daughter of immigrants, but that day in my office she sat hesitantly on the very edge of her chair, backpack on, and glanced frequently at the door, as if she hadn’t yet decided to stay. Her voice was flat, and she rarely made eye contact when she spoke. She told me that after failing a course by less than a percentage point, she was asked to take an academic leave of absence before her first year ended. She might be able to come back, she was told, in the fall and repeat her entire first year. What she was not told was that when she drove to school the day after her leave began, her student ID would not work, and she would not be let into the school’s parking lot.  

“They just threw me away,” she said.   

Maryam’s story—her whole story—would take me years to learn. How she was diagnosed with multiple sclerosis during her first year of medical school after months of attributing her symptoms to stress. How she learned that she was dyslexic in her second year of medical school. How intense test-taking anxiety finally drove her to seek help from a psychologist. That information would be given to me in pieces as she grew to trust me, and I have slowly and carefully put those pieces together. Even now, four years after we met for the first time and three years of meeting with her every other week, I know that Maryam has not revealed all the pain she felt during that time, or during the struggles she has had since. I believe that this is in part because of her reluctance to seem as if she is making excuses, in part because of the intense shame that accompanies failing in medical school, and in part out of deference for the archaic medical hierarchy that still hangs over our profession, and the accompanying perception that my time is somehow more valuable than hers.  

That hurt we embrace becomes joy. / Call it to your arms where it can change.

-Rumi 

Medical school is not for the faint of heart. As a result, supporting medical students—particularly those who are struggling—requires love, grit, and fierce compassion. I have learned both through my own experience with failure and from working with students like Maryam that if we are to live up to the titles of teacher, mentor, and advisor we must walk with our students; we must show up even when showing up is uncomfortable. It is precisely when things get hard that we need to lean in and wade through the uncertainty and pain with our students. This requires that we recognize that we have something to offer because of our own life experiences, but I believe the bigger imperative is that we acknowledge that the boundaries of our experiences limit our ability to know what our students are going through. The only way to begin to truly understand is to get very quiet and listen to their stories.  

When we listen to a story, research using fMRI demonstrates that our brain activity begins to synchronize with that of the storyteller; the greater our comprehension, the more closely our brain wave patterns mirror theirs. The areas of our brain involved in the processing of emotions arising from sounds are activated, particularly during the more emotional parts of the story. Even more amazingly, when we read a story, the networks of our brain involved in deciphering another person’s motives—in imagining what drives them—prompts us to take on another person’s perspective and even shift our core beliefs about the world. 

It is impossible to engage properly with a place or a person without engaging with all of the stories of that place or person.

-Chimamanda Ngozi Adichie 

These findings should not come as a surprise to those of us whose work includes caring for patients. As an emergency medicine physician, I have heard thousands of stories. Whether they are snapshots relayed through EMS of how a 14-year-old child was shot in the head at two in the morning on Milwaukee’s north side, an exquisitely detailed account of a 3-year-old’s fever and runny nose from her mother, or a reluctantly provided history of pain and despair that led a 12-year-old to try and kill himself, each of these stories should transform us. They should move us to want and do better for our patients, for our communities, and for our world.  

At the same time, it is essential that as physicians and educators we also recognize what Nigerian author Chimamanda Ngozi Adichie describes as the “danger of the single story.” As an emergency medicine physician, I only hear stories of peoples’ suffering; I am listening to them when they at their most vulnerable, on what may be the worst day of their life. I only hear of the tragedies that have befallen a neighborhood we serve. As an educator who mentors students who are struggling, I often miss out on their stories that are not about failure or crisis. Adichie warns that when we only listen for the single story, there is “no possibility of feelings more complex than pity, no possibility of a connection as human equals.”  

So then our charge as physicians, as educators, and as human beings is to make room for more than just a single story—to remember that all of us are much more than our worst moments, and that compassion and connection arise authentically when we recognize the full spectrum of humanity in one another.  

*Names have been changed.  

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

Reflecting the Change You Want to See – The Importance of Involvement in Equity and Inclusion Initiatives

From the January 27, 2023 issue of the Transformational Times

Perspective/Opinion

Reflecting the Change You Want to See – The Importance of Involvement in Equity and Inclusion Initiatives

By Michael Stout, Ed.D. – Master of Science in Anesthesia Program Director

The importance of diversity and equity in our organization is demonstrated by our values. But how we invest our time is where real change is cultivated… 

Diversity, Equity, and Inclusion goals are often easier to design than they are to achieve. We value their importance, yet gaps persist. These issues were seldom mentioned when I first entered graduate school. More recently, I would be hard-pressed to find a college leader who does not support DEI initiatives. It appears we renewed interest and enthusiasm for addressing gaps and inequality wherever they exist, including our college campuses. Creating a thriving community built on principles of respect and inclusion remains an institutional priority, but how can we make it imperative? The benefits of participation in DEI initiatives can extend beyond individual growth and development and promote positive change beyond our role. 

