Transformational Times
Words of Hope, Character & Resilience from our Virtual Community
Friday, March 27, 2020
Director's Corner
Bringing Medical Students to the Fight
by Adina Kalet, MD, MPH
Director, Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin
This week, I received an urgent survey that was sent to all New York licensed physicians from the Commissioner of the Department of Health, calling on us to “mobilize every available resource to fight one of the greatest public health threats of our lifetimes” through “immediate, collective action.” He ended the email, “I hope we can rely on your integrity, compassion, and your commitment to public service.” It was a powerful message directed at health care providers that are retired, actively working, or still in medical school.

As a physician entrusted to lead transformation of medical education, I am engaged with President Raymond, Dean’s Kerschner, Hueston, Webb, Dodson, and Hunsaker, among others, in discerning how the pandemic will impact our students. In New Yo rk and other states, senior students are being given the choice to graduate early so they can immediately serve as physicians in the COVID-19 surge. Medical educators everywhere are scrambling to offer safe opportunities where students can provide critical, impactful services that are also meaningful educational offerings. Like their colleagues around the country, MCW students are asking to help.

As we bring medical students into these efforts, we face a series of evolving questions:
  • Can students be safely included in patient care while preserving limited supplies of Personal Protective Equipment (PPE)?
  • Can statutory rules be loosened to allow students to provide and document Telehealth visits and other care for people who cannot access their physicians?
  • Can students help collect and distribute urgently needed supplies and PPE?
  • Are virtual clinical simulations adequate as students prepare to independently save lives?
  • With their unique skills, are there educational and quality-of-life activities students can offer to the community?

As educators, we must unleash rather than block students’ expressions of altruism. Just as HIV/AIDS, 9/11, and other stressful, uncertain experiences shaped my generation of physicians, the COVID-19 pandemic will certainly shape these students’ professional identities and character. We must take this moment – and these opportunities – seriously.
I returned to the Commissioner’s email and completed the survey. My husband – who works in New York City – will be called to action soon. And because I learned how to sew from my garment-district-worker grandparents, I will also continue making cloth surgical masks with pockets for N95-style filters. The next set will go to my brother, an emergency department nurse in New Jersey, who works in a hospital where much of their PPE supply was stolen last week.

Because we are health care professionals, we seek out opportunities to help our patients and our colleagues, even though it is safer to stay home. The instinct to run toward terrifying, uncertain situations rather than away is a result of our education and training. We watched our role models do the same. Our students are already showing that they, too, have this instinct, and it is up to us to open safe, meaningful, and life-affirming opportunities for them.
From the Front Line
Caring for COVID-19 Patients
The Froedtert Emergency Department Care Team,
Respiratory Care Unit

Photo by Chris Decker, MD (bottom left)
Vice Chair, Clinical Operations, Emergency Department and Executive Co-Leader, Ambulatory, Urgent Care, & Emergency Departments
PPE & Moral Injury
by Marty Muntz, MD

Healthcare team members around the country are being directed to adhere to Personal Protective Equipment (PPE) guidelines that don’t always fit emerging scientific evidence on coronavirus transmission. Of course, we should all thoroughly wash our hands and avoid touching our faces. That makes sense, although we all realize that it is incredibly hard to  not  touch our faces. 
Some clinicians, though, are uncomfortable being told that they don’t need to wear a mask in clinic if the patient reports neither a fever nor cough at the time of the visit. We remain six feet apart for as much of the appointment as possible, but we  do  need to examine our patients. We hope the guidelines are correct when we remain with our patients for less than fifteen minutes, minimizing the risk of having the health care worker be infected by an asymptomatic patient with coronavirus, or vice versa.  

Yet we read about community transmission by completely asymptomatic and very mildly symptomatic patients. We tell our patients to maintain social distancing at all times – even when people seem healthy – because anyone could have coronavirus and pass it on. Because of the work we do, we are stressed because we can’t even follow our own suggestions. 
The CDC guidelines are constantly shifting and – let’s face it – not reassuring when we’re told that we should use bandanas or cloth masks if we run short on PPE. It could happen.

