Voice of a Physician

Dr. Megan Mahoney is Chief of Staff of Stanford Health Care and Clinical Professor in the Department of Medicine at Stanford University. She relies on a close collaboration between health care administration, researchers, and medical education which is essential for ensuring a learning health system at Stanford. She served as Section Chief of General Primary Care from 2015-2020 and the Medical Director.  and Clinic Chief of Stanford Family Medicine, Stanford's academic family medicine practice at Hoover Pavilion 2014-2016. She has a passion for teams and technology in health care and leads team-based care redesign efforts and the precision health initiative called Humanwide (humanwide.stanford.edu).

October 7, 2020

Stethoscopes are Listening Devices: On Music and Medicine
By Megan Mahoney, MD, Chief of Staff

Dr. Megan Mahoney made these remarks at the beginning of the September 3, 2020 Stuck@Home Concert celebrating Women in Medicine.

     It is an honor to share the wonderful offerings of Medicine and the Muse featuring a roster of our talented colleagues. Medicine and the Muse is the perfect program to affirm our most powerful affinities. Medicine and art are allied agents of inspiration and connection. Healing and creating are inextricable. Doctors are often multi-talented artists. We wear our stethoscopes as tools or badges of authority. But most importantly, stethoscopes are listening devices. Listening to the symphony of life is primary care. Anton Chekov, a classic example of the physician/ writer, said that, quote, “practicing medicine alongside writing significantly broadened the scope of my observations, and enriched me with branches of knowledge whose true value for me as a writer can only be understood by someone who is a doctor.”  

    Chekov actually ended his thought with the phrase “who is a doctor himself.” Yes, he lived in a world where a doctor was a man. Today, we live in a world that shows progress is always possible, even if obstacles are entrenched and embedded power structures. In this year we honor the centennial of women’s right to vote, and the past months of overdue examination of race, gender, and economic equity, it is a time of structural stress and opportunities to evolve. We have come a long way from the battle for women and minorities to even be admitted to medical schools in the last century and a roster of great accomplishments propels us forth.   

         September is Women in Medicine month, a time to honor Elizabeth Blackwell, first female doctor, Becca Lee Crumple, first African American female doctor, Susan La Flesche Picotee, first Native American female doctor and Gerty Cori, first woman doctor to receive the Nobel Prize. Maria Montessori became the first woman in Italy to earn a medical degree. It was so unheard of for a woman to go to medical school that she had to get the approval of the pope in order to study there. We have had three female Surgeon Generals and women’s admission to medical schools has gone from 5% to 55% in fifty years.   

            And yet, the odds still favor privilege and this month launches a campaign called #HerTimeIsNow. This campaign is for gender equity, to address longstanding, well-documented disparities for all women in medicine, and particularly underrepresented women in medicine. While the number of women in the medical field increases every year, the discrepancy in leadership, income and influence is still dramatically disproportioned. I am a beneficiary of the long struggle for participation, especially in the professions and the sciences.

     My mother became one of the first black women with a PhD in math and rose to become one of the first black female college presidents. She modeled mindful observation of people and the ways of the world as a thinker and a protector, and most of all – she modeled calm tenacity. It will take more than wearing our stethoscopes to gain full respect and for every achievement we must prepare for new struggles. We are a long way from full equity across gender, race, or economics. In the current health and systemic challenges, this reality has been blown into full view. Now is an exquisite opportunity to enjoy the power of medicine as an art of mending and art as an act of healing. 

            We are lucky to have many talented women send their songs into the world tonight. Dr. Diana Farid merges science and poetry, music and art. Posing the central health question of the moment, she writes, “What happens when you breathe? Breath—the very air, stardust, the grand molecules of the universe—blossoms in the upside-down tree in your rising chest, animating and enlivening you. And when you breathe out, you send your song out into the world.”   

