By Dominik Dabrowski

Cześć. It’s the Polish word for Hello.
It has a couple of letters in it that English doesn’t have, so it even looks foreign.
But for me, it is familiar. And even though I grew up in America, it feels like home.

When I was young and getting to know people in my church community, Cześć was a reminder that I belonged.
When I went to a foreign country to visit cousins and grandparents, Cześć told me I was welcome.

I moved to Minneapolis 15 months ago for residency. I didn’t know anyone here. I had a lot of work at the clinic. The first few months were a bit lonely. Sure, there were my co-residents, nurses, and support staff, and having my dog helped, but it wasn’t the same.

Just as Thanksgiving passed, I heard that word again, Cześć!
“You speak our language so well! Do you want to come to our church?”
Before I knew it, I was saying Cześć every week. I even met some other doctors.
The first time I went to visit Wisconsin, where I spent Christmas Eve, and then New Year’s Eve, people were saying Cześć to me.
My first winter here was hard, but Cześć made it a little warmer.

Every so often, Cześć would come in handy in the clinic too.
I had one patient who told me about how his Polish led to his job as a contractor, and subsequently his injury, leading to my meeting him.
One another occasion, a surgeon I had never met found me and asked me a favor:
‘Our patient is ready for the operating room, but we’d like to explain to him and his family what they can expect. Can you tell them Cześć or something?’ (He did not literally ask me to say that).

Then, one day, I saw an attractive woman, and I told her Cześć! But she didn’t say it back.
Instead, she said Labrit! Which I now know is Latvian for Hello.
I guess my vocabulary and that sense of belonging have gotten a little broader. That word I keep using is a big reason why.
Now, Minneapolis feels like a second home, and Cześć really helped.

By Justin Shaw

05:15

I’ve barely walked inside from my car, eyes still adjusting to the bright hospital lights. Over the music playing through my headphones, I hear the call overhead “Level 1 Trauma Alert. Level 1 Trauma Alert.” A brisk walk down to the trauma bays and I get a report from the trauma nurses. “Incoming Level 1 Trauma: 50-year-old male restrained driver in a motor vehicle collision. Has been down for 30 minutes per EMS.” One of the nearby doctors, while shaking his head, chimes in, “This may be more of a teaching case.”

I don a gown and gloves and stand ready with my trauma shears as we wait for the patient’s arrival. Usual trauma protocols are followed; everything is a problem for this unfortunate patient. Me and my fellow medical student alternate doing chest compressions for ~15 minutes while the trauma attending continues to direct the team of resident physicians, trauma nurses, and various technicians. Sweat is dripping, and the glasses are slipping off my face—the trauma bays are kept warm. Our collective effort continues for some time, and time of death is called at 05:55. I think to myself, “I’m already exhausted and I just got here”.

06:00

Time for hand-off from the residents who were on-call overnight at the hospital. Our team gathers around a workstation to ‘run the list’ and discuss overnight events. My first dose of coffee is finally starting to kick in. Pre-rounding, rounding, notes and orders all ensue in the coming hours.

08:30

One of the residents says to me, “Hey we have a Level 2 coming in. Want to go lay eyes on the patient?” I respond, “Sure thing—I can head down in a minute.”

08:40

 I get the report from the trauma nurse near the Level 2 trauma beds. “56-year-old homeless male reports he was “hit by a truck” this morning. Multiple bystanders report he was not hit—the truck appeared to drive by him while he was on the side of the road.”

 I review the imaging we have gotten thus far and then head over to the patient’s bed and pull back the curtain. “Hi, Mr. Doe. My name is Justin and I’m a medical student working with the trauma team. How are you doing today?”

The ensuing conversation is still one of the most interesting conversations I have ever had with a patient. This man has been through a lot. Health & social issues include but are not limited to chronic homelessness, decades of illicit drug use & addiction, prior incarceration, and minimal motor function of bilateral lower extremities. He has been using a wheelchair for the past few years and living on the street for over a decade.

At the conclusion of my discussion with Mr. Doe, I asked, “Would it be okay for me to examine you given your history and experience with the truck earlier today?” He reluctantly agrees. With relatively benign imaging findings, my focus is on “anything else” that might stand out from a medical standpoint. There are some obvious abrasions scattered on various areas of his cachectic-appearing body, which are consistent with the story he recounted to me regarding today’s events. While examining him behind the curtain, he asks, “While you’re here can you look at the wounds under the bandages on the back of my legs? Nobody has ever done anything about them.” I reply, “Yes. Of course”. After carefully peeling away the scattered dirt-laden bandages, I find multiple unstageable ulcers on his lower back, buttocks, and thighs. The smell pierces right through my mask. I think to myself, “How long has he had these for?” and help him get dressed.

While the problems that I discovered on history & physical are not necessarily “trauma problems”, they are most certainly medical problems. Given Mr. Doe’s lab results and physical exam findings, in my opinion he would benefit from hospital admission with wound care and possible additional medical treatment.

