The Beginning

 Originally appeared in the May 13, 2022 issue of the Transformational Times

The Beginning

Linda Nwumeh

Ms. Nwumeh, a member of the MCW-Milwaukee Class of 2025, reflects on what graduation means to her each year...

“Graduation.” It is not a long word, or especially difficult to pronounce by the standards of the English language. How can such a simple word represent the culmination of all of the memories, triumphs, failures and learning that one experiences as a result of medical school?

It is a tall order, given that the knowledge gained alone is vast. As an M1, I found it hard to fathom how much more I understoond about the human body than I did just one year before. The curriculum is truly impressive when considering the sheer amount of material that is taught in just nine months―knowing that I had three entire years left to continue my learning was representative of just how much there was to know within medicine. The thought was very humbling.

Graduation would still truly be an amazing feat even if the experience of medical school consisted only of the knowledge gained as a result of the curriculum and clinical experiences. But there is so, so much more that a student lives through before they graduate. The bonds formed with classmates and faculty are priceless, and the struggles―both expected and unexpected―remain an unforgettable part of the experience. And for those for whom graduation has especially high emotional valence―perhaps due to loss or because of the implications for one’s family and community―graduation can be even more intense.

But graduation is not just a word. It is an experience in itself, and one that I am so happy the M4s each year get to have in person. As a person whose college graduation in 2020 was virtual due to the COVID-19 pandemic, I can attest that a virtual ceremony does not diminish the significance of the accomplishment―in fact, it may actually increase it. However, there is an excitement that is difficult to recreate virtually when you are not able to be together for the event in both time and space. We all deserve to celebrate such a momentous accomplishment to the best of our ability―you only graduate once from medical school.

And graduation will only be the beginning.

Linda Nwumeh is a member of the MCW-Milwaukee Class of 2025. She is an associate editor of the Transformational Times, a leader in MCW MedMoth and on the Executive Board of the MCW chapter of the Student National Medical Association.

Dr. Kalet Wins the 2023 AAMC Award for Excellence in Medical Education

From the November 10, 2023 issue of the Transformational Times

Our Friend, Dr. Kalet, Wins the 2023 AAMC Award for Excellence in Medical Education

By the Transformational Times editors

Sometimes, it turns out that our friend is pretty spectacular. 

Our editorial group, including Adina Kalet, MD MPH, developed the Transformational Times during COVID and has kept TT’s wheels on the tracks over the past three years. As we did so, we became accustomed to Dr. Kalet’s insightful comments and wise direction at our weekly virtual meetings. We devoured her Director’s Corners. We tracked down content contributors that she suggested. With her unfailing humor and insight, she talked us through each issue and kept things moving forward. 

Sure, we knew that she had other responsibilities. After all, she was running the Institute. She had published three books, fourteen book chapters, and over 200 highly cited scientific articles. We knew she was principal investigator on NIH and NSF grants. Of course we were aware of her multi-institutional educational trials. Yeah, she seemed to know absolutely everyone in medical education on every continent. But, to us, she was just Adina, y’know? 

Of course, we probably should have had a clue that she was a superstar. After all, she did receive the National Award for Career Achievement in Medical Education from the Society for General Internal Medicine in 2019. She was given the National Board of Medical Examiners John P. Hubbard Award in 2023, recognizing her extensive contributions to the field of assessment in medical education. But, during our weekly meetings, she remained the epitome of a collegial servant leader.

The AAMC’s most prestigious award

It turns out that our friend is pretty amazing. On October 25, 2023, MCW gathered to watch as Adina’s reputation and body of work were recognized by the American Association of Medical College with the AAMC’s Award for Excellence in Medical Education. The award recognizes the “highest standards in medical education,” and honors an individual or a team “whose contributions have had a demonstrable impact on advancing medical education. It “recognizes the highest standards in medical education.” 

More than once, we heard that the Award for Excellence in Medical Education is the AAMC’s “most prestigious award.”

