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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After the Loss of a Patient: Reflection and Connection Through Prose

By Hedy S. Wald

Lean machine of prose, stripped down to the essence, and a power-packed way to care for the caregiver… this was my experience of the 55-word story genre1 at a writing seminar. While I had some experience writing haiku, I was generally accustomed to reflective narratives3 as “story” so was nothing short of surprised when a compact 55-word prose “small jewel”2 about a patient who touched my heart and soul spontaneously emerged onto the paper.  It chilled me to the bone and warmed my heart. I was asked to read it aloud for the attendees – the hush afterward was a moment of sacred silence…
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Loss: The Hidden Barrier to Professional Identity Formation

By Meaghan P. Ruddy

Paying attention to the wider trends in medical education recently makes it difficult to miss the growing voice of Pamela Wible, MD and her crusade to end physician, resident and medical student suicides.  One premise of her argument is that all the language around burnout and resilience misses the point.  The point it misses? This demographic is suffering from abuse.

I tend to agree.  To this I would add that the result is not burnout but the closely related state of grief…
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‘Examening’ the New Year!

By Michael P. McCarthy

The New Year offers a clean slate, a welcome opportunity to try something new.  Given the title of the blog, Reflective MedEd, I would like to offer a way of refocusing and reorienting oneself through reflecting on the experiences of the day.  As Hedy Wald described in her blog post, reflection enhances a variety of skills that are essential for continuing professional identity formation for medical students, educators, and practitioners alike.  The process of the examen serves as a way to reflect by reviewing hour-by-hour the events, circumstances, and experiences of the day…
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Illness As An Opportunity for Reflection: Enabling the Unseen To Be Seen

By David Leach

On March 1st my aortic valve was replaced. I received extraordinary care, was discharged on the third postoperative day, and am doing very well. When I arrived from the operating room to the intensive care unit I had an endotracheal tube, two chest tubes, an arterial line, a jugular vein Swan-Ganz catheter, two 14 gauge intravenous lines, a urinary catheter, various chest leads monitoring my heart rhythm, a pulse oxygen monitor and I have rarely felt better. In fact I was filled with joy. The Society of Thoracic Surgeons rates the 1300 plus cardiovascular surgery programs in the U.S. and I was happy to discover that my local thoracic surgery program was highly rated. I was grateful to have a disease that was fixable and a surgeon who knew how to fix it. I was also terrified at what I would have to go through to get it fixed. I did not anticipate joy…
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Contemplation in Action: Reflective Habits in Clinical Care

By Karen Spear-Ellinwood

I began professional life as a lawyer, representing people accused of violent crimes, most having failed to graduate high school, if they made it there at all. I realized that while a lack of education accounted for a great deal of crime, the more dangerous affliction was a failure to reflect before acting.

After 13 years, I became an educator. I started in middle school. I constructed debates on history, legal and social issues, on weighing the potential harm of perceived ills and their perceived remedies. The sorts of subjects that forced reflection and self-awareness.

I told my eighth graders that lawyers never make decisions without reflecting on what’s likely to happen and what might happen. Lawyers had to know the law and they had to figure out how to apply it, sometimes while encountering unanticipated circumstances. I assigned these eighth graders to argue the side of the debate with which they vehemently disagreed. They had to stretch their perspective, I told them. See this issue from someone else’s perspective to reconsider their own position. They might not change their mind but they would understand the issue and themselves better…

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Becoming Zusha: Reflecting on Potential in Medical Education and Practice

By Hedy Wald

Reb Zusha* used to say: “When I die and come before the heavenly court, if they ask me, ‘Zusha, why were you not Abraham?’ I’ll say that I didn’t have Abraham’s intellectual abilities. If they say, ‘Why were you not Moses?’ I’ll say I didn’t have Moses’ leadership abilities. For every such question, I’ll have an answer. But if they say, ‘Zusha, why were you not Zusha?’ for that, I’ll have no answer.”   

*Rabbi Meshulam Zusha of Hanipol (Anipoli), pious great Hassidic Rabbi (1718-1800)

What is our answer when faced with the challenge of helping our “Zushas,” our learners and educators, be all the “Zushas” they can be?

Developing a “reflective culture” within medical schools and teaching hospitals can encourage and guide learners, educators, and practitioners to recognize and take steps toward realizing untapped potential in self and in health care teams. Within a longitudinal, developmental reflective process starting in year one of medical school, extending into residency  and beyond,1 reflection-fostered awareness of self, other, and situation facilitates purposeful, self-directed learning, more effective use of feedback, and development of new habits of mind, heart, and practice.2  Meaning is created from experience and newly illuminated capabilities may be actualized…

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