Speaking of Addiction…

By Meaghan P. Ruddy

When we speak of addiction, there is a lot we can say. We can talk about stigmatization, how stigma is a mark, a signifier of something often associated with shame and disgrace, which in turn are responses to things deemed problematic by dominant cultural narratives. We could focus on historical usages of stigmatizing practices, how we come to know disgrace and feel shame by observing how others, particularly those who are in helper roles, respond to our marks, and how all of this negatively impacts healthcare. And we could, as we often do, speak about it from the safe, professional distance of the theoretical.

But there is a simpler truth here.

It is the truth expressed by the civil rights movement, the equity in marriage movement, and women’s suffrage. It is the truth that fuels both political correctness and the fight against it. It is the truth that language matters.

Think about it. If it didn’t matter, we would never take offense, never laugh at a joke, never tear up at a well-delivered line in a film or speech. No one would bristle at terms with historically racist or fascist overtones.

Yet, we do.

Healthcare has made some progress but our work is far from over. The person-first language movement has done a lot of good; even the CDC-recommended terms of use for people with disabilities. Even the word healthcare is a relatively new and welcome reframing away from the silos implied by medical care, rehabilitation, nursing care, etc. The harsh terminology that was once part and parcel of “clinical-speak,” handicapped, gomer, diabetic, depressive, has largely been abated or is at least on the way out. There has been wide-spread recognition that these are people first, conditions second.

Except. Except for one challenging, and unfortunately swiftly growing population.

Addict.

Drug-seeker.

Yeah, but c’mon, someone might say. They are seeking drugs. They’re a huge problem! They should know better.Read More »

“You will be alright” – A Doctor’s Reflection on the Power of Hope

By Mahboobeh Mahdavinia

Alanna and Anthony are not yet ten years old, but they have been to the emergency room more times than most adults. Every few months since they were babies, their parents have raced them to the hospital for asthma attacks, superinfections of their severe eczema, or food allergy reactions. They each have been intubated twice in their precious few years of life.

But for the last year, Alanna and Anthony have not had to come to the ER in crisis. Instead, their parents have brought them to see me in my allergy clinic for scheduled medication shots and follow-up visits. I consider Alanna and Anthony a success story, or at least the start of one. But most hospitals would not – and neither would insurance companies.

The truth is, Alanna and Anthony have missed multiple appointments, and consequently missed almost half of their shots. Other patients I see have similar spotty records. Administrators who oversee my clinic have pointed out the large cost of no-show appointments. When inconsistent patients do come, their appointments often go overtime, creating conflicts with nursing and staff schedules. Some other hospitals and  clinic administrators would almost surely have come up with plans for dismissing Alanna and Anthony from the practice. However, we have all come to the agreement that we should do whatever it takes for them to stay as long as they choose. Read More »

“The Homeless Situation” – Reflections of a Neighbor and Doctor

by Suzanne Minor, MD, FAAP

The subject of the email read “MDC Commissioners Meeting to Address the Homeless,” the body asking me to attend the Commissioners Meeting to describe my challenges in dealing with the “homeless situation in our area” in order to force the Homeless Trust to allocate dollars to target the Miami homeless populations.  Common scenes in the nearby downtown Miami waterfront public park included all manner of dogs and owners frolicking in their respective packs, designer-clad joggers and boot campers, tourists snapping photos, parents hovering near toddlers, and men and women rolling out blankets or spreading out cardboard for the night.  This email started me to seriously reflect on the homeless living in the park.

I’ve lived in this area for 10 years now.  There are more homeless now than when we moved in, displaced to the local park by museum construction.  At first, it was awkward as the pristine park felt overrun with this new population.  For a time, I even avoided the park in the evenings, not wanting to be reminded of the poor after working to provide healthcare for them in the face of great obstacles in my professional life throughout the day.  Looking at the homeless in the park was painful, bringing up feelings of helplessness, hopelessness, failure – providing health care for the poor of Miami was so difficult.  For any patients in the county safety net system, subspecialty appointments might take 6-12 months patients and if homeless, those patients might not get the appointment notification at the shelter address they gave until after the appointment was actually scheduled.  Just to see me as a walk-in patient required them to spend hours in the waiting room to be fit in to the day’s census.  Work was like constantly climbing a steep hill without the necessary gear or support.  And seeing those patients at night reminded me of this defeat and wore at my reserves.Read More »

The Power is Yours: An Exhortation from an Undocumented Medical Student

By Sumbul Siddiqui

My parents immigrated to the United States when I was 4 years old, hoping to give their children a better life. I was raised in Georgia with my three younger siblings, two of whom were born here. Georgia has a policy called 287(g), in which some counties are proud to work together with ICE agents to detain immigrants.