Adina’s comments

Unsurprisingly, Adina’s prerecorded acceptance comments focused on students, colleagues, and learners rather than on herself. “We are educating physicians,” she said. “That matters.”  She continued that, “academic medicine has been so good to me because I could be a physician, leader, scholar, and innovator all within the same career. That’s really a gift of the academic medical center environment.” She added, “I’m very moved to have been nominated. If you look back at the numerous people who have won this award, they are my heroes and role models. It is the team I want to be on.” 

It was delightful to see our friend’s effectiveness, thought leadership, and hard work recognized by her peers in medical education. She really is a superstar working among us and, we are certain, she is nowhere near the peak of her remarkable path. We are fortunate to have front row seats as she continues on a journey that will improve physician education now and far into the future. 

From the rest of the Transformational Times editorial team, including Himanshu Agrwawal, MD, Wendy Peltier, MD, Bruce Campbell, MD, Kathlyn Fletcher, MD, Karen Herzog, and Joy Wick.

Lessons Learned While Caring for Dying Veterans

Originally published in the July 22, 2022 issue of the Transformational Times (Focus: Geriatric and Palliative Medicine)

Lessons Learned While Caring for Dying Veterans 

Adrienne Klement, MD

Dr. Klement, who completed a fellowship in Hospice and Palliative Medicine, cares for Veterans at the Zablocki VAMC in Milwaukee. As we approach Veteran's Day, she shares two stories from the COVID-19 pandemic that show some of the lessons she has learned caring for her patients…

“These doctors have the hardest job in the world.” It was a cold January evening during the pandemic, and the Milwaukee VA ICU was buzzing with a symphony of ventilator alarms, bedside monitor alerts, the closing and opening of isolation carts, and staff conversing about patient care needs. 

Visitor restrictions were in full force. Despite the noise, the unit felt empty and stark with closed doors and without families at bedside, except for one room. I gowned up and greeted our dying patient, Mr. D, and his family. 

There were several grandchildren joining on Facetime. We (they) had twenty minutes. We all had to speak loudly through our N95s to be heard over the Vapotherm. Mr. D acknowledged he was very sick. We talked about his hopes and wishes, and he gave his loving family all the appreciation he could muster. He just wanted to hug his grandchildren. At the end of the conversation, his son hovered in close to him and said, “Dad, these doctors have the hardest job in the world—they have done everything they can to help you. You are going to die soon, we are here now, and we love you.”

Lesson number one: Sometimes, the best way to reach a patient is through a trusted and familiar face.

I could tell Mr. D was holding back tears throughout our conversation. I wondered if this suppression of emotion was something he had learned in the military, and what trauma he had been through in the past. Was it a sign of weakness to admit feelings of fear or sadness? Was he trying to stay strong in front of his family as a way to bear their grief? I noticed a few quiet tears of my own while in the room, and I couldn’t help but wonder if my reaction was acceptable, or if it was detrimental to my roles as comforter and healer. 

When I got home later that evening, I started to unpack my (unexpected) reaction further, realizing that my tears were complex. They were a reflection of empathy, as I recalled holding my mother’s hand as a teenager when she took her last breath. They embodied frustration with the end-of-life isolation protocols. And they were tears of immense gratitude for the life of service Mr. D gave to our country, and for the care given by his Oncology and ICU teams.

Lesson number two: Showing emotion in front of patients, colleagues, or families is part of healing, for all of us.

The appreciation given to us by our Veterans and their families is transformative. Medical training is a long road that comes with many sacrifices, but also deep bonds and human connection. 

I had the privilege of helping to take care of Mr. R, who had end-stage leukemia, in both a consultative role, and also as his primary Medicine attending. It was so special to me as a teacher, to witness my resident-in-training also provide exceptional care and supportive listening. Mr. R and his wife expressed their deep appreciation for the unique care that he gave, and all that our VA providers gave through to his dying day. 

As an educator, I felt fulfilled in witnessing our team experience the most rewarding aspect of practicing medicine, relationships with patients. Mr. R’s military and life stories were therapeutic for all of us, and he reminded us daily that we are caring for some of the most selfless and resilient servants in the world.

Lesson number three: Reflecting on our Veterans’ acts of service and life experiences through attentive listening and presence cultivates gratitude for our work.

I am grateful every day for the meaning that my work brings me. I am most thankful for our Veterans who have served our country, and from whom we have much more to learn.

