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Transformational Times
Words of Hope, Character & Resilience from our Virtual Community
Friday, July 22, 2022
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A Note from the Editors:
This week's issue was mistakenly sent out missing an article. Please see the full issue below. Thank you for your understanding.
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In This Issue Focused on Geriatrics and Palliative Care: | |
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Director's Corner
Perspective/Opinion
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Kathryn Denson, MD: The Intersection of Geriatric and Palliative Medicine
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Edmund Duthie, MD and Angela Beckert, MD: History of the MCW Med-Ger Program
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Cara C. O'Brien, MD: A Small but Mighty Geriatrics Mentorship Program
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Elizabeth Bukowy, DO, CMD: From Broken to Hopeful: Reflections on Nursing Home Care During a Pandemic
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Katherine Recka, MD: A Generation of Stories
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Adrienne Klement, MD: Lessons Learned in Caring for Dying Veterans
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Sean Marks, MD: Counter Wisdom on House-Staff Mentorship
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Lara India, MD and Laura Johns, MD: An ED for the Ages
Take 3: Best Practice Models for Communication Skills Training
Poetry Corner
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Robert Friend: The Last Year
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Raymond Carver: Gravy
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Your Turn
Upcoming Events/Announcements
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Director's Corner
Grandma and I Learn Geriatrics Together
By Adina Kalet, MD, MPH
In this issue of the Transformational Times, focused on Geriatrics and Palliative Care, Dr. Kalet remembers what co-starring with her own grandmother in a brand-new curriculum taught her about why we must, and how we might, ensure all physicians are ready to care for the elderly …
A founder of geriatric medicine makes rounds on my grandmother
The local television magazine show sent a film crew to document when, for the first time in North America, medical students would be required to spend three weeks in a nursing home on a geriatrics clerkship. Daily clinical rounds were conducted by Leslie S. Libow, MD, who now is widely recognized as a founder of American Geriatrics. This was 1983, the early days. My dad recorded the show on VHS tape, which he still has somewhere in a closet. Since none of us has the appropriate viewing technology, I will recreate the scene for you from memory.
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Perspective/Opinion
The Intersection of Geriatric and Palliative Medicine
By Kathryn Denson, MD
Dr. Denson is a Professor of Medicine and Chief of the Division of Geriatric and Palliative Medicine at MCW. She shares the story of her journey to medicine and the rich intersection of caring for older patients and those nearing the end of life …
“Katie-girl, don’t waste your life… not on us old-people… can’t you be a pediatrician?”
My grandma was always full of advice, as grandmas should be. I was 18 and heading off to college, nervous but excited to find my place in life and see what was to come. I had always cared about and valued “old things” – whether people, trees, houses, books. There is a richness to be found there. I was determined to become a geriatrician, and that’s what came to pass.
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Perspective/Opinion
History of the MCW Med-Ger Program
By Edmund Duthie, MD and Angela Beckert, MD
Drs. Duthie and Beckert share the history of the MCW Med-Ger Program…
What was the problem in geriatrics training?
The American Board of Medical Specialties (ABMS) Certification in Geriatrics became available, and the Council on Graduate Medical Education (ACGME) certification of fellowship training programs was accredited in 1988.
The original Geriatrics fellowship training programs were required to be two years in duration. Within a decade, it was recognized that fellowship programs could not attract enough candidates to fill their training slots.
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Mentorship Initiative for Geriatrics Training
A Small but Mighty Geriatrics Mentorship Program
By Cara C. O'Brien, MD
Dr. O’Brien shares her reflections on the Geriatrics Mentorship program…
Every June, the Geriatrics faculty review the Geriatrics Fellowship program and put forward goals for the next academic year. This collaborative brainstorm can take time and many paths.
Last year, amidst the now-standard virtual age of zoom meetings, conferences, etc., it had become clear that our trainees were looking for more dedicated 1-on-1 faculty guidance in career planning, wellness, and medical training. As a result, we decided to initiate a new, formalized mentorship program between faculty and Medicine-Geriatrics trainees.
