How Do You Deal With Death All the Time?

By Shannon Tapia

My husband the Anesthesiologist came home one evening solemn, affected, not himself.  His patient died in the recovery room.  It was sudden, unexpected for my husband, and despite the team’s swift efforts and perfectly executed code, the patient died anyway.  It’s relevant to note that his patient was an almost 90 year old man with significant Congestive Heart Failure, probably Chronic Kidney Disease, and complete occlusion of one of his carotids who sustained hip fracture and thus required the surgery to pin his hip for both healing but also comfort.  This is the ultimate Catch 22 in medicine (or at least in Geriatrics).  Someone who really should not be having Anesthesia or surgery due to their life-threatening chronic medical conditions has an accident and now requires a surgery to make their remaining life bearable.  My husband and the surgeon delivered the bad news together, and as the patient’s wife understandably fell apart, my husband cried in front of patients (family) for the first time, ever.  As we processed this together, he asked me, the Geriatrician, “How do you deal with death all the time?”

I won’t pretend to have all the answers.  However, I don’t think my husband or any doctor is alone in needing help or any tips at coping with death. So here are some ways this mother, family physician now Geriatrician copes with death, an ever-present part of Geriatric medicine…
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“I Never Considered That.” Medical Student Professionalism Peer- Evaluations and the Self-Identity of a Future Physician.

By Anna Lama

I recently presented a workshop on the assessment of professionalism at the Southern Group on Educational Affairs (SGEA) conference.  I planned to discuss the elements of assessment: developing a framework to define professionalism, discussing successful assessment practices and reviewing the various tools available to assess professionalism.1  Much to my surprise, the discussion quickly moved into deeper inquiry on student participation, perceptions, and self-identity through the use of peer evaluations on professionalism…
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“Seeing” the Doctor: Depicting the Physician’s Self-Identity

By Stacey McClintick

What do you what to be when you grow up?  Do I even have to?  Can I cry now?  Can I show who I am?  I can only hope you will understand and be able to take away from me all that I have… because that is what I want to give.

I am not who you think I am.  Strong on the outside… an unstoppable ramble of insecurity,  Inquisitiveness and love on the inside.  I am a mom, a Maine, a wife, a soldier, a sister, an engineer, a daughter, a student doctor, a neighbor, a college student, a carpool mom, an artist… my own self gets lost behind all these things.

I lost “rank” to save my kids and my husband, but out of curiosity and hope for challenges and to experience life, I have gained so much more.  But it hurts sometimes to not be recognized in my current position for the experiences I have had.

At the same time it is hard to focus on the facts in medicine when the very curiosity of life which pulled me in persistently tries to pull me away.  ADHD?  Maybe… I have never given up… is that my downfall?

Here, regardless, I can be what I am.  In art my mistakes open up an opportunity for something wonderful I had never thought of before.  In life/medicine my mistakes are lives… more studying and more stress.

I thought long and hard about what I wanted to do for my mask, and even now I would need two, ten, or even forty more sessions to have my mask relay everything I wanted it to say. However, I understand that this was not the entire point of this exercise and that the goal was to find another way to work through the stress and in that, I was successful! (I only wish I could cash in its value more often)…
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Supporting Your Students in These Troubling Times

By Mark Kuczewski

University and college administrations have shown laudable leadership since the election in offering support to their students who feel under threat.  The strongest and most explicit statements have been in regard to undocumented students who have benefited from the Deferred Action for Childhood Arrivals (DACA) program.  As the almost 800,000 persons of DACA status could be sent back “into the shadows” by the next president, numerous universities have made statements elaborating the steps they will take to protect these students and supply them with legal and social support services. [1,2]

Furthermore, many other students including persons of color and students from the Muslim and Jewish faith traditions also are encountering increased interpersonal hostility and they fear potential discriminatory policies such as the rumored “Muslim registry.”  As a result, many universities and colleges have done a variety of things to support them including offering discussion forums and creating “safe spaces” where students can express their concerns without debate.  But many educators wish to know what they personally can do to help.  Let me offer a few suggestions…
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Sentimentality in Medical Professionalism

By James Smith

As we navigate current and future health care transitions, I am skeptical that our conventional understanding of medical professionalism will assist us.  We have defined and organized medical professionalism into list of codes, behaviors, and collective “group-think” to serve as an aegis to transient threats to the central role of the medical practitioner in historic and contemporary healthcare.  Or at least physicians have.  Professionalism, as a movement in medicine, arguably had its inception in this country with the organization of the American Medical Association (AMA).  The AMA’s initial agenda included a proprietary defense to the threat of “irregular” practitioners—those from alternative medical education pathways.  The central role of physicians in modern healthcare has been eroded by payers, the government, and the healthcare systems in which physicians find employment.  Or so physicians think.  In response, physicians have conveniently deployed “professionalism” as a shield against these threats, and the general threat of commercialism in medicine.1 Furthermore, professionalism has been nuanced, expanded and rolled out as a discipline to be taught in medical education in order to protect and retain a collective identity, resistant to oversight or intrusive engagement from the outside.  The self-serving nature of the call for renewed professionalism and its incorporation into medical education is thinly veiled by the allure (and illusion) that it may actually be effective.  All we are accomplishing is the depersonalization the very nature of the relationship between healer and patient upon which we “profess” our social vocation…
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