Adrienne Klement, MD, is an Assistant Professor in the Department of Medicine, and is a faculty member in the Division of Geriatric and Palliative Medicine at MCW. She attends on the inpatient Internal Medicine and Palliative Care consult services at the Zablocki VAMC, where she was recognized in 2022 as "Employee of the Year."

Being a Parent and a Pediatrician

Originally published in the October 22, 2021 Transformational Times newsletter

Being a Parent and a Pediatrician

Cassie Ferguson, MD

Every weekday morning, I am confronted with my failure as a parent. Instead of filling my three kids’ lunchboxes with a colorful array of washed and cut, 100% organic, GMO-free fruits and veggies and a lean protein-packed sandwich cut into a dinosaur shape, I am typically frantically grabbing for a Dole fruit cup, an unnaturally colored yogurt tube, and a bag of Fritos. Guilt inevitably washes over me every time I shove a PB&J made with Skippy and grape jelly on white bread into their lunch boxes, and I cringe thinking about the teachers seeing what I knowingly

feed my children.

What you are to be, you are now becoming

–Carl Rogers

I don’t know if I feel this guilt more acutely as a pediatrician—as someone who spent nearly a decade learning about how to keep kids healthy and should “know better”—because I don’t have a different perspective to which I might compare. My first son, Ben, arrived two weeks after I graduated from pediatric residency. Will arrived as I finished my pediatric emergency. medicine fellowship, and Nick three years after I became an attending in the emergency department (ED) at Children’s. I became a mother as I learned to become a pediatrician.

While the guilt may be sharper, there were advantages to my training when it came to caring for my kids when they were little. The nurses in the well-baby nursery taught me how to swaddle a baby so that they couldn’t free their tiny little arms. I knew that 100°F was not a real fever. And I could assure my husband (and myself) that our child would eventually learn to pee in the potty.

There were distinct disadvantages, as well. I also learned about the randomness with which a four-year-old is struck with leukemia. About what it sounds like to hear a mother’s heart shatter when she learns her sixteen-year-old has died in the car crash. The health and safety ofmy own kids can feel so fragile; regularly witnessing the suffering of kids and their families makes it difficult to believe that my own kids would be spared, no matter the real odds.

Every system is perfectly designed to get the results it gets

–Arthur Jones

Most of the suffering that we witness as pediatricians, however, is not a result of random chance. Disparities in the utilization of health care services and in overall health spending, structural racism, and residential segregation that limits access to good schools, jobs, healthy food choices and green spaces for the majority of Black and Latino or Hispanic Americans directly translates to poor health outcomes for the families for which we care. Kids dying from gunshot wounds, physical abuse, asthma exacerbations, drug exposures; these deaths are not random. They are a result of the systems we have purposefully built in America and continue to support with our inaction.

A friend once described having a child as forever walking around with your heart on the outside of your body. As a mom and a pediatrician, I’ve discovered that my heart can be broken not only when my own child falls and breaks their arm, or is bullied at school, but by anything that harms children anywhere. I have come to see this as our superpower—this tenderness and vulnerability spurs my colleagues to fight courageously for the radical redesign of our systems.

We are called to disrupt the cycle of interpersonal violence in our communities, to address food insecurity in our ED, to protest the attempt to ban books about racism from our schools, and to ensure that the way we treat acute pain is equitable.

Hope is the thing with feathers

–Emily Dickinson

This calling can feel overwhelming, particularly when I am in the ED managing twenty very sick patients and a full waiting room, and then receiving a page heralding the imminent arrival of yet another child with a gunshot wound. On those nights nothing we do feels like enough; it feels as if we are digging a hole in the sand as the walls are caving in around us.

On those nights, I come home defeated, or angry, or fearful; overwhelmed with the perspective on how dangerous the world can be for our most vulnerable citizens and feeling powerless to protect both my patients and my own kids.On those nights I come home to my kids and peer into their dark bedrooms, staring at their sleeping forms from the door, surprised at how easy and regular their breath comes. I renew

my vow to do what I can to make them feel safe and loved and find grace in the belief that this love is perhaps more communal than I realize.

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