Seeing for Myself in the Morgue

By Emily Hagen

As Dr. W, the pathologist, ushered my peers and me in, he made sure that we were properly wearing our masks, gloves, cloth gowns, and expressions of respect. He encouraged us to speak up if we felt too nervous to walk further inside. The morgue smelled of formaldehyde and goose bumps formed on my skin as my body sensed the frigidness of the room. I was more excited than scared to watch Dr. W perform an autopsy on Ms. S, our ninety-four-year-old “patient.” As a pre-medical student at the time, little did I know how much this experience would significantly shape my understanding of the practice of medicine. And it would imprint on me an appreciation for the autopsy.

Before we entered the morgue, Dr. W delivered a riveting presentation to us about the history of the autopsy and its importance to medicine. He explained how the autopsy is a valuable tool for understanding the pathogenesis of diseases and identifying potential treatments. I was captivated by his examples of current medical knowledge gained from postmortem findings. Our knowledge about cancer, the disease that took my own father’s life, has improved through autopsies. The American Academy of Pediatrics’ “Back to Sleep” movement of 1994 was informed by autopsies on babies who died from Sudden Infant Death Syndrome. I also realized that the autopsy could truly confirm a patient’s cause of death, as it has the potential to identify discrepancies between clinical diagnoses and a coroner’s findings. Dr. W worried aloud that the procedure has lost its preeminence as a powerful tool in evidence-based medicine. Technological advances combined with the unwillingness of insurers to cover autopsies threaten their existence as a practice. I found this intriguing and perplexing.

At the morgue, I observed Dr. W meticulously examine Ms. S’s organs. Never before had I recognized the direct clinical relevance of the biology and chemistry I studied. The autopsy progressed and a clearer picture of the possible causes of Ms. S’s death emerged. As the autopsy unfolded, more details about Ms. S’s life surfaced. She had given birth and developed uterine cancer during her life. She was not just a body with a puzzle of pathology trying to be solved.

I thought about how I could not wait to call my uncle, a physician who has been a mentor to me, to tell him about my day. In our subsequent conversation, I learned that he spent his first summer of medical school working on a pathology project and observing autopsies. My uncle shared with me that that even decades after these experiences, he still remembers the details of the first autopsy he observed, and that he took those clinical pearls with him into his future patient encounters. This highlighted to me that patients, whether in the context of an autopsy or otherwise, are invaluable sources of learning and growth for a physician.

Having studied medical ethics, I naturally began to consider the ethical and social dimensions of the autopsy. It was so moving to hear Dr. W explain that he strives to provide the family members of patients with the most truthful depiction of the deaths of their loved ones while tactfully addressing the difficulties of these conversations. Also, as Dr. W performed the autopsy, he convinced me of the importance of handling a patient’s body with the utmost respect and professionalism. These values will guide me through my life in medicine.

The morgue was far from scary. Any initial trepidation was transformed into deep curiosity. The sense of appreciation that I felt for Dr. W and Ms. S for all that they taught me was overwhelming. I saw for myself how valuable the autopsy is, and I encourage others to see it in this light as well. Autopsy in fact means, “to see for oneself.”

The importance of the autopsy seems to be evident now more than ever. The procedure has advanced our understanding of COVID-19’s pathophysiology, which can inform future treatments and perhaps a vaccine. The autopsy also informs mortality statistics and epidemiological data. Research and healthcare policy decisions regarding COVID-19 can consequently be more effectively shaped. Additionally, the autopsy allows us to further explore current public health issues, such as the opioid epidemic. It simultaneously teaches physicians about what happens to bodies stricken by opioid addictions. I believe we do a disservice to both medicine and society at large when we overlook the utility of the autopsy. Therefore, I am, and will continue to be, committed to making the autopsy a more prominent part of medicine.

 

Emily Hagen is a second-year medical student at the Loyola University Chicago Stritch School of Medicine. She is participating in the Bioethics & Professionalism Honors Program and looks forward to integrating her passion for bioethics into her future practice as a physician.

Befriending My Veteran Health Partner

By Linda Nguyen

When I began medical school, I signed up to volunteer with Veteran Health Partners (VHP), an organization that pairs medical students with veterans in the Recreational Control Facility (RCF) of the local Veteran Affairs (VA) Hospital. Veterans in the RCF unit have conditions ranging from spinal cord injuries to paraplegia, many of whom live there as long-term residents. As a Vietnamese-American daughter of refugees from the Vietnam War, I owed it to myself to get to know some of the honorable veterans who served.