10:00

I give a brief presentation on Mr. Doe to one of the senior residents and express my concerns. This prompts a discussion with the attending trauma surgeon and the emergency medicine physician who initially evaluated Mr. Doe. What ensues is what can be described as “an exchange of concerns” regarding Mr. Doe’s admission.

Mr. Doe is one of those patients who are often written off or disregarded based on their histories—both medically and socially. There were what I would describe as “radical” statements made about Mr. Doe inside and outside this conversation that I felt fell massively short in terms of empathy and professionalism. I thought to myself, “We all have the same information, so why does it feel like a fight to get this man admitted? The mechanism of injury that led to his presentation aside, he has multiple issues evident on labs and clinical findings that require medical attention.”

It was obvious that Mr. Doe had already been labeled when he rolled through the door… “a drug addict” … “homeless” … “not worth my time and effort”.

Most everyone has experienced hardship in one form or another. Regardless of those experiences, it is still our job to provide the necessary medical care in the appropriate environment. Bias, hatred, and annoyance can be hard emotions to cope with and work through. At the end of the day, all I can do is try my best to do right by my patients and serve as their advocate. This experience with Mr. Doe was a lesson in maintaining compassion and avoiding passing judgement on others. It was also a great reminder of my “why” I first wanted to go into medicine.

By Meaghan Ruddy

I do not consider myself a Christian. A fan of Jesus of Nazereth, particularly as the community of Luke told of him, sure, but not a congregant of any kind. Still, I woke up one Saturday morning thinking about Jesus taking lashes, and it occurred to me that this is a useful metaphor for a lot of what happens when someone is brought into a professionalism moment or are on an improvement plan of some kind because of a perceived professional lapse. I speak specifically here about professional lapses that have to do with attitude or tone. I find this kind of thing interesting because I am in a “new normal” moment in my own life where I’m coming to earnestly reckon with the systemic oppressors that we have built into organizational hierarchies, particularly in medicine, and even more particularly in medical education. This reckoning includes a growing understanding of the ways in which systems of oppression have infiltrated things like psychology, coaching, and profession-typical (analogous to neurotypical) modes of expressing how one shows up as professional.

It is a well-known and not-so-secret secret in medical education that education tends to be ahead of practice. It is similarly known that education-leveraged advancement can be hampered by practice because trainees want to, and often need to, adhere to the rules of the structures in the given specialty by which they wish to be accepted. Given that medicine is toxic, perhaps not more so than any other entrenched profession but uniquely to itself and its environments, practices, and hierarchies, the pressures on medical students and residents end up becoming backward pressures on medical educators. This occurs because, however inadvertently, learners are set up by the tension between education and practice in situ to either fail or attempt resistance then fail. Even programming that happens in astute and well-funded academic health systems finds itself forced to rotate in clinical environments that are often much too overwhelmed with the activities of engaging in clinical care delivery to give much thought to intentional progress.

Adding to this tension is the twisted fetish medical education has with learners being change agents. It is right up there with the false hope of self-directed education and military envy, which of course are opposing forces. Medicine wants so badly to generate rote followers that it tends to call intensives “boot camps” then turns on a dime to expect agency from those same recruits. Then we are surprised at the rampant mental health and addiction in medicine. As someone who works to be engaged with evidence and who saw a loved one come home from an actual military boot camp, this dark fantasy is an insult upon an injury. The positions of education leadership, be it DIO, program director, accreditor, what have you, have more power to change the clinical environments than residents and students and truth be told, even they will fail against the pressures of for-profit motivations, which can and do exist even in nonprofit systems.

I woke up thinking about Jesus in relation to all of this because for some reason it occurred to me that when we think about Jesus accepting lashes and punishment for our sins, there is, I think, a tendency to focus on how and why Jesus is willing to accept this; his grace in the face of those who would punish him. Such a focus quickly becomes a rationale for deriding anyone who is not so willing to forgive, to just take it. In the instance of students and trainees, this derision shows up as directives to placate, keep heads down, and just get the work done.  What might be a more helpful framework for this metaphor is to look at those who are delivering the lashes (and remember that when Jesus turned the other cheek it was a dare to engage in a cultural slight on the part of his violator). What if we asked what violence says about those who do the whipping, those who uphold the structures of oppression, that they would continue to do so, even when the focus of their ire forgave them? If we become more interested in focusing on those in power in moments where a learner, or even a faculty member, are brought before some sort of body for a professionalism review, would the deliberative body be not only more just but also more capable of itself becoming a change agent? If there is someone who is repeatedly brought before such a body, and that body were to look more deeply at the context rather than defaulting to enforcing fit with broken systems, it might see the truth of the needs within the systems with increasing clarity.