    Dr Amy Alexander has chosen a haunting uncanny song for our moment, We Can Never Go Back to Before from the musical Ragtime, we will hear “Back in the days when we spoke in a civilized way.” We ache with recognition. Or, we might find ourselves in the double bind that Kyla Kent will sing about. She is Technical Director of the SAMBA Center researching the muscle bone unit and she is a kickass bluegrass musician. The song “Somewhere Between”, is a musical version of the 7 ½ floor in Being John Malkovich, coping with being dropped in a position hard to fathom, and maybe too easy a metaphor for our collective challenge. Like most good country music, the song hits the hard truth. Gastroenterologist  Dr. Alexandra Weingarden will sing about people we can’t tell if we like or can’t stand. Vanilla Ice Cream, is the classic from the musical She Loves Me. And we are lucky that Pediatric Anesthesiologist, Dr. Alyssa Burgart, will sing “Vote them Out” this evening.  

        Human Biology major Gaby Li has selected the cello masterpiece, “Après un Rêve,” by Gabriel Fauré. Dr. Lynn Gerber Ngai, an accomplished violinist, who completed her anesthesia fellowship at Stanford this year, will play an excerpt from Jean Sibelius’ violin concerto. This famously difficult piece of music speaks to the precision and passion required to be a physician. YES! 

        Doctors have long excelled in the arts, for their own sustenance, balance, healing and for nurturing others. We work in a soundscape of electronic pings and human sighs of all tones - from agony to relief. We can translate them into the purity of music, to energize, soothe, inspire or rally. One of the many talents a doctor needs is a good ear, being in tune and creating harmony. I look forward to the pleasures we are about to share. And the generosity of our doctors, performers and music in our lives in celebration of Women and Medicine. 

Anthony Fleg MD is a healer, a father, a husband, a brother, a son and a family physician at the University of New Mexico in Albuquerque and with the Native Health Initiative. His work focuses on love as a foundation for health and activism, strength-based approaches to health, and getting communities walking/running for wellness. He says, “Writing has been a part of my life for decades, and even more so during the pandemic.”

September 1, 2020

A Shoeless Hike
By Anthony Fleg, MD

We had escaped to hike, a Mother’s Day celebration.
I was depleted, finishing a 7-day stretch of hospital medicine in the new world order – face masks, globs of hand sanitizer, lonely patients, and some conversations reduced from in-person to tablets.
So depleted, in fact, that I worried if I could muster energy to make Mother’s Day special for my wife.
“Get the kids ready, pack them in the car,” I texted as I left the hospital.
I knew if I could avoid slumping into a chair or onto a bed, I had a chance.
So it went – “Dad’s home” followed a minute later by the car starting our escape into the Sandia Mountains that shadow our city of Albuquerque.
We arrived. The ritual of checklist that comes with having four children began. Water bottles? Check. Sunscreen? Check. Hats? Check. All children present? Check.
All looked to be in order until my personal check. Shoes? Shoes? In my haste to leave, I had left shoes behind.
Leaving me with a quick decision to make. Option 1: Smile and enjoy a shoe-less hike, saving our Mother’s Day adventure from crashing to a halt. Option 2: “Everyone back in the car. Wave to the hike that would have been.”
Option 1 is our world.
Making the best out of the less-than-optimal, far-from-normal options. Option 1 is virtual birthday parties, graduations, and weddings. Option 1 is our decision not to give up, not to give in, but to get creative.
So we hiked. Passerbys trying not to stare too long at my socks. A few made jokes. One family with young children asked “What happened to your shoes?” as they headed up the trail as we made our way back to the car.
“A bear just jumped out of nowhere and snatched them. Said he wanted Nikes.”
The “really??” look on the faces was a small victory for my defeated feet, stinging from the rocks and roots incessantly poking from underneath. My wife, citing social decency and Navajo tradition that says by naming an animal you call them to you, gave me that look, ending my shoe-less victory dance.
My feet survived, the hike was saved, and Mother’s Day happened. Maybe my feet were even strengthened by the uncomfortable experience.
Today will give us such moments, with an Option 1 in each case that does not feel like the right answer, but which is the best option.
Pick Option 1. Be proud. Get excited for what this path might hold. Feel free to laugh - at yourself, at your feet, at the moment - if needed.
Option 1, as a friend reminded is simply this: “Don’t fight the current, find the current and flow with it.”