My first encounter with ICE officers was probably when I was 14 years old, just about to enter the 9th grade. I remember this moment very well, because the night before I had watched this scary movie called Saw. So, I was terrified that someone was going to kidnap me. I checked my closet and slept with the lights on that night. No one came for me, but my mom was taken. Two ICE officers entered our home that morning. I only heard bits and pieces because my mom had closed my bedroom door and told me to go back to sleep. Eavesdropping, I heard them tell my mom to go with them, and she would return back to her family soon. That took 3 months. She was taken to the Atlanta Detention Center, and then transferred to an Alabama detention center.

I don’t remember much of what happened during that time, but I do remember visiting my mom in the Atlanta Detention Center. We were only allowed to see her for a brief moment. She was wearing an orange jumpsuit – crying. Her handcuffs were taken off so she could talk to us through the glass window. I told her that everything was going to be okay even though I had no idea what was going on – or really, a clue about our immigration system. When my mom returned, I started high school, and I didn’t think much about immigration again.

Fast forward to my sophomore year in college. They come for my dad. Within just a few months, they come for my brother. My dad was gone for 2 years, and my brother was gone for 7 months. They were both in two different detention centers. Sometimes, I had to figure out who to visit – whether I would drive an hour up from Atlanta to see my father or 3 hours down to see my brother.Read More »

The Poetry of Dianne Silvestri, MD

Dianne Silvestri, MD, a retired academic physician, is author of the chapbook Necessary Sentiments. Her poems have appeared in Barrow Street, Naugatuck River Review, Poetry South, The Worcester Review, The Healing Muse, New Limestone Review, Zingara Poetry Review, The Main Street Rag, American Journal of Nursing, JAMA Oncology, and elsewhere. She is Copy-Editor of the journal Dermatitis and is founder and leader of Natick’s Morse Poetry Group in Massachusetts.

Hearts, Exposed – A Medical Student’s Reflection on Witnessing Their First Patient Death

By Erik Carlson

“Hospital’s on lockdown.”

The security guard didn’t even throw us a backward glance as he shouted the news over his shoulder before continuing on his brisk jog around the floor. I turned to the chaplain I was shadowing that Friday afternoon. A Dominican sister from the Dominican Republic, she called herself a “Double Dominican.”

“Why is the hospital on lockdown?” I asked, trepidation coloring my voice gray.

“That’s hospital procedure whenever they bring in a gunshot victim. Would you like to go? They’ll need a chaplain, so I’ll be going.”

During our first year, my medical school requires students to shadow a chaplain in the university hospital. These chaplains, who come from a variety of faith traditions and backgrounds, address the emotional and spiritual needs of patients, often liaising between the medical team and the patients’ families. Before entering the hospital that afternoon, I was determined to put aside any preformed notions about healthcare and spirituality and to approach the experience with as open a mind as possible.Read More »

No Smoking This Side of Room: Reflecting on things that aren’t there any more after 42 years as a student and a teacher in a medical school

By Michael Dauzvardis

In The Beginning

It was June of 1977 and I had just begun my graduate career in anatomy.  Little did I know that I would be taking all my major classes with the medical students.  A lifelong journey in accompanying medical students in various ways had begun.

The Lecture Hall

A typical day in anatomy class began with 130 or so medical students, shuffling sleepy eyed into their small seats with swing out mini desk tops. They came bearing newspapers, coffee mugs, 3 course breakfasts, adorned in hair too long and shorts too short.  Bell bottoms, blue jeans, and baseball caps ruled the day.  I quickly assimilated by wearing my new Levi overalls. On the right side of the room (while facing the podium) was a sign affixed to the wall which declared “No Smoking This Side of Room.”  Now I must say that on the opposite side of the room I did not observe a lot of smoking but on more than one occasion I observed a student chewing tobacco and spitting into a large plastic cup during lecture.  The class of 122 consisted of 90 men, and 32 women– with a racial and ethnic composition of 1 black person, 3 Latinos, 7 Asian-Americans, and 111 Caucasians.  Forty-six of the men had mustaches, with the majority of those also sporting beards.  It was the prime of the disco period and it showed.