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Perspective/Opinion
From Broken to Hopeful:
Reflections on Nursing Home Care During a Pandemic
By Elizabeth Bukowy, DO, CMD, Division of Geriatric and Palliative Medicine
After nine months of COVID outbreaks and research I thought I was as prepared as I could have been. Then a new more transmissible variant hit. It was the hardest month of my young career.
October 20, 2020
My first day back from maternity leave was spent taking my Palliative Medicine board exam. The next day I would return to my nursing facilities. COVID had been relatively quiet while I was out. We still didn’t allow visitors, there was no treatment options for outpatient let alone the nursing homes. Staff was short and personal protective equipment (PPE) even shorter. I returned with the hope that a vaccine was headed our way and soon we could offer some hope to my scared residents.
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Perspective/Opinion
A Generation of Stories
By Katherine Recka, MD
Dr. Recka shows how, as healthcare workers, stories surround us every day …
Early in my career, as a student, the stories were new to me. As an M3, I tried to reorient a delirious Veteran by asking about his service history, and he barked in a moment of clarity: I! KILLED! NAZIS! Back then we had more WWII Vets, and it was impossible to miss the humbling contrast between his late teens and mine. Their defining moments became cocktail party anecdotes without the urgency of a generation leaving us.
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Perspective/Opinion
Lessons Learned in Caring for Dying Veterans
By Adrienne Klement, MD
Dr. Klement shares lessons she has learned through caring for her patients…
“These doctors have the hardest job in the world.” It was a cold January evening, and the Milwaukee VA ICU was buzzing with a symphony of ventilator alarms, bedside monitor alerts, the closing and opening of isolation carts, and staff conversing about patient care needs. Despite the noise, the unit felt empty and stark with closed doors and without families at bedside, except for one room. I gowned up and greeted our dying patient, Mr. D, and his family. There were several grandchildren joining on Facetime. We (they) had 20 minutes. We all had to speak loudly through our N95s to be heard over the Vapotherm. Mr. D acknowledged he was very sick. We talked about his hopes and wishes, and he gave his loving family all the appreciation he could muster. He just wanted to hug his grandchildren. At the end of the conversation, his son hovered in close to him and said, “Dad, these doctors have the hardest job in the world—they have done everything they can to help you. You are going to die soon, we are here now, and we love you.”
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Perspective/Opinion
Counter Wisdom on House-Staff Mentorship
By Sean Marks, MD
Dr. Marks reflects on many years of mentorship through the lens of being a Hospice and Palliative Medicine clinician...
So, I have some difficult news to share – it is mid to late summer…already!
Gasp.
While naming this should motivate us all to get outside in the nice Wisconsin weather while it lasts, it should also inherently remind us of our current place in the academic season. New house staff have gotten on their feet and are embracing exciting learning opportunities within their chosen specialties. Meanwhile, there are scrambles afoot for each of them to find the best clinician mentor pairing.
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Perspective/Opinion
An ED for the Ages
By Lara India, MD and Laura Johns, MD
Behind every patient in the Emergency Department is someone’s loved one. Geriatric-friendly EDs help put that truth back into focus for elderly patients...
New patient in bed 14: 93-year-old Male, chief complaint: Altered Mental Status. Triage note states family brought him in and report he is confused from his normal self. This patient will hereby be referred to as bed 14. Whoever he is beyond these walls, that is who he is in the ED.
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Take 3
Best Practice Models for Communication Skills Training
Drs. Renee Foutz and Alexandria Bear answer the following questions:
- What do you consider the essential resources and tools for teaching communication skills?
- What are the most important communication skills for students learning Palliative Care?
- Can you share an example of a 'Best Practice' training session you have taught, and what made it work?
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Palliative Care Team Chaplain, Jacob Taxis, MDiv, BCC, has selected two poems for this issue that capture aspects of our work and the privilege of what we witness in providing EOL care.
Jake kicks off our interdisciplinary rounds each week on the FMLH service with what he have affectionately named, ‘Deep Thoughts with Jake’, which includes a poem, artwork or music, upon which we can reflect as a group, to set the tone for the day. This has been an amazing gift to our team, and we recently celebrated his 400th offering! Please take a moment to enjoy these reflections...
The Last Year
By Robert Friend
This is the last year.
