Heart Attack

From the February 24, 2023 issue of the Transformational Times

Heart Attack 

Karen Herzog

A path from fear to grace. Ms. Herzog writes about how, for decades, the threat of death was never far away from her mother, yet compassionate caregivers brought both hope and healing ...

 

Compassionate medical care gave my mom 43 more years of life after a heart attack at age 47. 

I was fourteen when the attack began while Mom was carrying hay to the calves on our family’s dairy farm in Iowa. For reasons I don’t understand, it took 24 hours for attending physicians at our small-town hospital to diagnose it. She was admitted for observation, then transferred by ambulance to a better-equipped hospital 30 miles away after tests confirmed her diagnosis the next day. Lack of communication did not give us confidence in her care. I was certain she was dying; a “heart attack” sounded brutal to a teenager. 

Dr. Andrew Smith, the internist who treated Mom at the transfer hospital, was both an excellent physician and a kind person. She recovered and trusted him implicitly as she continued to see him regularly. He called her his "miracle patient," and made her feel safe in his care. He was thorough in practice and attentive to factors that influenced her health, including the 1980s farm crisis that hit our family hard, and put our land into foreclosure. 

 

Mom cried when Dr. Smith retired thirteen years after her heart attack. I wonder whether he remembered her as fondly as she remembered him. 

 

I felt like I knew Dr. Smith, too, though I never met him. He gave Mom confidence that she could recover and be well again. 

 

I don’t know many details of the heart attack in Fall 1977. I mostly remember the force with which it hit my teenage brain that my mom’s heart was perfect only in a manner of speaking. Her heart was damaged and could stop beating at any time. It’s something most kids don’t have reason to think about. 

 

Every time Mom experienced angina during my teen years, it was scary. The knowledge Dr. Smith shared with her was important to the whole family. It gave us the sense that a frightening situation was under control. 

 

I never got to know the cardiologist in Iowa who kept Mom’s heart going for more than three decades. I moved away after college. Among his greatest gifts to us was arranging for Mom’s aortic valve replacement to happen in Milwaukee, where my sister and I live. He knew the value of her recovering near her daughters, and made it happen quickly with a phone call to a medical school friend. 

 

A surgeon’s smile 

 

Open-heart surgery on Valentine’s Day is both poetic and terrifying.   

The surgery to replace a valve severely damaged by stenosis happened two weeks after Mom turned 78, and two years after Dad died of complications of diabetes. Her surgeon, Dr. Paul Werner, was matter of fact as he talked about the procedure. We didn’t appreciate his personality until we saw his huge smile as he approached my siblings and me after surgery. He told us that in addition to replacing the aortic valve, he did a single vessel bypass “while I was in there.” His smile was warm, and showed how gratified he was by his craft. 

 

I would like to think the cow valve stitched into Mom’s heart on Valentine’s Day was also a gift from Dad – the dairy farmer who first swept her off her feet at a dance hall called the Electric Park Ballroom in her late 20s.  

 

Post-op gift from a physician neighbor 

 While still in the hospital, Mom was diagnosed with diabetes. My neighbor, Dr. Sophie Kramer, offered to help us navigate the new diagnosis while Mom temporarily lived with me during cardiac rehab. 

 

Dr. Kramer -- well-known among my friends for providing compassionate, excellent care for elderly parents -- made herself available for questions at any time. She agreed to be my mom’s internist when Mom moved from Iowa to Milwaukee permanently, four years later.  

 

It didn’t take long for Dr. Kramer to join Dr. Smith in the sweet spot of my mom’s heart, where she remained for eight years, until Mom died. Dr. Kramer set the bar high for excellence with compassion. Her mind focused on clinical care, while her heart cared about Mom’s comfort and quality of life. She listened intently, and gently asked questions to better understand the many challenges in Mom’s daily life due to severe arthritis and other medical issues. We could see the concern on her face, and her genuine desire to relieve the suffering. 

 

 Seven months before her death in 2019, Mom fell out of bed in a rehab unit where she was recovering from a broken leg. We were furious that it happened while the bed was in an elevated position. The next day, we moved her back to her apartment for 24/7 private care and hospice. Her badly bruised forehead was a daily reminder of the trauma, but Mom was happy to be home with her cat, Molly. Within days of the move, Dr. Kramer visited Mom at her apartment. She was concerned. She understood Mom’s need to feel safe again. 

 

I can only imagine how emotionally draining it must be for a physician who practices a holistic approach to patient care. Medical care within tight schedules and corporate management is not conducive to compassion, and neither are the long, exhausting hours of a physician’s practice. I often wonder how compassionate physicians can stay compassionate, and how they maintain their own healthy balance. 

 

Soap opera ending 

 

Fear was a visceral part of our lives until Mom’s heart did stop beating, six minutes into her favorite soap opera, The Bold and the Beautiful, and four days before Christmas in 2019. 

She was 90 and had rebounded dramatically in hospice care. The decision to start hospice care was gradual. We all recognized Mom faced daily challenges on many fronts. Prioritizing her comfort was the right call. She did well with 24/7 caregivers and hospice team members who set her up with a great bed and made her comfortable with massages and oatmeal baths. At the end, when Mom became unresponsive, my sister and I stayed at her bedside. We wanted to make sure her pain was managed, and to hold her hand for our own comfort. 