Admittedly, I have struggled to find time to participate in development programs. There are countless instances when I have received an email and thought, “That sounds interesting. I would really like to attend that event” only to be pulled immediately back into the consuming list of my daily tasks. Inevitably, the date passes without consequence. While missing an opportunity is usually disappointing, the explanation that other activities were more pressing suffices to allay my concern. However, the impact my non-participation has on my team, and the larger organization, is often missed. A person’s priorities can be discerned by where they spend their most precious resource, their time. How could my faculty, staff, and students understand my support of DEI initiatives, if they do not see me participate? 

These programs are designed to help move our organization

The resources dedicated to them aim to transform our campus community and achieve outcomes that align with our values. As an academic leader, I wish for everyone in my unit to attend these events. I welcome the transformational ideas they bring back to our team. But if I choose not to participate, why would I expect that anyone else will? Therefore, my decisions have expanding ripple effects. These decisions not only impact my own development, but can also impact my team, and the larger organizational culture. 

There is growing evidence that improving diversity yields benefits in both private and public institutions. To this end, I pledge to attend an IWILL event to broaden my views on gender. These programs present opportunities to demonstrate our commitment to improving organizational culture. I am grateful for all the hard work, generously provided, by those who organize and attend them. 

While the demands upon our time are likely to remain unchanged, investing in these initiatives can help close the gap between the aspiration for change and its achievement. 

Michael Stout, EdD, is an Assistant Professor in the Department of Anesthesiology at MCW, a Certified Anesthesiologist Assistant, and Program Director for the Master of Science in Anesthesia Program at MCW.

Bearing Witness to Pain

 From the January 27, 2023 issue of the Transformational Times

MedMoth Story

 

Bearing Witness to Pain 

 

 

By Meghan Schilthuis 

 

 

Meghan Schilthuis, a third-year medical student at MCW-Milwaukee, shares an impactful patient encounter from her first clinical rotation. This story was shared as part of the 2022 MCW MedMoth storytelling evening…  

 

I began my M3 year this past June on my pediatrics rotation, excited to convert knowledge gained from many hours spent studying for the USMLE Step 1 into “the real world” of patient care. I spent my first two weeks in outpatient clinics and had a lot of fun interacting with relatively healthy kids. I wasn’t sure what to expect as I moved to the inpatient portion of the rotation and began a week of night float at the Children’s Hospital of Wisconsin.  

 On my second or third night, my intern and I got a call about an adolescent boy who would be coming up to our team. I began looking through his chart and learned that this boy, who I’ll call Zack, was being admitted with concern for infection in the context of extensive burns suffered a few months prior. My heart fell when I read that these burns were the result of an attempt to end his own life. What sort of situation would we be walking in to?  

When Zack arrived on the floor, my resident and I went to go see him together. We found him lying in bed, heavily bandaged, and clearly in a lot of pain. After we gathered some history and did as much of a physical assessment as possible, Zack’s mom looked at my resident and asked, “Could we speak out in the hall for a couple of minutes?” I wasn’t sure if I was supposed to follow my resident out into the hall, but felt like I should stay behind with Zack. 

 As my resident and Zack’s mom walked out, I had a brief moment of panic; what could I do or say that could possibly help him feel any better? I had no medication to offer him. His skin was so painful to the touch that I couldn’t offer a hand of comfort. I settled for asking him about the stuffed frog he had. He suddenly stopped writhing, locked eyes with me, and exclaimed, “I wouldn’t have done it if I knew it would be this much pain!” Even though we hadn’t talked about how he got his burns, we both knew exactly what “it” he was referring to.  

I fought back any chance for my eyes to well up with tears. “I’m sorry you’re in so much pain. We’re going to do everything we can to help you feel better.” Even though I knew I probably shouldn’t, I couldn’t help but think of my little brother who is the same age as Zack; my little brother who loves to play football and baseball, concoct interesting culinary combinations, and learn new songs on his bass guitar. How could a middle schooler like Zack be saddled with so much pain at such a young age? 

After a few minutes, Zack’s mom came back with my resident and said to me, “I’m sorry, Zack can be a little dramatic.”

“Oh, no, don’t worry,” I told her as I waved goodbye. My resident and I left to staff the case with the attending before our next admission. 

The busyness of the rest of the shift kept me occupied, but I found myself thinking about Zack as I drove home and got ready for bed. When I called my mom to catch up the next day, I shared some of the story with her. She could tell that I was still feeling badly about Zack. She encouraged me to stop worrying about him, which sounded a little harsh to me at first, but she was correct in pointing out that my concern would not change things for Zack. 

Even still, I left our conversation wondering how physicians can best bear witness to their patients’ suffering without allowing it to consume their thoughts. 

In my interaction with Zack, I felt a tension between my strong desire to alleviate his pain and an uncertainty about how to do that. Even though I felt like there was little I could do for him at the time, looking back, I hope that our brief connection helped him feel less alone in that moment. 

I never saw Zack again after that night and don’t know what happened. Wherever he is today, I hope he’s healing and doing well.  

 

Meghan Schilthuis is a third-year medical student at MCW-Milwaukee. She is one of the student leaders of MCW’s MedMoth storytelling event.  

 

There is No Success Alone

From the 1/20/2023 issue of the Transformational Times

There is No Success Alone 

By Cassie Ferguson, MD – Associate Director of the Kern Institute 

 

 

"Talent wins games, but teamwork and intelligence win championships." 