I was paired with a veteran who did not participate in any group activities or get out of bed most days. When I arrived at the VA to visit him for the first time, I was nervous. Would he find any interest in talking to a medical student? I took a deep breath, then knocked on his door.

“Hello sir! This is Linda, your student volunteer,” I said.

“Come in.” he said.

I walked in slowly, just enough to peek past the curtain and see the veteran sitting in the hospital bed. He had white hair, wore glasses, and seemed to be in his eighties. He smiled warmly and attempted to turn down the volume of the TV screen. I asked if I could help, and he said that he could turn it down himself. We shook hands and I pulled over a chair to sit facing him.

He started off the conversation by saying, “So tell me about yourself.”

I replied, “I’m a first-year medical student who moved here last year from California. In my free time, I love hip hop dance and cooking.”

He thought that my educational path and hobbies were wonderful. He then apologized for not being able to fully face me or turn down the TV volume. I assured him that it did not bother me. He shyly remarked how sometimes it is hard for him to remember the exact word he wants to say. I encouraged him that he could try to describe whatever word he was trying to say, and that I would do my best to listen and understand. This alleviated some of his apprehension, as I saw him relax and feel more comfortable around me.

Eventually, the nurse peeked his head into the room to say that visiting time was over. As I was leaving, I smiled to myself and thought, “I think I made a new friend today.”

Our monthly visits continued, and eventually we gave each other permission to ask anything we wanted about the other person. I was curious to hear about his experience serving in the Vietnam War. I learned that he was traumatized by many of his experiences during his service. I was the first Vietnamese person he had interacted with since the war.

I told him about my own family, that my parents had to flee the country to ensure a better future for their children. They are eternally grateful to veterans who fought in the Vietnam War, and see them as heroes. He listened to my story intently. Afterwards, we both looked at each other in silent agreement, in awe that decades later, a veteran was becoming friends with a Vietnamese-American.

This has been a meaningful year for me with VHP, transitioning from a member to a president role. As we near student organization board transitions, I am proud of the work that my board and I accomplished this year to improve the operations of VHP and make this a more positive and rewarding experience for both the veteran partners and medical student volunteers. Even as I took on this leadership role, I maintained my monthly visits to my paired veteran partner.

The most rewarding part of volunteering this year was being able to meet his entire family during Christmas. It warmed my heart dearly to hear how much his family valued my visits with my veteran partner, and how excited they were to meet me. My veteran partner invited me to stay and watch the family exchange gifts, and I offered to take photographs of the family for their family photoshoot. I felt so welcome. My veteran partner went so far as to call me an “honorary” family member.

I still visit my veteran partner every month and will continue to do so. I think the most important lesson I have learned while volunteering with VHP is reminding myself that sometimes the most meaningful service that you can do is listen to someone. Make them feel heard. That their needs and wishes matter. I saw the impact it made when I was mindful about what it was my veteran was concerned with at the time, whether it be the ability to turn the pages while reading books, getting to step out of bed, speak, etc. I am lucky to be a part of whatever sparks joy in a patient that day.

 

Linda Nguyen, MA, is an aspiring physician-bioethicist, currently pursuing an MD at Loyola University Chicago Stritch School of Medicine. She currently conducts clinical research on advance care planning and has a background in education, student affairs, and diversity and inclusion work.

 

 

“¿Que Vamos a Comer?”/ “What Are We Going to Eat?”: Latina Prenatal Care and Access to Food During COVID-19

By Daniela Vargas

As a public health nurse, I work in reproductive justice, prenatal and postpartum care at a Federally Qualified Health Center (FQHC) in San Francisco. I am aware that my job comes with a high responsibility as I am assessing for social and structural determinants of health as women begin their prenatal care. In the wake of COVID-19, my work has become more critical as basic needs like food, shelter, baby supplies, legal support, mental health and safety are now even higher for Latina mothers than ever before. The barriers in accessing healthcare, food and shelter that were there for Latinx patients prior to COVID-19 became even wider gaps when “Stay at Home” or “Shelter In Place” policies were first enacted in the City of San Francisco along with eight Bay Area counties even before the State of California and other states followed.