This is not to say that there are no professionalism issues, no attitude issues, no individuals that should be addressed and corrected. This is not to say that there is no entitlement or immaturity in medical professionals. There absolutely is, are there is in every profession, and truly, even though I’m not sure as of this writing what the percentages are, after more than a decade in this industry it would not surprise me to find out that people who feel particularly suited to heal or to help also are afflicted with certain types of attitudes to do so as they wish. However, both of these things can be true. It can be true that there are a lot of rebels without causes in medicine, and that there are rebels with causes in problematic systems. The fact that there are still labs that are forcing racial differentials on metrics where race has no bearing is evidence of the entrenchment of systems of oppression and medicine. The fact that medical students and faculty of color have had to be the generators of textbooks and learning materials about what skin-based conditions look like in non-white skin is evidence of the entrenchment of systems of oppression in medicine. The fact that powerful male physicians condemn and demean their female colleagues and residents by making snide comments about needing lactation rooms is evidence of the entrenchment of systems of oppression and medicine. The fact that so many medical professionals would prefer to die in silence than admit to anyone that they need help with a health condition such as addiction and mental illness is damning evidence of the systems of oppression in medicine.

If we are not taking the opportunity that we have as leaders in medical education to specifically hold the magnifying glass over such things, what are we doing? If we are not actively reviewing and critiquing long-held assumptions in the structures of medicine, are we not simply yet another generation that upholds them?

It is without question that change takes time, and that turning the policies and procedures and attitudes and behaviors of longtime leaders in health systems is akin to trying to turn the titanic with oars and elbow grease. This does not mean that it is not a worthy, important, and vital activity. In fact, given all that has occurred with COVID and the powerful rising of anti-racism and related movements, it may mean precisely that it is so worthy. Perhaps the lesson of the 40 lashes is not to accept punishment with grace, but rather to hold up the mirror to those holding the whips to say, what are you actually doing?

By Nikita Mehdiratta

Seared into the depths of my being, this profound encounter unfolded during my tenure as an intern doctor in 2020 amid the bustling chaos of the emergency room in India. The scene is set in a small, dimly lit hospital room with medical equipment scattered around. The air is heavy with tension, pain, and the smell of antiseptics. As I walked into the emergency ward, my eyes were immediately drawn to a young, 17-year-old boy lying in a corner bed, his body covered in burn wounds. My solemn expression was concealed behind a surgical mask. The suffering he must be experiencing seemed unimaginable. Taking a deep breath, I approached him, offering a reassuring smile.

I tried my best to remain composed, reminding myself of my duty as a doctor to alleviate pain and provide comfort. “Hold on, my friend,” I whispered, my voice filled with empathy. I removed the damaged tissue with painstaking care, exposing raw, vulnerable flesh beneath. The stench of burnt flesh filled the room, making breathing difficult. As I worked, I exchanged glances with the nurses, their expressions mirroring my sadness and determination. Throughout the procedure, the boy’s family stood by his side, their anguish palpable. The mother clutched onto a pendant of her deity, silently praying for her son’s recovery. The father stood silently, his face etched with guilt and despair.

Despite his efforts to remain strong, the patient, let’s call him Alex, winced in pain as I began tending to his injuries. As I continued to work on dressing the burn wounds, the screams of the teenage boy echoed in the minor operating room. Each peel of charred skin brought a fresh wave of agony to his already tormented body. I could see tears streaming down his face, mixing with the sweat and grime that covered his skin. “Please… make it stop!” Alex screamed, overwhelmed by the pain. I paused momentarily, assuring him we would take breaks whenever he needed them. “Just remember,” I said, “talking might help distract you from the pain.” With tears streaming down his face, Alex weakly nodded, trying to divert his attention from the torment. I conversed as I continued my work, hoping to alleviate his suffering. I asked him about his daily routine and what he enjoyed doing. His voice trembled as he spoke. “Well, I go to school every day,” Alex began, his voice shaky. “And after finishing my homework, I love playing cricket with my friends. It’s the best part of my day.” His words struck me like a dagger, and I couldn’t help but wonder what had led him to this point. What could drive a young boy to inflict such immense suffering upon himself? Summoning my courage, I decided to ask the question that haunted my thoughts. “Alex, if you don’t mind me asking, how did this happen to you?” His response struck me with disbelief and confusion. “My girlfriend… she broke up with me,” he confessed. I struggled to comprehend how heartbreak could lead someone so full of life and joy to such a desperate act.

Finally, after an eternity, I finished dressing his wounds. As the conversation with Alex ended, it became evident that healing wasn’t just about treating physical ailments but addressing the emotional and psychological scars that often remained hidden. As I left the minor operating room, I couldn’t shake off the heavy weight in my chest. The boy’s cries haunted me, and a whirlwind of inquiries surged through my mind, urging me to delve deeper into the intricacies of human behavior. It left me pondering perplexing questions. We have inevitably encountered heartbreak, traversing the emotional labyrinth of loss and pain. Yet, in the face of adversity, why do some people contemplate ending their own lives while others even suppress any inclination or thought of such despair? Is it conceivable that a complex interplay of genetics and environment shapes our cognitive frameworks, influencing how we perceive the world and respond to its tumultuous challenges? Mental illnesses can transcend generations, their origins entwined in our inherited traits and the environmental triggers surrounding us.