As physicians at an academic medical center, we work in inter-professional teams and learners in our clinics. While our students have been temporarily removed from direct patient care in our clinical learning environments, our residents and other health care professionals continue to care for patients and participate in all team activities. They should look to us as role models who speak up for the best interests of our patients and teams. Are we fulfilling our duty to these colleagues and learners by remaining silent when we believe that following the guidelines may not be sufficient to protect our patients and teams? How can we expect our learners to employ courage and speak up if something is wrong when we do not?
We all understand that there’s a national shortage of supplies, and we support decisions to supply the best available PPE to our colleagues who work in high risk settings. At the same time, many of us are being told we should not use even the most basic loop face masks in situations with real but unknown levels of risk. 
The AMA ethical guidelines (linked below) say that “a physician shall, in the provision of appropriate patient care,  except in emergencies,  be free to choose whom to serve,” meaning that we sometimes put ourselves in harm’s way for our patients. COVID-19 certainly poses an emergency.
Bottom line: we aim to provide compassionate care at all times, but what if our efforts inadvertently are harming patients or our teams we’re supposed to lead, or our own families? 
"Several of our Central Wisconsin community partners are working with us to ensure that students can both be safe and continue to be an important part of the healthcare system. It would be much easier to "just say no" but they recognize the value of our students as not only current, but also future, physician workforce. I appreciate their efforts and forward thinking in a crisis situation."

Lisa Grill Dodson, MD, Campus Dean, MCW-Central Wisconsin

"I'd say, selflessness has abounded in our entire organization as the world changed overnight with COVID-19! I have witnessed this exceptionally as our high-level leadership works 24/7 on crisis preparedness, keeping our students safe and connected, escalating new workflows to 'flatten the curve'. For me, it's our frontline ICU, ER and Medicine colleagues who are rising, with a new kind of grit, to amazing personal and professional challenge. We need to support them, and all in our community, to find creative ways for self-care and connection. Together we can do this!

Wendy Peltier, MD, Hematology and Oncology, Palliative Care

"I'd like to shout-out to medical students Tory Patek, Ashley Pohlman, and Megan Reinhard who organized a MCW virtual cutest pet contest called "Bark Madness." They really deserve some love and recognition because what they are doing is giving our community something so fun and optimistic to engage with while we are all isolated. We all really appreciate what they are doing - it's given us something light and different to talk about and something to look forward to each day."

Anonymous, MCW-Milwaukee Medical Student

"My roommate was on a trip when the concerns about COVID-19 were just starting, and she was infected. Luckily, I left the house to spend time with my family over break before she returned from her trip, so I am at my parents' house and cannot return home until after April 1st. My parents also offered to take care of my niece while working from home so my sister and her husband can continue to work. My parents are housing and feeding me while juggling being daycare to a 2-year-old and working from home. They are my superheroes ."

Anonymous, MCW-Milwaukee Medical Student

"My mother-in-law (elderly with multiple comorbidities) has told us that if she becomes seriously ill with COVID-19, she does not want to be placed on a ventilator. She wants to make sure younger people have access to this life-saving treatment."

Rebecca Lundh, MD, Resident, Family Medicine

"Watching neighbors taking turns walking our 90-year old neighbor’s dog, and watching my husband spending days and nights poured over
COVID-19 studies so that he can inform colleagues about the spread of this virus and how best to protect oneself - both of these acts reflect respect and love."