-Michael Jordan 

The depth and breadth of our collective success in the Section of Pediatric Emergency Medicine is staggering. And the pride and reverence with which each of us holds these successes, regardless of the role we played in them, is a testament to the love we have for our patients and for one another.  

It also is a testament to our leader, Dr. David Brousseau.  

Our section begins 2023 with a goodbye to our chief of eleven years, whom we affectionately call D-bro. Dr. Brousseau is leaving for Delaware after 23 years of service to MCW, and I couldn't let him leave without trying my best to explain how much he has meant to me and to all of us – to our team. 

The Section of Pediatric Emergency Medicine is working to address food insecurity among our patient's families, improve patient health literacy and numeracy, strengthen the coordination between the Emergency Department (ED) and our EMS colleagues, decrease sexually transmitted infections in our adolescent patients, share our experience in pediatric sedation medicine with colleagues in under-resourced countries, sharpen our section’s bedside ultrasound skills, ensure all patients have access to life-saving flu vaccines, and give kids who have been victims of interpersonal violence a chance to go to summer camp. Among other things. 

Our team is committed to this challenging work. We also like to win. We are especially proud of wins that showcase our team’s ability to work together creativity – even when it has nothing to do with emergency medicine, and everything to do with teamwork. Even if it’s just for fun. 

For six of the seven years that the Children’s Specialty Group has held a Halloween costume contest at Children’s Wisconsin, the Section of Pediatric Emergency Medicine has either won first place or been in the top three (we don't count the year we were allegedly disqualified). This success is not by accident. Every year, months in advance, we vote on a theme and then each of us—faculty and staff—works on putting together our individual costume such that it fits into the theme. As an often overlooked and perhaps maligned department of the hospital (hey— we don’t like to call you to consult at 0300 either), winning this contest has become a source of pride, primarily because we do it together.  

All hail the Section of Pediatric Emergency Medicine’s Halloween Costume Dynasty. 

“How lucky I am to have something that makes saying goodbye so hard.” 

-A.A. Milne 

I admit this Associate Director's Corner is less an article than a love letter to my pediatric emergency medicine colleagues and to Dr. Brousseau. 

Twelve years ago, I was a new attending physician and had just moved back to Milwaukee with my husband, our three-year old son, and a newborn. I felt so lost. I remember wanting desperately to contribute and to feel useful, yet not knowing how. Within three years, I was co-directing the Quality Improvement and Patient Safety Scholarly Pathway for the medical school, was selected to participate in MCW’s Docere II teaching course and had begun an advanced improvement methods course at Cincinnati Children’s Hospital.  

I acknowledge this required a certain amount of work on my part, but I also know that none of it would have happened without Dr. Brousseau and those foundational opportunities that were key to me building what has become an incredibly fulfilling career. 

Even more meaningfully, for the past 12 years Dr. Brousseau has consistently reminded me what I am capable of and what I contribute, empowering me to take risks and to step into roles I thought were too big for me. 

As I look around at my section colleagues, and at what they have achieved, Dr. Brousseau’s legacy becomes very clear: His leadership has enabled us all to thrive. We are purpose-driven and optimistic; we are continuously learning and pushing for change; we know how we can contribute to the greater good of the section and our community at large and we are given the space to do so. Even in our section's darkest hours, instead of fear and uncertainty and anger tearing us apart, we rose together, becoming closer and more determined to navigate the darkness together. 

"The good leader is he who the people revere. The great leader is he who the people say, we did it ourselves."

-Lao Tzu 

In this country, we like to think of good leadership as big, bold and brash. Crashing through obstacles, pushing past limits. Loudly declaring itself. All-knowing. Strength of conviction is often more apparent than strength of character in the leaders we choose and in those chosen for us. 

Dr. Brousseau, however, has shown me leadership that enables thriving is quiet. It takes mindful, careful steps as if feeling the earth beneath its feet as it walks. This kind of leadership is inclusive. It widens our field of attention and helps us be aware of when we are being called to be more loving, more compassionate, more open hearted. It engenders trust -- not through convincing, but through presence. And it doesn’t get frustrated when it must explain how to calculate positive predictive value for the 1000th time during journal club. 

“Goodbye always makes my throat hurt.” 

-Charlie Brown 

Whenever I sat down with Dr. Brousseau in his office for my annual faculty review, he always began our conversation by asking, "What is your favorite part of your job?"  

If I had that question to answer one more time, knowing that it would be our final faculty review and the last time I would have the chance to share my answer with him, I would say this: 

There are too many favorite parts to name them all. I love showing up to the ED and getting a hug from the person I’m getting sign-out from. I love that when I want to switch a shift so that I can see my kid’s baseball game, someone will instantly volunteer to help. I love that our section meetings never end on time because we are all so excited to see and talk to each other.

Perhaps most of all, I love that I have the freedom to do what I love to do with people I love, and the support and encouragement to keep doing it better.  

Thank you, Dr. Brousseau, for pushing us, for fighting for us, for holding us all together. For helping us to thrive.  

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