A portion of a newspaper containing the daily crossword puzzle would be passed around for each student to contribute. The instructors drew on a thing called a chalk board while some students tried to keep up on their yellow pads of legal paper. Audiovisuals consisted of carousels of 35 mm slides projected onto a pull down screen in the front of the room. On more than one occasion I observed a professor drop his entire tray of slides before lecture.  The slides would fly in all directions. Students and staff, eager to be helpful, would assist in reloading the carousel, but since slides needed to be placed upside down and reversed in order to be projected correctly, this usually resulted in much confusion and sore necks during the lecture.  These slide carousals also provided for the mischievous opportunity of inserting bogus slides into the lecture.  If a lecturer wanted to show a “film strip” he had to notify the AV department in advance so they could bring in a reel-to-reel projector, whose sound never worked and which often melted the film.

There were no computers or cell phones (two payphones were mounted outside the lecture halls).  Pocket calculators were the rage–and I even saw an occasional slide rule.  Virtually all students participated for 15 dollars in a co-op note club.  Each student would be assigned a lecture at which he or she would take detailed notes.  These were typed out, mimeographed and distributed to the entire class.

The lecture hall had a center aisle, but no side aisle.  As a result, students had to climb over each other to get to and from the end seats.  Furthermore, the floor slanted at almost 45 degrees toward the front such that a dropped pencil or spilled cup of coffee made it all the way down to the lecturer.  The lecture hall spanned two floors with the upper half flanked by the outer windows in a manner leaving a precarious eight-foot drop hidden by curtains– which on more than one occasion gobbled up a medical student like a bug in a Venus flytrap.

The Pub

There was a long, often leaky, run-down hallway that connected the medical school and hospital with the dental school, a dark tiny basketball court, an old theater, and the beloved pub. The pub served pizza and sandwiches and soft drinks for lunch during the week.  But, at 2:55 pm on Fridays, students, staff, and faculty could be seen with their tongues attached to the outside of the pub Read More »

“Pobrecito” – The Fine Line between Compassion and Infantilization

By Fabiana Juan Martinuzzi

“Pobrecito”– she said as we discussed the patient’s pneumonia course before entering his room.

Pobrecito” – she repeated as we donned our gloves.

Pobrecito”- she mouthed to us in front of our patient.

Pobrecito”- she whispered in my ear as we left the room.

That day, “pobrecito” became a word I eliminated from my vocabulary. In Spanish “Pobrecito” translates roughly to “poor thing” or “poor baby” and it is an appropriate word to use to show empathy with an endearing connotation. However, when one of the healthcare providers in the team used it incessantly to show pity in front of my 60 year old patient with cerebral palsy and dementia I began to cringe every time I heard her say it.Read More »

A Quick Method for Faculty and Students to Serve as Role Models for Personal Wellness Activities

By Jeffery D. Fritz, Sandra Pfister, Diane Wilke-Zemanovic, Sally Twining and Jose Franco.

Can we incorporate into the curriculum a quick and easy way to promote awareness and the practice of wellness by both medical school faculty and students? At the start of the fall 2017 term, course directors overseeing first- and second-year pre-clinical instruction at the Medical College of Wisconsin encouraged each faculty member to develop a simple communication slide. These instructors were asked to include an introductory slide noting their practices of wellness to be shown at some point in their instructional block. The exact content of this slide was not prescribed; however, all participants were encouraged to include images and personalize the content to the degree that they felt comfortable. Given the magnitude of this initiative – it would involve over 300 different faculty members and reach over 500 first and second year students across three campus locations – it was hoped that voluntary participation by faculty would be sufficient to would significantly enhance student and faculty awareness and practice of wellness/wellbeing.

Faculty participation across the 13 pre-clinical first and second year courses was surveyed throughout the academic year by reviewing the recorded sessions for inclusion of the introductory wellness content at any time during the session.Read More »

My Pediatrician

By Puja Nayak

“Doctor,” I say, my voice fading. I hear footsteps running and my eyes shut.

Hours later, I have a wire in me. I try and pull it out but my doctor stops me.

“No, don’t do that sweetie.”

I give her a look. I don’t understand why I’m here. My head is hot, I am sweating, and many students surround me, taking notes. Are they talking about me?

“Honey, you have something called Kawasaki.”

I raise my eyebrows.

“Your body and I are fighting it, so you will be okay.” She hands me a juicebox and leaves the room with my parents.Read More »