Sujana Bhattacharyya DO is a Bay Area native and Stanford alumni. She is a recent graduate former Chief Resident at the New York Presbyterian-Columbia University Family Medicine residency. She believes in the power of writing as a source of healing, expression, and gaining insight into lifes mysterious experiences. She currently resides in Jersey City, New Jersey with her husband and two parakeets.

August 12, 2020

Mercy
By Sujana Bhattacharyya DO

It was April 5th, 2020. In the months prior, I imagined, she had been grappling with the isolation of her newfound unemployment. The pandemic’s solidarity was possibly a relief: the rare solace of the permission to take a pause. Her new days were partly spent with long walks near Baker Beach, saluted by the loyal, majestic Golden Gate, the cool San Francisco sun embracing her and her spirited two year old son. Nearby, rainbows of tulips dappled grassy fields and perfect sunrays streamed through the California redwoods, a beauty typical of the area.

We had been playing the proverbial phone tag between two coasts. Missed calls took form in hey- how’s-it-going texts, elongated voicemails with humored venting, and exchanged pictures of our everyday happenings. As COVID loomed across the country, our lives and responsibilities were different. I began to fear for my patients’ lives in New York City, for my elderly parents in the Bay Area, and for the consequences of having to halt my fertility treatments. Meanwhile, partly due to necessity and partly to her enjoyment, she cradled the full-time art of motherhood. It was the longest we had gone in our 20 year friendship without directly speaking.

Overnight, sometime between a jovial Saturday evening family Zoom and an anticipated Sunday morning breakfast, her heart stopped. 100% blockage of her proximal left anterior descending artery they said. Medical school had taught me that blockage of this artery was the classic “widow-maker,” and rarely thought to be a “widower-maker.”

So rare in fact, the idea of a cardiac arrest in a 30-something female, was not considered, and even less so in the panic of the pandemic. At first, when she woke up from sleep and strained for air, the paramedics surely thought her symptoms were “just COVID.” She was treated cautiously, with no medical workup, and taken to a hospital with ironically only a few COVID cases. She was secured in an isolated Emergency Department room--no guests permitted--left alone to the sounds of her own slow gasps and uncomfortable bouts of nausea. Her lifeline seemed to be her sister, a physician, who was a phone call and an hour away. She vomited, felt misleadingly better, but as pain crushed her chest and classically radiated to her back and down her left arm, she called her sister back in terror.

Something’s really wrong. I can’t breathe.

Get. Help. Now.

With steel strength and sheer will, she somehow stumbled to the nurses’ station, as nutrients and oxygen stopped flowing to her most vital organs. She collapsed on the cold ED ground, finally, finally, finally getting the attention of medical staff, now credulous. Forty-five to ninety minutes of desperate CPR ensued, I was told.

***

By this time, New York was swimming in COVID. At my hospital, the sights of people piled in the ED, heaving for air, breaths away from intubation, had become familiar visuals; for survival, as many physicians did, I numbingly focused on the tasks of patient care.
I got the text from her husband during morning rounds: she had a massive heart attack an hour ago. Shocked out of my numbness, I excused myself, pain searing my chest, to call him. Words blurred and news shattered. “They are rushing to put her on something called ECMO.” ECMO?? I screamed silently, equating this life-sustaining machine with ultimate death. “I’m here with you,” I said bravely. Decades of friendship and rainbows of memories flooded my mind, tormented by the prospect of life without her; tormented by her present day image, body fighting on ECMO and breathing by ventilator, a now hauntingly common fate.

Only a miracle could turn this around, we said. Just pray, her sister whispered, brokenly.

***

In the deliberated weeks that followed, waiting took agency in fervent texts, get-well-soon videos, Zoom chats, GrubHub gift cards, fresh meals, care packages, candlelight yoga. GoFundMe triumphantly raised tens of thousands of dollars overnight. In silence we waited, sometimes eagerly and often helplessly, mulling on every update. She’s had multiple strokes. She may never regain neurological function. She opened her eyes once today. She spiked another fever. She’s getting a tracheostomy. She’s being transferred to a new hospital. No, visitors are still not allowed.