The first question I ask the mothers coming into the clinic is  “How are you and how is your family?” The answer is usually “We are okay, we are doing the best we can,” as they hold onto their composure. My second question is always, “Do you and your family have food to eat?” And that is when many of the reactions of these mothers change. The eyes of these mothers say it all, often filled with tears telling me that they are happy to become mothers but that since the “Stay at Home” policies began, it has caused major instability preventing them, their partners or families from working. Many of these Latina mothers are immigrants from Mexico, Honduras, El Salvador, and Guatemala. Some of them are here as permanent residents but the majority are undocumented, either newly arrived seeking asylum or have been here for several years.

These Latina mothers talk about “Stay at Home” with me while mentioning how afraid they are to come to their visits and how they don’t even want to leave their homes even to get fresh air. My nursing visits that are spaced out for 30-minute slots, are now going over time with the complexities that Latina mothers are facing in the middle of the COVID-19 pandemic. I am used to holding the hands of patients or giving hugs when patients ask to give them to me but with social distancing, I have to stay 6 feet away and wear a mask. This has changed how I am able to provide human connection.

The one thing that has not changed, has been the ability to cry with my patients as they tell their stories of how COVID-19 has disrupted their ability to work and pay their expenses which they must do so  that they can prove to immigration officials that they can make it in this country. Many of them allude to the recently revised “Public Charge” regulation that has scared Latinx families from accessing services in fear that the federal government will not allow them to remain if they do so.. These mothers feel hopeless and scared that they might not be able to feed their families or pay back the rent money they owe since they haven’t been working. Latina mothers feel time is running out for them since they will have to take leave from work to care for their baby. For those who are undocumented, these mothers cannot apply for unemployment or get paid maternity leave.

Working with mothers and their babies while seeking prenatal care has other new challenges in the wake of the COVID-19 pandemic. Black, Indigenous and People of Color (BIPOC) birth workers have worked hard to integrate comprehensive and supportive structures in birthing for vulnerable populations such as Latina mothers. But with all focus going to COVID-19, many of those structures have been deeply modified or no longer present. Centering pregnancy or prenatal education sessions are being done remotely or cancelled. In-person prenatal services have been moved to telephone calls to prevent COVID-19 exposure. Prenatal education funding is also being rerouted towards COVID-19 efforts. Unlike elective procedures that have been put on hold due to this pandemic, prenatal cannot be paused. Instead of diverting from comprehensive prenatal education due to the pandemic, we need be providing more prenatal/postpartum educational services around pregnancy and COVID-19 and in-depth needs/health assessments with expecting Latina mothers about the insecurities they are facing and doing so in bilingual formats I feel that even more than ever, we have to be more vigilant regarding the health of Latina mothers, their babies and families.

Before these Latina mothers leave our clinic, they are given a bag of food, basic necessities, a small grocery gift card, and are enrolled in food access programs. I tell them, “if you need anything, please call me.” They respond, “Claro que si enfermera, muchas gracias,” translated as “Of course nurse, thank you so much.” They lean in to hug me but I have to pull back because of social distancing. Daily, I leave the clinic with my mask on and tears rolling down my face hoping that this pandemic improves so that the mothers I care for can feel safe to access the things that are most basic to all of us, most especially food.

Daniela Vargas, MSN, MPH, MA, RN, PHN is a DNP-Population Health Leadership student at the University of San Francisco School of Nursing and Health Professions and alumna of the graduate Bioethics & Health Policy Program at Loyola University Chicago. She works as a Public Health Registered Nurse serving the Latinx community in San Francisco, CA at a Federally Qualified Health Center (FQHC) and provides prenatal care and education as well as a comprehensive women’s health services to a primarily Spanish-speaking population, many of which belong to the Undocu community.

COVID-19 Trilogy in 17 (Haiku)

by Hedy Wald

 

Civilization

No longer as we knew it

Rainfall hits dry ground

 

Stripped down to essence

We treasure touch of cool breeze

When hug cannot be

 

Pause, unmask to breathe

Hope sustains as the tree bud

Bursts forth in Springtime

Hedy S. Wald, PhD is Clinical Professor of Family Medicine at the Warren Alpert Medical School of Brown University and Faculty, Harvard Medical School Global Pediatrics Leadership Program. She presents internationally on interactive reflective writing-enhanced reflection supporting professional identity formation, promoting resilience and wellbeing, and Holocaust and medicine in health professions education and practice.

