Transformational Times
Words of Hope, Character & Resilience from our Virtual Community
Friday, April 17, 2020
In this Issue:

  1. Director's Corner by Adina Kalet, MD: Preparing Our Students
  2. Perspective from Kathlyn Fletcher, MD: Residency During COVID 
  3. Perspective from Nathalie Abenoza, Christian Hernandez, Eli Martinez, Javier Mora and Sebastian Daniel: Community Raised & Engaged
  4. Reflections: What have you noticed most about social distancing?
  5. Take 3 from Angela Polcyn, MS, Bereavement Coordinator, FH
  6. Announcements | Resources | Ways You Can Help
Director's Corner
Preparing Our Students for Internship During the Pandemic: The Virtual “Night onCall"
by Adina Kalet, MD, MPH

Ring! Ring!

The medical student clicks the mouse and looks at the face on her computer screen.

“This is Dr. M. You paged me?”

“Yes Doctor, you’re covering Mr. Jackson, right? He was ready to go home in the morning, but… ”

So begins a 3-1/2-hour immersive, simulated “Night onCall” (NOC) we designed six years ago to assess each senior medical student’s readiness for transition to internship – the final medical school clinical exam just before graduation. This year, for obvious reasons, NOCs are being conducted virtually and are much “higher stakes,” since students have been on a clinical pause and are unable to complete their graduation requirements in any other way.
Photos from the Front Line
Received by Froedtert Cancer Care Center
with a donation of PPE. Shared with permission.
How MCW's Residency Directors and Residents are Dealing with COVID-19
by Kathlyn Fletcher, MD, MA

In the musical Hamilton , after surrendering to the Americans, the British staggered away singing an old drinking song that repeated the words “The world’s turned upside down.” That phrase continuously resurfaces in my consciousness these days. As a residency program director, I am constantly barraged with changes, adjustments and contingencies. We are tasked with being flexible and leading our trainees so that they can do the same. In the midst of this uncertainty and constantly changing landscape, we need to create moments of connection and normalcy for our programs.
Community Raised & Community Engaged: The Latinx COVID-19 Response in Milwaukee's 53204 & 53215 Zip Codes

by Nathalie Abenoza, Christian Hernandez, Eli Martinez, Javier Mora, and Sebastian Daniel
Milwaukee is an extremely diverse city known for its scenic lakefront, Giannis Antetokounmpo, breweries, Summerfest, and the wide array of ethnic festivals. Unfortunately, Milwaukee is also known for its racial, ethnic, and socioeconomic segregation. The COVID-19 pandemic and its life-altering effects were severely underestimated across the globe, exposing many critical flaws in our health system. As described previously by Dr. Chris Davis’ Perspective in the Transformational Times , one of these cracks in the system is how COVID-19 mortality rates are disproportionately impacting people of color locally and nationally. Despite these sobering statistics, enforceable Safer-at-Home orders enacted by our governments, and the masks we now wear, we want to spotlight an incredible community program we have partnered with helping Milwaukee’s Southside Latinx community during these trying times.
" My take on social distancing is that of great concern to those who are not following the "stay at home" request. Even though I very rarely go further than my driveway to get the mail, there are times I need to carefully venture out. When I do, I notice parking lots full of cars at stores that are still open. I notice groups of people hanging out and walking around. I notice that when you stand in line to check out, following the six-foot-rule, people will cut in line thinking you aren't in line.

I guess I just don't see those who are mindfully following the social distance suggestion because, most likely, they are "safe at home." I want to say THANK YOU to THOSE people. Well done!"

Judy Borchardt, Staff - Pediatrics

" I am disappointed by the part of our population that seems to have an utter disregard for the rules to maintain social distancing. Some will not wear a mask in public. Recently, I saw police have to escort a person out of a public building for not following social distancing rules.

Some people seem to think there is no COVID-19 virus being spread right now. I am appreciative of those that respect the rules. They are the ones who want to see this end sooner rather than later."

Steve Vinohradsky, Patient - Froedtert Hospital

"One of my colleagues is keeping track of how many hugs I owe her, how many times we would have hugged since social distancing began. We are at 44. I tell our residents, "Don't sit on the patient's bed, don't touch your gown with bare hands, don't talk to that parent without a mask, don't, don't, don't." I feel like an admonishing grandmother.

A colleague tells me his cousin is intubated in the ICU with COVID. He tells me this through a mask and glasses, but I can see his eyes are rimmed with tears. How difficult it is not to place a supportive hand on his back, to show him my concern with a touch. Social distancing has amputated a limb I never knew I had."

Megan Schultz, MD, MA, Faculty - Pediatric Emergency Medicine

"What I notice is the strong desire, even need to somehow extend across the social distance at home, at work, at church, in our community. To respect the requirements of six feet, but to demonstrate a closeness that overrides this. How to do it is a repeat challenge. Every day, every hour.