This experience forever changed me as a doctor, leaving an indelible mark on my professional journey. As the scene concluded, a newfound resolve filled my being. I made a solemn vow to truly hear the cries that extend far beyond the realm of the physical. Driven by the sincere desire to provide enhanced support to those grappling with mental anguish, I chose psychiatry as my specialization. With compassion as my guiding light, I have embarked on this chosen path.

Carolyn Roy-Bornstein

“How’s the baby in the box?” I asked. It was how I had come to greet the mother of a jaundiced newborn every morning that I’d rounded on the pair. The mother smiled and peered through the clear plastic of the incubator that housed her daughter—the third child in her family I had cared for.

“Breast-feeding like a champ,” she reported. “Maybe a little less yellow?” she added hopefully.

The infant was less yellow. Her bilirubin had peaked. We would discontinue phototherapy, check for rebound and discharge her later that day. And I would continue to take care of her and her family for 15 more years until my retirement.

“The baby in the box is all grown up,” I will comment to her mother on our last visit together. Mom will nod and agree. We will look at each other silently, smiling through tears.

Similar scenarios played out daily as I saw each of my families one last time. Every visit a good-bye. Some patients I had cared for since the day they were born. Some were even “grand-patients”, my fond label for those children whose parents I had also taken care of when they were little. And then there were the newer patients—the young ones I would never see grow up. 

My interactions with patients in those last days were increasingly nostalgic; my wistfulness over the end of my career grew steadily. I thought constantly about the coming years and what my days would look like. It was clear to me that to live a meaningful retirement, I needed to merge my two passions—medicine and writing. In evolving away from caring for patients (to paraphrase Serena Williams), I would have to lean into a different kind of care.

 In narrative medicine, I have found that throughline – the connection between a practice made up of my own patients and one in which I care for the caregivers.  

 I began leading narrative medicine workshops for family medicine residents at the program where I was on faculty early in my career. I started our sessions by pointing out all the ways that literature can benefit a physician’s education. Close reading of poetry sharpens our observational skills. Studying representational art improves clinical acumen. Reflective writing, then sharing that work, fosters empathy and deepens our relationships with each other. 

We read Pablo Neruda’s “The Poet’s Obligation”, reminding ourselves of what drew us to this caring profession in the first place. We read Naomi Shihab Nye’s poem “Famous,” exploring our own personal strengths and gifts. Theodore Roethke’s villanelle “The Waking” launched a conversation about life and death, God and nature, purpose and fate. Literature became our common bond, the great equalizer bridging any gaps between our ages and experience.

Then Covid hit. Hard. Our writing sessions took a back seat to ramped-up call schedules, tele-medicine training, and the steep learning curve needed to care for critically ill patients with a novel and deadly virus. I felt the absence of our sessions like a drought. I wondered if the residents felt the same.

As the pandemic wore on, the residents got worn down. They were exhausted and overwhelmed, one death-filled shift bleeding into the next. 

  “The residents are really hurting, Carolyn,” the program director told me one day. “Can you help?”

And here was my chance to make a difference. I would no longer be caring directly for patients suffering from Covid. But I could support the doctors who were. I could provide solace through literature. Offer comfort in words. 

At first our sessions were held online. Residents logged in from call rooms and nursing stations. They came from clinics or their own living rooms. They came masked; they came wearing headphones. Eating sandwiches or drinking coffee. But they came. And they were hungry for this space, this clearing. This time away from the pressures of call and the hospital and death.

Eventually we met in person. Still masked, we shared poetry. We read Fran Bartkowski’s “Hospital Haiku” trying to find that “back door” that all our hearts needed in order to let go of the suffering we were constantly bearing witness to. We did reflective writing exercises using the prompt “How have you shown yourself compassion?” Some residents shared their work with the group. Some sat silently with their words. One woman cried.

Her hand had been the first to shoot into the air when I’d asked if anyone wanted to share what they’d written. But when I invited her to read, she froze. Tears brimmed in her eyes. Her voice cracked. 

 “I’ve changed my mind. I don’t want to share,” she said. “But I think I’ve given myself a lot of compassion this year.”

 “I’m glad,” I whispered gently.

Initially I used literature selections from well-known narrative medicine curricula or from suggestions made by other writers-in-residence who had mentored me. But as I found my footing, I started letting one session feed another. Recently some of the residents shared their fear that they were becoming part of an uncaring medical bureaucracy that ignored patients’ wishes, providing care they may not agree with or see the need for. So, I prepared a session using William Carlos Williams’ “The Use of Force” as a springboard to talk about these profound issues of autonomy, advocacy and beneficence. 