Being a Medical Student During the COVID-19 Pandemic

By Michael Bertenthal

As a kid, I was a devoted soccer goalkeeper.  I lived for the opportunity to step in front of an oncoming shot to protect the net.  I loved the action of diving to make a save, getting my knees skinned and uniform muddied, and occasionally colliding with oncoming players.

When I entered high school, I encountered players senior to me who had the skill or physical stature that I had not developed, and I was asked to be the team’s backup.  I made a mental list of my roles on the team.  I told myself that if I practiced hard, I was not only preparing myself to enter a game when my number would be called but that I was also pushing my teammates to improve in their roles. I was even voted a team captain because of my encouragement to others and served as something of a player-coach role through my guidance from the sidelines.

As a fourth year medical student set to graduate in May, living through the era of COVID-19 has me again considering some of these roles.

I pursued a career in medicine for some of the same qualities that attracted me to goalkeeping.  I enjoy working on a team and doing whatever I can to protect—patients from disease.  I don’t mind putting in the hard work, to get dirty in the pursuit of a cause greater than myself—helping people, my patients, in some of their most difficult hours.  Like goalkeeping, it is sometimes necessary to put one’s self in harm’s way to do this.

As COVID-19 has developed into a pandemic, we medical students have been left in its wake.  Throughout medical school, we have learned to walk an unusual line between student and doctor.  This crisis has now bolded that line.  As universities across the country sent their students home, we too have been told to stay home.

There are many reasons for this. Our roles as student doctors require supervision, which is difficult in these hectic times.  Our very presence in clinical settings utilizes precious masks, gowns, and gloves.  Beyond that, what unique responsibilities and liabilities do universities face to protect their students from harm, and how is that distinct from that of paid employees, such as residents?

Setting aside the idea that students miss out on observing and partaking in clinical activities during this historic moment, the fact remains that fourth year students are merely weeks away from being considered competent to care for patients as house staff.  What practical sense, then, does such an artificial line between student and doctor now make?

For this reason, political leaders across the country are calling on medical personnel who are currently outside of the workforce to begin seeing patients. Medical schools in some of the hardest hit areas have obliged by expediting graduation and licensure requirements to call fourth year students, suddenly, new residents.

For the rest of us, we wait.  It’s now again useful for me to consider my goalkeeping days as I sit here on the sidelines of the health care system.  As students in an uncertain time and in an ill-defined role, we can build our knowledge of the pathophysiology and epidemiology of SARS-CoV-2.  This will make us better equipped to treat patients when our “numbers” are called.  Students have even carved out opportunities to assist clinically, if remotely.  We can serve in other vital roles in the community: in food provision, child care, and housing services.  These are familiar protector skills that many of us have mastered over the years.  We can be captains of encouragement by supporting our loved ones emotionally, and we can also support them medically by providing guidance on best practices. We too can step back and focus on aspects of ourselves that, upon reflection, need tending.  We can practice much needed self-care prior to the next onslaught of training ensues.

Invariably, sitting on the sidelines is an uncomfortable and disappointing position. May it help cultivate a fire that will burn inside of us to do our best for our patients when we return to action.  May it help us consider what is the best version of ourselves that we can contribute—now and in the future.

 

Michael Bertenthal is a 4th year medical student at Loyola University Chicago Stritch School of Medicine.  He recently matched at the University of Chicago in pediatrics, where he is excited to continue to serve in Chicago’s communities by contributing to health and wellness opportunities for children and families.

On Being a Doctor and a Human in the Pandemic: Connection and Vulnerability

By Amy Blair

With each passing 24 hours, my roles of physician and physician educator and mother (and human of the planet Earth) have been taxed in complex ways. The problem-solving demands are intense and the solutions often feeble, weakened by uncertainty, if not paralyzed. It feels as if the rug were pulled out from under my stable pillar of work-life balance and I teeter and totter as the emails, announcements, protocols, and crash courses in new technologies try to blow me over each day. It is a new flavor of exhausting. A sympathetic overload (as in autonomic nervous system).

Of course, my patients are facing new challenges for which there is little precedent and for which they have few relevant experiences to draw on. They face many pressures such as a devastating loss of income from which the more privileged are insulated. Thus, they can underreact and indulge denial rather than think like the epidemiologists we would have them be.