There will be no other,
but heartless nature
seemingly relents.
Never has a winter sun
spilled so much light,
never have so many flowers
dared such early bloom.
The air is brilliant, sharp.
Never have I taken
such long, long breaths.
Gravy
By Raymond Carver
No other word will do. For that’s what it was.
Gravy.
Gravy, these past ten years.
Alive, sober, working, loving, and
being loved by a good woman. Eleven years
ago he was told he had six months to live
at the rate he was going. And he was going
nowhere but down. So he changed his ways
somehow. He quit drinking! And the rest?
After that it was all gravy, every minute
of it, up to and including when he was told about,
well, some things that were breaking down and
building up inside his head. “Don’t weep for me,”
he said to his friends. “I’m a lucky man.
I’ve had ten years longer than I or anyone
expected. Pure Gravy. And don’t forget it.
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Readers share their thoughts
Finish this sentence:
"My life would be incomplete without..."
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...amazing people. My family and the great folks I work with (staff, students and faculty) give my life meaning. I get to mold and be molded by the bright, inquisitive, generous, talented, knowledgeable people who fill my life. Those connections and the shared vision to make the people and world around us a healthier and more vibrant one makes life far more complete.
– Christopher Knight, staff
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...my family
– Zandra Clevert, staff
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For this week's reflection prompt, please answer the following question:
What was your favorite childhood vacation?
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Endocrine Grand Rounds Special Session:
"Providing Care for Transgender Youth: Discomfort Beyond the Binary and Developing a Transition to Adult Gender" by faculty candidate Abby Walch, MD
July 28, 2022
4:00 - 5:00pm CT
HUB - A6520/A6628 - Combinable Conference Room
or via Webex
Meeting number: 2620 031 6356
Password: EndoCME
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New School of Medicine Curriculum: Faciliatotr Recruitment for Fall 2022 Pilots
The Curriculum Innovation team is recruiting small group facilitators for our Patient-based Discussions in the 2022 fall semester. These pilots will occur in both the M1 and M2 curriculum and take place during various dates and times. An electronic sign-up sheet has been compiled and can be accessed below. Please review the available sessions and add your name as available.
Our Patient-based Discussions will be student-led, small group discussions, wherein students will apply basic science principles to a patient scenario. Ten students will be assigned to each group and each group has one faculty facilitator. The facilitator supports student-led discussion of the learning objectives, makes connections between the foundational science concepts and clinical features of the case and encourages students to ask questions and seek out answers from trusted resources. In this role, faculty will serve as facilitation experts rather than content experts; therefore, mastery of the content is not required. Facilitators will be provided with detailed facilitator guides, a facilitator checklist and a 30-60 minute preparatory session prior to the discussion.
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Promoting Equity in Heath Care through Human Flourishing, Justice, and Solidarity
Read this article by Fabrice Jotterand, PhD, MA; Ryan Spellecy, PhD; Mary Homan, DrPH and Arthur R. Derse, MD, JD just published in the Journal of Medicine and Philosophy
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Let Me Ask You Something Podcast
Listen to Dr. Adina Kalet as an interviewer as the group discusses "Because We Care: A Philosophical Investigation into the Spirit of Medical Education" by Camillo Coccia and Mario Veen. You can download it here.
This is the 8th installment of the series on philosophy in medical education of Mario Veen and Anna Cianciolo, which appears in Teaching and Learning in Medicine: An International Journal -- it will also appear as a book chapter in our upcoming book Helping a Field See Itself: Envisioning a Philosophy of Medical Education (Springer, forthcoming 2022).
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The Transformational Times publishes weekly, delivering stories of hope, character and resilience to our virtual community. | |
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Bruce Campbell, MD, Editor-in-Chief
Editorial Board: Kathlyn Fletcher, MD, Jeff Fritz, PhD, Adina Kalet, MD, Wendy Peltier, MD, Erin Weileder, Nabil Attlassy, Julia Bosco, Ana Istrate, Scott Lamm, Sophia Neman, Wolf Pulsiano, Eileen Peterson, Neehal Shukla, Sarah Torres, Anna Visser, James Wu, Serena Zacharias & Emelyn Zaworski
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