Transformational Times
Words of Hope, Character & Resilience from our Virtual Community
Friday, May 8, 2020
In this Issue:

  1. Director's Corner by Adina Kalet, MD: Working Toward a Philosophy of Medical Education Transformation
  2. Perspective from Kathlyn Fletcher, MD: Rare Interdisciplinary and Interprofessional Opportunities for Residents
  3. Perspective from Sandra Pfister, PhD: Walking with Purpose at 64
  4. Perspective from Malika Siker, MD: Lessons from "Life is Beautiful"
  5. Reflections: What is more noticeable in your life now, since all of our recent changes?
  6. Take 3 from Benjamin Hofeld, MD, Chief Resident, Internal Medicine
  7. Announcements | Resources | Ways You Can Help
Director's Corner
Working Toward a Philosophy
of Medical Education Transformation
by Adina Kalet, MD, MPH

The education of healers has always mattered to society. Over the centuries following Hippocrates, physicians received training as apprentices, each learning from a mentor and practicing precepts handed down in centuries-old texts. By the end of the 1800s, the U.S. was dotted with various types and qualities of medical schools and medical “sects.” No license was needed. Anyone could “practice medicine” in the U.S. Unstudied treatments were often toxic or deadly.

In 1910, Abraham Flexner, an American educational transformer supported by the Carnegie Foundation, released a report outlining how medical education should be structured, including periods of preclinical and clinical content with standardized, significant, supervised learning centered around the role of science. The report forced the closure or consolidation of almost half of US medical schools, improving the quality of medical education and practice across the US, but also effectively limiting training to upper class men and limiting high-quality healthcare access to those who could afford to pay. These are consequences we have yet to fully overcome.
COVID-19 Offers Rare Interdisciplinary and Interprofessional Opportunities to Residents
by Kathlyn Fletcher, MD MA
The COVID-19 pandemic has caused many disruptions to the normal functioning of our hospitals. Some services have become busier; some have gone nearly idle. In the first few weeks of the pandemic, leaders scrambled to figure out how to plan for a potential surge of unknown proportions. 

As hospital and educational leaders prepared for a surge at the VA, some clinical services were re-imagined. Residents and advanced practice providers from dormant services were assigned to busier services, and in some cases, services were combined. This shuffling of workers led to new interdisciplinary and interprofessional teams, offering fresh opportunities for interpersonal networks and experiences. 
Walking with Purpose at 64

by Sandra Pfister, PhD

I turned 64 in January of the year of COVID-19. It's not surprising then that John Lennon and Paul McCartney’s lyrics, “Will you still need me, will you still feed me, when I'm sixty-four,” have started to resonate with me more and more these days. It doesn’t help that there have been a few misplaced words from some of our politicians that older people would (should) risk death in order to keep the economy open during the crisis.
I tell myself often I’m not "that old," but the daily video conferences where I get to see my face up-close-and-personal on my computer screen keep reminding me otherwise. In addition to trying to find a setting that allows me to touch-up my image (!), I have thought maybe I should wear makeup while working from home (#WFH), something I rarely do when at work. Yet, it’s not really about the number of years behind me or the wrinkles I see on the screen, but more about the words of Lennon and McCartney. It's more about wondering whether I am needed in this time of COVID-19. I will never be a frontline care giver and my training as a vascular pharmacologist are unlikely to make me an essential worker. Will you still need me when I'm sixty-four?
Lessons on Resilience, Empathy, and Magic from Life is Beautiful & Roberto Benigni in the COVID-19 Era

by Malika Siker , MD

In 1997, the Italian movie Life is Beautiful (La Vita è Bella) burst on our cinema screens and became an international sensation. In this story, a Jewish father named Guido is imprisoned in a concentration camp with his son Giosuè and goes to absurd and humorous lengths to shield Giosuè from fully realizing the monstrous reality surrounding them. Roberto Benigni, who co-wrote, directed, and starred in the film, played this epic role with conviction, compassion, and comedy, challenging viewers to wonder how far they would go to spare their child from ugly truths. I recall Guido’s charm, wit, and devastating wink, as well as how hard I worked to hold back tears as the credits rolled when first seeing the film as a college student. I am ashamed to admit that I was successful. Not a single tear fell.
The COVID-19 pandemic is not even remotely comparable to the horrors of Nazi Germany during World War II. There is no debate. Adolf Hitler and his accomplices murdered 17 million innocent people in Europe as part of a pogrom of deliberate and systematic extermination over six years. However, I have found myself thinking of Guido’s approach to life and have been inspired by his spirit as a physician, an educator, and a mother of young children navigating the COVID-19 crisis. 
"Life has changed, and sitting outside I am reminded of the beauty of nature, which brings me back to my earlier years as a nurse. Forty years ago, life was simple. There was time to “stop and smell the roses.” People were sick, but they got better. Isolation was rare. Gloves were donned to insert foleys and hands were used to clean patients. Medications worked- there was no Corona virus. Charts were stacked awaiting notes, and time was spent sitting and listening to a scared patient. Nurses did hands-on-nursing, and felt they made a difference in patients’ lives!