Kayt Havens, MD, Kern Institute

"I was running out of food at my apartment I received a text from a friend whom I haven't talked to in months offering to bring me home made soup and pasta. She new times were tough for me and other healthcare providers and wanted to help. "You can't take care of us if you can't take care of yourself" she said. Thanks to this amazing person I now have a week's worth of delicious home cooked dinners thanks to the thoughtfulness of her and others like her in our communities. It is easy to feel as if sacrifices we make and risks we take in our order to provide care for those around us aren't appreciated, but this act of compassion and kindness reknewed my spirit, my desire to serve."

Evan Henricks, MD, Resident, Geriatrics & Gerontology
Share a reflection for our next issue:
From the Front Line
Three Questions for
Sarah Zais, RN, CVICU

1. When did you realize that things were serious? 

"I grew more concerned with the rapid spread of the virus in Washington and Italy and increased when I saw how the virus overtook Italy's healthcare system. The spread did not match that of the flu or any other virus I've seen."

2. Where are these events taking you?  

"Practically speaking, the nurses on our unit are preparing to work extra hours. We're mentally preparing ourselves for having more ECMO circuits on the unit than ever before. We're worried about losing staff to illness and having to work with more critical patients with less resources (staff, PPE, ventilators, back up equipment, etc.). Personally and professionally, I am feeling more and more passionate about wanting hands-on staff having a voice in decision making. I've heard so many potentially great ideas and perspectives in the break room from nurses, RT's and physicians that I work with; I want their voices heard and I want their ideas discussed at a higher level." 

3. What has surprised you most?   

"The variety of responses from people continues to surprise me. Both good and bad. It surprises me that there's still no toilet paper on shelves. It surprises and encourages me to see neighbors leaving care packages. It surprises me to see how a community can come together to support one another in practical ways. It has been beautiful to see restaurants provide Emergency Department staff with food, to see people donating N95 masks to us, to see people getting creative with Skype happy hours. It also, honestly, surprises me that wearing a bandana in lieu of a mask has been suggested as a valid option. I'm surprised that many of us feel fear of being left unprotected."
"Talking with one of the nurse practitioners in our hospital’s new COVID-19 ICU one recent night, I asked what worried her most. ‘Patients dying alone,’ she replied … it’s up to us, the health care workers who are seeing these patients at the front lines, to find ways to maintain connection, to balance our fear with tenderness.”

by Daniela J. Lamas, MD, Writer and Critical Care Physician,
Brigham and Women’s Hospital, Boston, MA
New York Times, I’m on the Front Lines. I Have No Plan for This
Coping with COVID-19
Mental Health Interventions to Support
Health Care Workers
Student COVID-19 Initiative

After COVID-19 forced unexpected alterations to student schedules across MCW, a group of medical students felt that despite no longer being able to participate in physically treating patients, they wanted to be able to help support the MCW community as well as they could during this unprecedented time. It was with this thought that they organized to help support not only virtual patient care initiatives, but others tasks such as gathering and assembling PPE supplies, as well as coordinating a system for students to help with triaging patients through telehealth.

By partnering with faculty and staff, much of these efforts are already under way. Any faculty, staff or students who are interested in getting involved, or have an idea for partnership regarding COVID-19 efforts, please reach out to Kate Stark , Austin Dopp , or Kyle Murray .
 Calling All Sewers!

Children's Hospital and Froedtert are in need of personal protective equipment (PPE) to protect their care givers. One item they are in desperate need of is face masks.

If you, or someone you know can sew, we've linked the approved face mask patterns from both hospitals below.
Virtual Art Club!

An online community has been created to share creative pursuits with others in the MCW community – visual arts, music, poetry, short stories, and more!

Follow and post your artwork on the Facebook Page “MCW Art Club” or on Twitter or Instagram using the hashtag #MCWArtClub.
Thank you to all who donated blood this week! While the critical blood shortage has been overcome, we will continue to need donors throughout this health crisis.
Artwork courtesy of Theresa Maatman, MD
The Transformational Times publishes weekly, delivering stories of hope, community, caring and resilience to our Medical College of Wisconsin community and the Kern National Network for Caring and Character in Medicine.
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