For instance, I accompanied one of my patients as she tried to come to terms with her COVID19 positive test and the need for home quarantine. She asked me how she could return to work at a downtown office, needing the income.  I explained the CDC guidelines which include quarantine for 7 days. Then she asked “…could I still do my (GrubHub) food delivery?“Read More »

Look for the Helpers

by Justin Triemstra

“When I was a boy and I would see scary things in the news,

my mother would say to me, ‘Look for the helpers.

You will always find people who are helping.’”

                                                                                                                                                   -Fred Rogers

 

Scary things in the news…

Look for the helpers…

You will always find people who are helping…

These 3 phrases could not be more descriptive of our current world, nation, state, city, and health systems. We have all seen the scary things in the news over the past 3 months and have watched our colleagues care for the ill and vulnerable who have been affected by this pandemic. At first, it seemed like a distant threat, yet, we all knew it would come to our institutions in time.

New York City, Seattle, New Orleans, Detroit, and countless other cities have already seen the waves this pandemic can bring to a community. In Grand Rapids, Michigan, the pandemic has now reached our doorstep. Our frontline colleagues have begun to see the first set of ripples, and now, we all wait for the waves that may follow.

This period of waiting brings out emotions of nervousness of what is to come, worry about whether we as health care providers will get infected or even worse, bring it home to our loved ones, or fear over the possible lack and rationing of PPE.

Nonetheless, we know our helpers have begun helping. Nurses. Physicians. Advanced Practice Providers. Respiratory therapists. Physical Therapists. Occupational Therapists. Speech Therapists. Patient Care Technicians. Pharmacists. EMT’s. Social Workers. Pastoral Care. Medical Assistants. Environmental Services. Food Services. Operation staff and leaders. And all other health care workers are being the helpers.

So, when we hear (or see) scary things in the news (or in the hospital), look for our helpers (colleagues) because you will always find (your friends) who are helping.

 

Justin D. Triemstra, MD, FAAP is an Assistant Professor of Pediatrics and Human Development and Associate Program Director and Helen DeVos Children’s Hospital and Michigan State University College of Human Medicine.

Called to Serve: A Medical Student Response to Canceled Classes and Rotations in the Pandemic

By Elizabeth Southworth

“So what’s the plan for the students” asked my attending during morning rounds on Monday March 16th. We were discussing the many changes that had already occurred over the past several days; the rooms in the Surgical ICU that had been sequestered for possible corona virus patients, the restrictions on visitors to the hospital, and the impending decision regarding 3rd and 4th year medical students on clinical rotations. Moments later the email came in – “All M3 and M4 students will immediately stop participating in their clinical clerkships or those electives that involve patient contact”. With those words, my 4th year of medical school came dramatically to a halt.

An email like that can be taken one of two ways. It can give you permission to relax and take a long break before residency, or it gives you permission to leverage your skills during an uncertain time in medicine. I am proud to say that my colleagues at Stritch School of Medicine choose the latter and began working together to fill unmet needs.Read More »

My Covid Epitaph

If I do not survive Covid

Please note the hopes we shaped before

The concerts, hikes and family feasts

Still on schedule, still in store.

 

I can write my colleagues’ tributes now

I hope you will be flattered,

How you toiled, co-authored, supported staff.

You smiled when it mattered.

 

But we will die. I’m sorry, friend,

That for us it could be

Sharply, while we labor on

Do you think that’s as it should be?

 

In the hallways, exam rooms, and clinics

Doctoring amid pain and tears

Shared mission, on-call nights, holding,

Kind gravitas calming our fears.

 

What I left of me at the hospital

Created a void we sensed elsewhere

Keying our door, scratching sweet Maggie

In my lap, iPhone, my comfy chair.

 

They bravely passed with no regrets.

We salute them now

We loved, respected and mourn them

But whom did I fail and how?

Michael F. Bierer, MD, MPH, FASAM is an internist and addictions specialist at Massachusetts General Hospital and an Assistant Professor of Medicine at Harvard Medical School. He is a Public Voices Fellow with The OpEd Project. Dr. Bierer is a member of the Massachusetts General Hospital Addiction Consultation Team and faculty of the Addiction Fellowship. At Massachusetts General Hospital, he is part of a large primary care practice that has been transformed by the COVID-19 pandemic.