Life was simpler then - now, we need to take time for ourselves, our family and friends, and know that a new way of life is ahead."

Linda Fridlington, MSN RN - Froedtert Hospital Advanced Practice Nurse, 4NW Transplant

"Stop and smell the roses! My MCW office is typically filled with many plants. As we shifted to WFH and hibernating labs, I sadly brought the plants home. They all survived the trip and were set up around my new workspace. Since I am not typically in my office at night, I discovered one night that one of my plants goes to sleep nightly. I was completely unaware that oxalis fold up at night - my quarantine discovery!

I look forward to the day when these plants can move back to campus, but for now they are safer at home."

Mindy Dwinell, PhD - Physiology

Sometimes your joy is the source of your smile, but sometimes, your smile can be the source of your joy -Thich Nhat Hanh

"Spending so many of our days in masks has made me keenly aware of the power of a smile, and how challenging it is to not freely share expressions. Whether this might be with a fellow shopper or check-out assistant, a colleague at work, or when eagerly listening to a patient tell their story. Words seem strangely inadequate when not tied to sharing or reading facial expressions.

The COVID crisis has thrust us into times of fear and uncertainty, when this simple way to connect our humanity is strangely absent...................without a genuine replacement."

Wendy Peltier, MD - Palliative Care

Next week's reflection prompt:
Tell us what you hope we all learn from this experience.

From the Front Line
Three Questions for
Benjamin Hofeld, MD

Chief Resident, Internal Medicine
Medical College of Wisconsin

1. What has surprised you?

"For me, the ultimate uplifting surprise has been the zeal of our trainees and staff to care for our SARS-CoV-2 positive patients. There's a palpable revitalization of purpose in both our trainees and staff. This "call to arms" has been such a motivating affirmation of the oath we took, and the lifelong commitment we made to care for the sick.

Many of our residents reached out to program leadership asking how they could additionally help during this time. Staff have volunteered time for patient care above and beyond their requirements. Trainee program leadership has hurdled over the obstacles of this pandemic to continue fostering educational and emotional growth, as well as protecting the physical safety of our trainees. 
The way that our medical community has passionately and reflexively risen to the challenge of today's pandemic has been a beautiful surprise and silver lining."

2. What do you hope we all learn from this experience?  

"I hope that the medical community and society as a whole learn that the health of any individual at any time is dependent on the health of the whole community. A pandemic is a prime example of this principal, but infectious diseases – let alone pandemics – are not the only examples of this. I hope we learn to prioritize and fortify the health of socioeconomically disadvantaged people in our community with insurmountable health inequities. Throughout our country socioeconomically disadvantaged people have been disproportionately affected by COVID-19, and some major cities up to 2 to 3 fold. These disparities have vast adverse implications for all of us."

3. What else do you hope we learn?   

"Life is precious and delicate. A lot of us know this, but I hope that from what we have witnessed we more deeply appreciate this truth. Many of us in the medical community witness dying and death fairly often, but the dying and death we have witnessed from this disease is unprecedented. Some of us have seen young, healthy people die suddenly, or older patients with seemingly mild disease unexpectedly and rapidly deteriorate later on. Being a part of the experience of this pandemic has taught us things that can't be learned by reading or watching a video."
“She is wary when she hears platitudes about the 'heroic' work of health-care professionals. She doesn’t want to be glorified all of a sudden. 'This is what we trained to do,' she says. 'This is what we do. That was true a year ago, and it will be true a year from now.'"

Cady Chaplin, RN
Lenox Hill Hospital

"A City Nurse: Healing in the ICU during COVID-19"
The New Yorker, May 4, 2020
MaskUpMKE: On the Move!

The Kern Institute has transitioned all mask kits and assembly coordination to the United Way of Greater Milwaukee at Fiserv Forum, in collaboration with the Milwaukee Bucks. We will continue the work of prioritization and distribution of the masks throughout southeastern Wisconsin, leveraging MCW community ties and our knowledge of public health.

You can still volunteer to help us reach our goal of assembling 3.5 million masks for healthcare providers and other essential workers by using the link below. Thank you!
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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