Though the “affiliation” that  happens when we share our written words generally refers to our relationships as colleagues, I often find residents deepening their relationships with themselves; that is, they discover aspects of their deeper selves which they were unaware of before. Sometimes they see a past decision or action in a new light. Recently one of the residents wrote beautifully about bearing witness to the death of one of her patients, his young son at his bedside. We listeners were all, to a person, moved.

 “How did it feel to write those words and to share them?” I asked. The resident paused, gathering her thoughts.

 “I guess I was carrying a lot of guilt for not doing more for my patient at the end of his life,” she said quietly.

 My heart cracked.

 “I noticed you used the past tense just then,” I told her. “I hope that means you’re letting go of it.” 

She nodded in silence.

I have traded in growth charts and vaccinations for poetry and prose. I am still exploring that liminality between retirement and relevance, between patients and posterity. Still finding my post-retirement way. But I have found my throughline.  I no longer care for children and their families but for the doctors who treat them. Nourishing those doctors with story. Creating space for them to reflect through writing. Using literature to center us all in a turbulent world.

Disha M. Patel

As a medical student during a global pandemic, it has been an immense honor, but also a heavy burden, to shoulder the responsibilities of a healthcare professional. From battling vaccine misinformation to managing chronically ill patients via telemedicine, I have been able to have these first-hand experiences owing to the longitudinal chronic care curriculum offered at my school. The longitudinal chronic care curriculum at the Medical College of Georgia provides the opportunity to work with a real patient to gain knowledge and confidence, and to experience patient care ownership, in preparation for our entry-level encounters in the hospital setting. This curriculum allowed my student partner and me to follow an assigned patient monthly through our telemedicine chronic care clinic during our first year. During our last scheduled visit, we learned that our unvaccinated patient had unfortunately passed away following a long stay in the hospital due to COVID-19 complications. The experience has left me with lessons learned and unanswered questions that will shape me as a person and a future physician.

The first time we met RP, it was a telemedicine visit in January 2021. RP had an extensive medical history including a previous stroke, heart bypass surgery, hypertension, congestive heart failure, chronic ulcers on his legs due to poor blood flow, and nerve damage in his feet as a result of his type 2 diabetes. However, during this first visit, his biggest concern was his non-healing open ulcers on his legs that had made moving around very difficult. We talked about his pain management and wound care and discussed exercises to help with the blood flow to his legs. At the end of the visit, RP disclosed that he had experienced some right-sided weakness that resulted in a fall around Christmas. This took me by surprise because this was my first visit with a real patient and, from what was being described, it seemed like the patient may have had a stroke. I felt that the weakness and fall should have been the first things he told us about during our visit, though afterwards I realized that he may have not understood the importance of that information. We contacted patient care coordination to get him an appointment to see his primary care physician as soon as possible and get him scheduled for an MRI.

During our second visit, we learned that RP never went to get his MRI due to his claustrophobia. We tried to comfort and counsel him on the importance of getting the MRI, but he never overcame his fear. I realized that sometimes, no matter how hard you try, patients may not do what you want them to, even if it is in their best interests. But I was frustrated, because I wanted to do right by my patient and to help him get better. Our subsequent telehealth appointments with RP mostly focused on wound care, physical therapy, and whether he had experienced any more stroke-like symptoms.

The last time we talked to RP he was in the hospital, though we didn’t suspect that it would be the last time. He had been in the hospital with COVID pneumonia for over two weeks. He had gotten somewhat better, but he still had not fully recovered because of his other chronic issues. He was discharged two days after our conversation but returned a day later due to respiratory failure and shock that led to his passing. I did not learn of his death until it was time for our regular telehealth visit the following month; when I checked the chart before his visit it stated that RP was deceased. This caught me off guard and I did not know how to feel. The longitudinal curriculum had allowed me to get to know this patient and to follow him over the past year, but now he was just gone. He had died only two days after we last saw him. I felt lucky that after all our video calls I had the privilege to see him in person that last time and to meet the man behind the screen because of a missed telehealth visit.

I’m sharing my experience with RP because I need people to see and acknowledge that the medical education I have received during the pandemic is not the same medical education that others before me received. Not only did I have to learn how to navigate the pressures and difficulties of medical school, but I had to deal with unanticipated major life changes brought on by the stresses of the pandemic that were taking a heavy emotional and mental toll on the global population. Starting medical school during the peak of COVID, I was overwhelmed with the frustrations of virtual lectures, the inability to shadow/volunteer in-person, and restricted social interactions. But the pandemic not only affected the structure of the classroom; it made my first patient into my first patient death.

Because of COVID, the many high risk and immunocompromised patients we saw in the chronic care clinic were now predisposed to an additional risk that increased their rates of morbidity and mortality. Many students might not encounter their first patient death until they are well into their clerkship rotations or even into residency. Yet I had to learn how to navigate the emotions of a patient death as a second-year medical student with my first patient. When I first learned that my patient had died, I was not equipped to process my emotions. I could not fully comprehend that the patient to whom I thought I was about to speak had passed away almost three weeks ago without me even knowing.