 

When what I had feared since high school finally happened, it thankfully was so peaceful, my first thought was something I later would have teased her about, had death not been permanent: How could she not stick around until the end of a Friday cliffhanger of “The Bold and the Beautiful?” She slipped away quietly as I sat beside her, absorbed in the first six minutes of a soap opera we had watched together for decades. I did not expect her last heartbeat to seem so natural. The grace in that moment took away my fear. 

 

I’m grateful that the Kern Institute at the Medical College of Wisconsin is nurturing compassionate clinical excellence, alongside self-care, as an integral part of physician training.  

 

Patients and their families need the heart of medicine to keep beating. 

 

Karen Herzog recently joined the Transformational Times as Copy Editor. She believes in the power of compassionate medical excellence from personal experience and is honored to be part of the process of medical students and physician faculty members reflecting on their own experiences of hope, resilience, and compassion. As a former journalist who witnessed unimaginable tragedies through decades of reporting, she is amazed by the brain’s ability to compartmentalize. She also understands that what we see, and what we experience, becomes a part of us that requires a gentle touch, too. 

The NRMP Couples Match: Three Questions for Two People Seeking One Match

 From the February 17, 2023 issue of the Transformational Times

 

The NRMP Couples Match: Three Questions for Two People Seeking One Match 

 

Alexandra Kershner and Andrew Sepiol

 

Ever wonder what it would be like to couples’ match? What is the good, the bad, and the ugly of the process? Here is our perspective on our experience, and some advice that hopefully can be helpful to you! As a couple are trying to match into OBGYN (Alex) and Internal medicine with the possibility of doing fellowship (Andrew).  

 

How did you and your partner come to the decision to couples’ match? 

 

For us, it seemed to be an easy decision because the most important thing to us as a couple was to match together, no matter where it was. However, it was still riddled with anxiety and daily conversations to try to calm the nerves.  

 

How would it work out for us? Are we both strong candidates? What would OBGYN being more competitive do to our match process? Would it give us the desired outcome of being at a strong program together? Would we even still be close together?

 

Even though the couples match created more anxiety and complexity to the match process, we decided the couples’ match was the best choice for us. Most of all, it would give us the best chance to stay together during residency and provide a way to make our relationship a priority alongside our careers in medicine. 

 

 

What has your experience been with the couples’ match process? Have there been any unforeseen benefits or drawbacks? 

 

The couples match takes an already 10/10 stressful process and turns it up to 11 because it over doubles the number of variables to consider, especially if one partner has a competitive specialty in mind (like Alex). Despite the stress, our couples match experience overall has been, as we would like to say, lucky. We have been lucky in the fact that we both received a good number of interviews individually and many of those interviews overlapped, so we didn’t have to worry about possibly ranking a lot of programs that weren’t close together.  

 

The largest benefit of the couples’ match was being able to draw on the strengths of each other’s applications to gain each other interviews at a few programs if one of us hadn’t heard from a program yet.  

 

Alex:  

One drawback is trying to interview while keeping in mind that you are looking for two people instead of just yourself. Of course, you should always vette the program for yourself, but I found myself always thinking about how we could function and be happy together at the program during my interview.  

 

Another drawback is when I interviewed at a place I absolutely loved, but my partner didn’t receive an interview anywhere in the area, so that program got taken off the board. Of course, that is a personal decision that occurred between my partner and me and probably looks different between each couple's match. It all comes down to values and what you are looking for.  

 

Andrew:  

I also wonder if applying as a couple hindered us from gaining interviews at a few places that we might have gotten as individual applicants. 

 

 

What do you wish you had known prior to undergoing the couples match? And what advice would you give others who are considering the process in the future? 

 

Andrew:  

There isn't much I didn't know about the couple match, simply because I wouldn't make such a big decision without carefully researching and thinking through the costs/benefits of it. I knew we wanted to be together and that we had to make it happen, so we did.

 

My advice to future couples is to carefully consider all the variables around each partner's strengths/weaknesses and how this may impact the match. I think it also helps to work with your medical school admissions committee or interviewing future candidates in general because it gives insight into how you're being evaluated. Knowledge about how interviewers think is invaluable because often they are going into the interview with an agenda with things they are looking for on a checklist. If you manage to meet those marks, great; if not, you might be able to advocate for yourself by wording your responses in such a way that you can turn certain weaknesses into strengths. My example is that I feel on our campus we must overcommit ourselves to doing things to be competitive. This is both a weakness because I have trouble with some obligations because of this; but also, a strength due to developing great time management and knowing how to prioritize my life in such a way that I can get things done.  

 

Alex:  

Since interviews are virtual, I wish I could have mentally prepared myself for how many interviews I would attend. Being on Zoom for an entire day of interviews and then getting back on Zoom for the resident social later that night five days/week was exhausting. I felt like I had to do many interviews to help myself and my partner feel comfortable in our couples match, because the reality is that you don’t know how it is going to turn out. When you are adding in another person, it takes it to the next level of complexity.  

  

 

Final advice:  

Be prepared to have hard conversations and make sure you give each other plenty of space to talk about aspects of programs that you loved or disliked because if you have those honest conversations, it will make your rank list the best for both of you.  

Here is extremely valuable advice I got from a resident: First, create your rank lists separately without the influence of one another. Then, once you have your individual rank lists, come together and discuss the compromises you are willing to make or the distances you are willing to travel. I think this piece of advice really allowed us to not overshadow each other’s preferences and really created a rank list that considered both of us and our goals.  

 

 

Alex Kershner and Andrew Sepiol are medical students at MCW-Central Wisconsin. 

The Valentine's Day issue of the Transformational Times

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