Supporting Your Students in These Troubling Times

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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

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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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Lessons Learned from a Beatbox Heart

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By Tim Lahey

Two days ago, Jimmy stuck a used needle into the soft skin of his forearm, and released 20 milligrams of black tar heroin and a bolus of bacteria into his blood.

The bacteria floated from vein to artery as he nodded, eventually sticking themselves to the ragged edge of his aortic valve.  There they multiplied and burrowed until each systole whipped a two-centimeters of snot back and forth in his atrium.

Fevers came first, which Jimmy ignored while buying more black tar at a rest stop on I-91.  A day later, little red stigmata appeared on the palms of his hands as plugs of snot lodged in small vessels there.

When he couldn’t breathe, Jimmy went to the ER.  My medical student and I met him there as he shook in bed.  A snarl of IV lines snaked under the covers.

Jimmy gave one-word answers to my questions, and did not open his eyes…
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Our Devices, Our Selves: How to Avoid Practicing Distracted Doctoring

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By Laura Vearrier

Americans check their phones an average of 46 times per day, (Eadicicco 2015) and they do so no matter what they are doing, including while driving, while at church, during sex, or out to dinner. (Rodriguez 2013) Are healthcare providers any different?  In a survey of medical students, 46 % reported texting, checking email, or making a call on their personal devices during a patient encounter, and 93% had seen a senior resident or attending do so. (Tran et al. 2014)  The answer to this problem is not as simple as turning off the device.  Improvements to medical care afforded by personal devices include efficient access to electronic text books, up-to-date literature, medical apps such as dosing calculators, and improved provider connectedness, among others.  The flip side is that the inevitable distraction created by smartphones creates a threat to professionalism in healthcare…
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Healing, Hate, and Solidarity

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By Duncan Maru

“Non-violence is the highest spirituality”  Mahavir, Jain Spiritual Leader

“Lord, make me an instrument of your Peace, where there is hatred, let me sow love.”  St. Francis of Assisi

As a physician, it is my calling to heal. Healing goes far deeper than knowing the right science and prescribing the right medication.  It involves a deep and uncompromising feeling of compassion and love towards our patients.

How might a clinician think about the results of last week? President-elect Trump rose to power with a rhetoric of hate, division, and otherness.  Our country suffers deep income inequality and lack of opportunity. Our citizens suffer from the concentration of power and wealth and the resulting lack of education and opportunity.  Mr. Trump understood people’s anger and channeled it towards hate.  Yet hate is incapable of solving problems.  Believing this election was a referendum on America overcoming hate and fear, my family and I had supported and campaigned for Secretary Clinton…

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Filling the Vacuum: Immigration, Health Policy and Latino Leadership in Medicine

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By Jacob Begres and Orlando Sola

“When Mexico sends its people, they’re not sending their best. They’re not sending you. They’re not sending you. They’re sending people that have lots of problems and they’re bringing those problems with us. They’re bringing drugs, they’re bringing crime, they’re rapists, and some, I assume, are good people.”
-Donald Trump

The history of the United States is defined by waves of immigration, starting first with English religious migrants and moving through migration from Europe, Asia, Africa, and South America.  Though we have seen periods of migration from a variety of cultures and ethnicities, the Latino experience has been particularly entwined in our country’s history and reaches back to the very founding of the nation, when lands inhabited by Spanish-speaking communities were integrated into the new American social fabric.  Despite this long history of Latino migration, however, the history of discourse surrounding Latino economic and political migrants has been fraught with bigotry and historical myopia from its political leaders.  We need look no further than our own presidential election to find examples…
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Popocatepetl and Iztaccihuatl, a poem by Guadalupe Garcia McCall

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A NOTE FROM THE AUTHOR

This poem is metaphorically from the cutting room floor, meaning that it was cut from the original manuscript for my novel-in-verse, Under the Mesquite.  My editor at Lee & Low Books, Emily Hazel, and I both agreed that given the nature of the manuscript, our intended audience, and the gentle treatment of the cancer in the rest of the narrative, this poem was too complex and a bit too graphic to be included in the final draft.  To this day “POPOCATEPETL AND IZTACCIHUATL” remains one of my most beloved poems.  I share it with you as an ofrenda, a humble offering, in gratitude for the wonderful reception, support, and warmth bestowed upon me during my author visit to the Loyola Stritch School of Medicine on October 25, 2016.  I hope you enjoy it.
All my best,
Guadalupe Garcia McCallRead More »

Moving Beyond “Boxed-in Thinking”: Imagining a Problem from the Patient’s Perspective

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By Manveen Saluja

A number of years ago a woman in about 50 year old presented to my office complaining of “walking on a vein” in her left foot. She reported having seen a number of physicians – 9 in total – with no successful resolution.  She was told that there is no vein that could possibly roll under her foot, and her complaint was dismissed.

Her past medical history was significant only for a healed fracture in her left foot that occurred 9 years ago.  She believes the sequela to the fracture is that “a vein rolls under her foot” as she walks. She does not experience pain in the foot, but she is very distressed because she can’t walk or dance as she could before the fracture.  As I talk with her, I realize she has been experiencing this unpleasant sensation every time she walks for 9 years…
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Memento Mori- Reflecting on my Death and the Education of Medical Students

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By Laura Creel

As part of their undergraduate medical education, students discuss end-of-life care; they hear lectures about valuing the lives and deaths of future patients; they are instructed in the legal issues surrounding advance directives and care planning.  They see death, too—see it in the cadavers that they incise, see it in patients who die surrounded by family members and in patients who die alone.  Sometimes these experiences with death are personal; many times the experiences are stripped of emotion because they occur in clinical environments.  But although students see death in medical school, some recent research shows that approximately half of residents do not feel well-prepared to deal with the deaths of patients.[i]

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Ideals and Inadequacies: Living the Physician’s Vocation

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By Amy Blair

I was not sure I wanted to be a physician when I stood in front of the dark blue US mail box on the street corner of my college campus, one hand on the door handle and the other on my neatly typed applications, hesitant to let them go. I wanted an extraordinary life, but I wasn’t sure this was the right path.

The closest I felt to certainty was when I shadowed a family physician who cared for immigrants in a rural Midwest clinic.  He had served as a physician to countless victims in El Salvador during the civil war in the 1980s.  His past and current practices were rooted in his social justice, in the philosophy that all humans on the globe deserve the physical, mental and emotional well-being necessary to arrive at their potential.  I wanted to be a part of that and I began to imagine myself as a physician…
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