I had spent the past nine months talking to RP every month, getting to know his health struggles and the challenges in his life. And now he was gone, and those conversations were over. Even though I knew he had many chronic problems, I never really thought about the fact that he could die while he was in my care. I thought he would be there for our remaining visits.

After wrapping my head around the fact that my first patient had died, I began to question myself: Could I have done something different to have changed his outcome? Could I have convinced him to get the COVID vaccine if I had pushed a little harder? And if so, would he still be alive today? I had a responsibility to take care of the well-being of this patient and I felt like I failed him. This is a tremendous burden to carry. Even though I know RP had other physicians taking care of him, I can’t help but wonder if just maybe, if I had said something different or done something different, that he would have gotten vaccinated and could still be alive today. No one can truly prepare you to deal with your first patient death. But entering medical school, I never thought that I would be experiencing a patient death so soon and so remotely.

By Brooke Schwartz

I feel off this morning. My head feels heavy, and my throat is sore. I roll out of bed and reach for one of the at home COVID-19 tests stacked in my bathroom. I discard the instructions, as I have them memorized by now, and wait a few minutes. It’s negative. I put on my scrubs, grab my new monofilament, and head to the free clinic where I am currently rotating as a third-year medical student. 

It’s time to see my first patient of the day. I am excited because he is an elderly man, Mr. E, whom I have seen before. He is a 78-year-old struggling with homelessness, depression, hypertension, peripheral claudication, wet macular degeneration, and sensorineural hearing loss. His gratefulness to our clinic and his warm personality are endearing. I can hear Mr. E in the waiting room asking the volunteer for help filling out his paperwork because he can’t see the small print. The reems of paperwork at a free clinic can be daunting. I listen more closely as the volunteer carefully goes through each question with Mr. E. He speaks with her in Spanish and his voice is deep and strong.

Eventually, the door leading from the waiting room to the central hallway of the clinic swings open, and I see Mr. E dressed in his usual green cardigan and button-down plaid shirt. He waddles into the exam room floating his cane above the ground. “Why does he refuse to use his cane the proper way?”

He reminds me of my grandma who recently passed. She, too, was a strong-minded spirit stuck in a weak, withering frame. She, too, clung desperately onto her independence to the detriment to her overall health. Their refusal to accept their frailty evokes a strong desire within me to protect them.

From what I remember about our last visit, I know Mr. E. does not view his health as a concern, but his lack of employment is at the very top of his priority list. He sees himself as a failure of man, relying on his eldest daughter to house him, which she does—begrudgingly. On the other hand, my priority was keeping him from having a heart attack and ending up unconscious on the side of the street. We will discuss both issues again this visit.

I knock on room number two along with my in-person translator and find my dear patient behind it. We exchange smiles and a handshake. The translator and I have both seen Mr. E four times now, and we are well adjusted to effectively communicating with each other. We know to speak in short sentences and to allow ample time for the patient to express all his concerns before responding.

“Hello again, I am so glad you came back for your follow-up. How have the at home blood pressure readings been?” As the translator begins, I cough. Immediately, I feel guilty. Is my throat still hurting? Did I take the COVID test too early? Do I have a fever? Suddenly, I picture my vulnerable patient hospitalized, intubated, and falling ill to COVID-19 because of me. I quickly pull myself back into the conversation; over the course of my medical school, COVID-19 has forced me to become comfortable with this nagging anxiety of infection and transmission.

Mr. E. responds, “My pressure has been a bit better, but I couldn’t pick up the medication you prescribed at the last visit because it is $18 at Publix, which is just too much right now.” I zone back in as the ever-present difficulty of treating uninsured patients rears its ugly head.

“Did you use the GoodRx coupon we showed you last visit?” He looks confused. “No, I forgot what that is.” I pull out my phone and open the application. “I found it for $6 at your local Winn-Dixie for a 90-day supply.” He reaches up and taps my phone screen to zoom in as I make a mental note to print out the coupon for him this time. There is a look of relief in his eyes, and he says, “That is much more affordable. I promise to pick it up after I leave today.”

We finish the visit and I exit the room to present the patient to my attending. She is concerned he does not remember much of what we talked about at the last visit and suggests we perform a mini-mental state examination. He scores phenomenally, and we are relieved. We send him off with the prescription, GoodRx coupon, and plans for another visit in a few weeks.

My attending sees the despair in my face as I wave goodbye to Mr. E. She allows me a moment to reflect. Elderly patients have always been a difficult population for me to see due to their vulnerability. I feel a sudden urge to walk them to their car, drive them to the pharmacy, and, overall, deliver care I would not consider for others. Unlike most other patients, I saw Mr. E. weekly for a month and spent time in between other patients calling MEDICAID representatives to help with his case.

I must let go of my emotional attachment to Mr. E as the waiting room fills up, but I know it is this compassion that will help to make me a good doctor. I plan to practice in a way my emotions can aid in patient care, and I refuse to allow the hardships of medicine to hinder raw human-human interactions. I will allow myself to feel the emotions of my patients, while also providing them a strong backbone to lean on.

