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 »

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. 

The Guilt Does Not Go Away: A Physician’s Tribute to Elephant Mothers

By Maha Mahdavinia

It started almost from the moment my son was born, after I held that precious little breathing miracle of life in my arms and he stopped crying right away. I was filled with joy and love, as if beautiful, peaceful music was playing in my ears. I wanted to hold him all the time and never leave him. Then I remembered: My maternity leave was only six weeks. All of a sudden, the music stopped. It was replaced by a gnawing pain in my belly. Not from the unexpected ruptures of birth — I couldn’t care about those less at that moment. The pain came from guilt. In six weeks I would have to leave my baby every day, from very early in the morning until six or seven at night, when I came back from the hospital. I was a medical resident, and my work hours were long and uncompromising. As I sat in the recovery room of the maternity ward, my mind turned from awe and wonder to anguish and doubt. What was I thinking having a baby? I was so busy with work, and my job was very stressful. Surely I wouldn’t be a good mother.

Life went on, but the guilt did not leave me. It just changed shape, then doubled when we had our second child. It became sharper any time they fell and I wasn’t there; when they got sick or misbehaved; when they were late to school and I thought I should have pushed them to get up earlier; on the mornings when I was in hurry to get to work and had to raise my voice or give them lectures in the car. Those times the guilt crawled all over me and took control of my day.

At times I thought I should have quit residency, but then I asked myself: What about my other responsibilities to society? I take care of children with severe allergies, asthma and immunodeficiency – that work is also important. If I had quit residency, would I even be a better mother?Read More »

Avoiding Compassion Fatigue: Drain Less, Recharge More

By Eran Magen

You open yourself up to the pain of others, in order to be a comforting presence in the middle of a terrible experience. It helps them, and it drains you. It is exhausting to experience so much secondhand suffering. Over time, it sucks the color out of your own life, leaves you depleted, less able to connect with the next person and to enjoy your own life.

Compassion fatigue. Whether it’s the compassion in us that gets fatigued, or the fatigue caused because of compassion, the phrase rings true. Sometimes, compassion fatigue results in a growing internal resistance to witnessing the suffering of others. We avoid seeing them, hearing them, smelling them; and when we must, we avoid considering their suffering with any depth. We become numb to it, and witnessing the agony of someone else stirs no greater a reaction in us than seeing a pebble fall and strike a rock. Our own joy becomes flatter, duller. We avoid the pain by blunting our ability to feel, and it becomes harder and harder to see the good and to believe in it.

Compassion fatigue is a form of depletion. Depletion happens when the rate of drain is greater than the rate of replenishment. So there are two things to do: Drain less, recharge more.

DRAIN LESS

Connecting with the suffering of others is draining, and more so when we are more emotionally merged with the person we are supporting. On the spectrum that runs from “Totally Separate” to “Totally Read More »

10:56 – The Minute a Patient’s Life Ends and a Medical Student’s Life Changes

By Rachael D’Auria

The hierarchy in medicine, dark humor used to cope with difficult patients, and embarrassment of not knowing answers to endless questions being thrown your way are some of the many horror stories students above me have attempted to prepare me for. However, no amount of preparation could prepare me for witnessing my first death.

As I watched the residents add notes to patients’ charts, an announcement over the loudspeaker made all the physicians abruptly look up from their computers. “A 79-year-old male is being transported to the ER in a full code.” Immediately, residents, nurses, and attending physicians started prepping the trauma bay, as I, a rising second-year medical student doing clinical research in the emergency department, attempted to stay out of everyone’s way. I squeezed myself into a corner of the trauma bay and made sure I was not blocking any important machinery. The trauma bay erupted with activity as EMS workers rolled the patient into the room while administering CPR and rhythmically squeezing the ventilation bag. He was quickly moved onto the trauma bed and the CPR machine continued chest compressions. The patient’s wife sat near the room’s entrance as the team administered epinephrine, calcium chloride, and bicarbonate while attempting to intubate him.Read More »