I find myself wanting to greet every staff member I see and encourage them...thank you for your work today! You are doing well! I'm glad to see you are taking a moment to eat! In this way I accept and reject social distancing ."

Kelly Ayala, Nurse Practitioner - Internal Medicine

"We wore cloth masks to go vote in last week's primary election. Most people were good about the six-foot distance and hand washing, but at least half of the voters were without masks.

An article in The Atlantic entitled "The Social-Distancing Culture War has Begun," quoted a man from Texas saying, "The recent wave of government-mandated lockdowns was a product of panic-mongering in the mainstream media." When asked about shelter-in-place orders, a Louisiana woman replied, "What the hell, is this 1940s Germany?”

Hoo-boy. Some of our fellow citizens are already becoming fatigued or complacent. I worry that people will disregard the precautions before the danger has passed."

Bruce Campbell, MD, Faculty - Otolaryngology

Share a reflection for our next issue:

From the Front Line
Three Questions for
Angela Polcyn, MS
Bereavement Coordinator,
Froedtert Hospital

1. What has surprised you most about responding to the COVID outbreak?

"One of the most surprising experiences of finding myself in the midst of the COVID crisis is how my relationships with my colleagues have changed. We are in uncharted water and finding out how to swim together. My conversations have more grit and honesty. I am experiencing my own personal and professional vulnerabilities as well as those of every single person working in healthcare right now. We have found the willingness and the need to give a voice to our collective experience - to honor the burden of our responsibility, the uncertainty of the future, and the pain of our grief. 
With this experience, every day is a lesson in resilience. We are having to renegotiate our sense of control, identity, and how we find meaning both professionally and personally, and we are building relationships and levels of trust with our colleagues that will forever connect us."

2. What have you found that families need most?  

"As a Thanatologist, my primary goal is to support the bereaved. Most normative grief trajectories include accepting the reality of a loved one's death and the process of restoring a sense of well-being. The current situation we are in has derailed this process. Most of the bereaved families I have spoken with are still in a state of shock and numbness, and rightly so. As the days and weeks go on, and we continue to be isolated and cut off from our support systems, death rituals, cultural connections, and our ability to collectively grieve, our responses and experiences will be delayed.
We are a community in the center of crisis, and our focus is on practical concerns. This is okay. Just because so many of the bereaved are not yet able to face their grief and sit with it, does not mean there is something wrong. Delayed grief can be an adaptive response. Families are waiting to touch the rawness of their grief until they are able to gather, mourn, support one another, and take that first step toward restoring a sense of well-being. They are graciously making peace with a situation they cannot change. This gives me hope."

3. What advice can you share for dealing with grief?   

"The experience of grief is already isolating, and cuts us off from friends and family. Not only this, but as healthcare professionals we have an added sense of responsibility and purpose. It is okay to acknowledge your suffering as a healthcare professional right now. Fight the urge to minimize your pain - you have every right to it. 
If you find this difficult to do, then view your suffering in context of the larger perspective - but do not lessen its validity. See it for what it is and give yourself permission to honor your pain and experience, and open up the space for self-compassion. List out the things you have lost - name them, speak them out loud.
Self-compassion is about attending and befriending our struggles, making a place for them in our narrative. Finding truth in our suffering, making a place for it, and holding space for others who are suffering - this is the self-compassion we need right now."

"Preparations seem alarmist until the disaster hits, then they seem inadequate."

by Laura C. Michaelis, MD
Associate Vice Chair, Department of Medicine
Associate Professor, Division of Hematology/Oncology
Medical College of Wisconsin

"In Anticipation of the Wave"
The Hematologist, April 7, 2020
Over 100,000 Masks
Assembled and Distributed!
As of this week, the Kern Institute has coordinated the assembly and distribution of over 100,000 face coverings throughout Metro Milwaukee!

Masks are being donated to a variety of city and community organizations, including the Milwaukee Public Schools Meal Pickup Locations, the Milwaukee Grocer's Union, The Sherman Phoenix, the Milwaukee Rescue Mission, Feeding America of Southeastern Wisconsin, the Milwaukee Police and Fire Departments, and the Milwaukee County Department of Corrections.

MCW students, faculty and staff have been assembling the masks for the past three weeks. Please contact Joan Weiss if you can help!
Write on the Virtual Gratitude Board!

Whether you're grateful for the volunteers who are assembling masks for our community, or for the people leaving colorful chalk messages all over our medical campus, we are all working hard to be there for each other in ways that deserve to be acknowledged.

Click on link below and share what you're grateful for!
MCW's Office of Educational Improvement Launches
Distance Teaching Toolkit!
Be a Hero - Donate Blood!
The Transformational Times publishes weekly, delivering stories of hope, character and resilience to our virtual community.
Bruce Campbell, MD, Editor-in-Chief
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