Time for the next patient.

The day progresses and I begin to feel more ill. I excuse myself from clinic and head home. Another COVID test is pulled from the stack and once again, it’s negative. As I fall asleep, I’m worried the test tomorrow might not be. “I can’t believe I shook Mr. E’s hand. I can’t believe I let him touch my contaminated phone! Am I a horrible provider?” The guilt consumes me as I wonder if I have put the very patient I want to protect the most at risk of acquiring the frightful illness of COVID-19.

Brooke Schwartz is a third-year medical student at the Florida International University Herbert Wertheim College of Medicine. She is interested in pursuing Pediatrics.

Bearing Witness:  Storytelling by Healthcare Professionals and Learners During Times of Uncertainty

Lisa Howley, PhD¹; Virginia Bush¹; Elizabeth Gaufberg, MD, MPH^1,2

1. Association of American Medical Colleges
2. Harvard Medical School

Corresponding Author: Elizabeth Gaufberg, Elizabeth_gaufberg@hms.harvard.edu

When the coronavirus pandemic hit North America in March of 2020 the medical profession was plunged into a crisis more devastating than any it had faced in the previous century. Trainees and physicians were called to the frontlines to care for extremely ill patients for long hours in the context of inadequate knowledge, skills, and equipment; patients were dying without loved ones to hold their hands and ease their passage. Ethical dilemmas around distribution of limited resources permeated each medical decision and led to moral injury for providers who could not deliver the quality of care that was standard just weeks prior. Healthcare professional burnout and suicide increased from the already significant pre-pandemic rates^.1 Many medical schools limited students to virtual learning to protect them from exposure to the virus; yet a byproduct of this prudent decision was that many students found themselves isolated from peers and teachers, and in living situations suboptimal for class attendance and studying. Some questioned whether they were getting an education that would allow them to become good doctors.

Amid the first surge, following mounting protests over policing practices in communities of color, the murder of George Floyd on May 25, 2020, ignited a period of civil unrest with urgent calls for structural change within policing and other societal institutions. Racial disparities in Covid-related hospitalizations and deaths drew attention to inequities in health and healthcare. Academic medicine embarked on a period of self-examination around issues of race, resulting in efforts to address racism in medical schools and health systems. Ideological divides within our profession and nation were intensified at a time when uniting around a common purpose was never more critical. And yet for many, an enhanced sense of meaning and rededication to one’s calling permeated the chaos; among them were medical students who assumed the mantle of advocate, discovering avenues for self-expression and collective action.  In a time of devastating illness, social upheaval, and economic ruin, we invited the academic medicine community to tell their stories.

AAMC FRAHME AND CREATIVE EXPRESSIONS DURING TIMES OF UNCERTAINTY

In 2017, the Association of American Medical Colleges launched a new initiative called FRAHME (the Fundamental Role of the Arts and Humanities in Medical Education). This initiative advances the powerful and transformative role of the arts and humanities in achieving core 21^st century outcomes for medical learners. FRAHME has produced a robust and diverse portfolio of programs and resources.² Well-designed and integrated arts and humanities educational experiences can foster many core skills of doctoring, including close observation and interpretation, reflection and metacognitive awareness, empathy, teamwork, well-being practices, and the ability to engage respectfully in difficult conversations. Some of the desired outcomes of arts and humanities integration have come to the fore during the pandemic. Those include improving the capacity of health professionals to be adaptive, resilient, lifelong learners who appreciate the impact of social factors on health and illness and can respond effectively to complex challenges.

In the Spring of 2020, with the support of the National Endowment for the Arts, FRAHME established a creative forum for healthcare professionals and trainees to bear witness to these unimagined and rapidly unfolding challenges. Making stories, narrative, or poetic, spoken or written, or performed as music or movement, is an essential part of being human.  Storytelling allows us to give form to complex or ambiguous experiences; we may then metaphorically walk around that form, stand back or come closer, examine curves and imperfections and possibilities.  Engaging both the head and the heart, stories allow us to share our personally unique vantage points as well as our shared humanity with one another. Listening to stories within a community enables us to identify common values and goals, and to bridge ideological divides. Perhaps most important in these times of adversity, story sharing reminds us that we are not alone in our suffering.

Creative Works

Three distinct opportunities to share —55-word stories and poems, The Good Listening Project collaborative poems and StoryCorps recordings — have resulted in a repository of oral and written creations, providing opportunities for current reflection and an historical imprint of these uniquely challenging times. This repository can be found at https://frahme-aamc.org/.³

• 1. 55-word stories and poems: The 55-word story or poem activity has been used in many U.S. medical schools to encourage reflection and meaning-making in support of professional identity formation.⁴ The exact word count specification invites attention to language choice as well as the creation of a narrative arc that may not emerge from a more open-ended format. In June 2020, we launched a broad call for 55-word submissions and original poetry and collected over 300 submissions over the course of one year.

• 2. Listening Poet Sessions with the Good Listening Project:  In partnership with The Good Listening Project, FRAHME provided a creative opportunity for members of the academic medicine community to take part in a private conversation with a trained Listener Poet.⁵ Listener Poets engaged in brief virtual sessions with hundreds of volunteers who each shared their unique experiences during this period of upheaval and suffering.  The poet then produced a custom poem based on the conversation, which was emailed to the recipient within 24 hours. In the words of one recipient “When I received the poem the next day, it brought me to tears. It put everything into words that I was feeling; it was very healing for me.”

Figure 3

One Listener Poet shares the following example which emerged from a conversation with a faculty member who had been a Professor of Integrative Physiology for almost four decades. The Professor brought the tools of mindfulness and self-care to medical students, many of whom had been studying long hours, day after day, in isolation for the past year.  

Caregiver, Care for Yourself

You have come here to help others

and yet it has been a year of

unrelenting work

isolation

stress.

Your chest tight, tired, heart hungry for touch.

We were born to engage

but can you embrace

and be held through a screen?

Here, here are the tools:

ancient and intimate as a whisper

known in every mindful moment.

Rise, take your precious body

and walk,

run,

race back to yourself.

Rise, taste hope in another’s eyes.

Here is the first patient.

Caregiver, care for yourself.

Listen, you are here, you are held in hope,

made whole in a moment of awareness and connection.

You asked to serve, to heal others,

but you were swallowed by a pandemic

and in the fearful dark

you leaned to breathe, to wait,

to trust, and believe.

Caregiver, care for yourself.

Anonymous, Professor

Through our partnership, we conducted 254 listening poet sessions and a curated collection of the poetry is available online and in a TGLP published hardback set of books. In the 15-series The Good Listening Podcast, a Listener Poet brings three poems along with the stories shared in the conversations that inspired each work.⁶

• 3. Oral History Project with StoryCorps: The AAMC also established a partnership with StoryCorps, one of the largest digital collections of human voices, featuring conversations recorded across the United States and around the world.⁷ Healthcare trainees and professionals were audio-recorded telling their own stories or engaging in meaningful dialogue with one another.  These stories are now preserved in a special AAMC collection within the StoryCorps Archive, which is housed in the American Folklife Center at the Library of Congress. As of the time of this essay, a total of 13 recordings are included in this collection.⁸ In addition, several longer clips were edited into a set of 4-minute offerings which may be shared in educational settings and on social media.⁹

Closing Reflections

The AAMC FRAHME story collection has opened a window into the emotions and lived experiences of our pandemic storytellers. One story at a time, we have learned something about grief and loss, guilt and shame, racism and poverty, and the enormous power of loving relationships, spirituality, gratitude, and resilience.  The intensity of the pandemic continues to wax and wane to this day, and we have intermittently returned to somewhat more normal educational, professional and life circumstances. Yet burnout and post-traumatic symptoms are likely to plague our healthcare learners and workforce for a long time to come. Story-sharing may allow us to greet each other in places of honesty and hope, and to begin to heal.

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Funding: The authors received financial support from the National Endowment for the Arts (NEA) for work described in this article.

Acknowledgement: The authors extend their gratitude to the following individuals and organizations for their efforts to make this story sharing initiative a reality: StoryCorps; The Good Listening Project; Alison Whelan, MD; John Nash; Brandy King and Adrien Barrios.

References:

1. Linzer M, Stillman, M, Brown, R, et al. American Medical Association – Hennepin Healthcare System Coping with COVID Investigators. Preliminary report: US physician stress during the early days of the COVID-19 pandemic. Mayo Clinic Proc Innov Qual Outcomes. 2021;5)1):127-136. https://doi.org/10.1016/j.mayocpiqo.2021.01.005

2. The fundamental role of arts and humanities in medical education. AAMC. June 30, 2020. Accessed April 12, 2022. https://www.aamc.org/what-we-do/mission-areas/medical-education/frahme

3. Creative expressions during times of uncertainty. AAMC. October 15, 2020. Accessed April 12, 2022. https://frahme-aamc.org

4. Scheetz A, Fry ME. The stories. JAMA 2000;283(15):1934. https://doi.org/10.1001/jama.283.15.1934

5. The Good Listening Project. Accessed April 12, 2022. https://www.goodlistening.org

6. The Good Listening Podcast. The Good Listening Project. Accessed April 12, 2022. https://www.goodlistening.org/podcast

7. StoryCorps. Accessed April 12, 2022. https://www.storycorps.org

8. AAMC. StoryCorps Archive. May 2020. Accessed April 12, 2022. https://archive.storycorps.org/communities/aamc

9. AAMC. On the front lines: stories recorded with the Association of American Medical Colleges. StoryCorps. July 13, 2021. Accessed April 12, 2022. https://storycorps.org/on-the-front-lines-stories-recorded-with-the-association-of-american-medical-colleges