On May 1st, I tested positive for COVID; the suspense of waiting for her prognosis became a definitive intermission. My thoughts forcibly migrated inward, while my body fearfully battled the virus of the pandemic. Body aches rendered into relentless fever, aching to the bones, unshakable chills, and leaden bedbound fatigue. In my quarantine and my illness, I wept for my deceased COVID patients and families, for our ED doctor who tragically died by suicide, for my friend, an indirect casualty of the pandemic. As I lay prone to offset my wheezy, precariously shallow abdominal breaths, I wondered: would my husband get ill? Would my lungs deteriorate? Was I forming ominous clots? Then: could the virus ruin my reproductive organs, still aching to bear a child? Would my insides ever be the same; would she ever be the same?

***

It was May 27th,. My fever had broken, aches subsided, breathing eased. Two days prior, George Floyd had been killed by asphyxiation and the nation erupted through lockdown in fires of protest. Amidst it all, I felt the desolate silence of her absence.

Then her number appeared on my phone. I accepted the FaceTime, exhaling. There she victoriously sat, an unassuming symbol of mercy. A neck bandage sealed her previous tracheostomy, a tube dangled casually from her nose, a telemonitor with a low battery beeped auspiciously. The strokes had impaired her vision. But life was returned in her brilliant smile and characteristic laugh. On the hospital patio, adorned in a cotton gown, gently hugged by the California sunlight, tulips speckled near her wheelchair, she squinted her tired eyes happily towards the phone, listening carefully to my voice.

It is so good to see you again, we said.



Emily Aron MD is an Assistant Professor of Clinical Psychiatry at Medstar Georgetown University Hospital in Washington, DC. Her clinical work focuses on prevention of mental illness, working primarily with historically marginalized communities where traumatic events are frequent and access to mental health resources is scarce. Dr. Aron is the co-director of the Professional Identity Formation curriculum that provides coaching to medical students throughout their four years of schooling to promote resilience and wellbeing. She is the mother of two children and married to an emergency medicine physician and finding the silver linings in quarantine. Follow her at @emilyaron2.

June 3, 2020

Emily Aron MD wrote this epistolary response to a Writing Medicine Workshop prompt: Write a letter of advice to recent graduates.

Dear Incoming Residents,

Congratulations, you are now going to be responsible for the lives of others. You will learn to touch these lives. Physically, yes--but you will also leave an indelible emotional fingerprint. You will learn about the human psyche, defense mechanisms, cognitive distortions, phenomenology. You will hear about suffering and it will all be important and it will fill your office and your stomach like an ever-expanding balloon. You will walk home with your patient’s voices and their problems, cloaked in their invisible suffering.   

And you will build a callous in order to show up for another day, otherwise you will wither like a flower on a hot August afternoon. It will feel impossible sometimes. You will feel angry and disengaged. Made cynical by the sociopaths and burnt out by the grunt work, the paperwork, the health system that is broken and the insurance companies demanding your time and energy to wait on hold again, it will feel beyond what you can manage.

But then, one day, you will wake up and walk back to the hospital. The patient will be sitting there, heart beating and eyes blinking. You will feel confident. And you will feel privileged to have a window into humanity, this person’s life unspooling before you. 

You are a healer and the world needs you.

 

Cynthia Nguyen MD is a cross-cultural psychiatrist in private practice, adjunct clinical associate professor in the medical school, and advisor to undergrads in Human Biology. She has taken care of refugees/ immigrants since the fall of Saigon in 1975, long before she ever thought of becoming a doctor. Dr. Nguyen completed 9 years of a PhD program in languages and civilizations at Harvard before switching to medical school at Stanford. She is very interested in the trauma story and narrative arc of her patients.

May 27, 2020

By Cynthia Nguyen MD 

I am wearing my black pencil skirt by some designer that cost more than 6 months’ rent and a couture shirt with an asymmetric collar and a cashmere sweater with mother-of-pearl buttons down the front. I can’t remember the shoes I have on, but they had to have been unbelievably beautiful and handmade, so I know at least I am well-dressed to end my career in literature.  

I am on a panel at the Association for Asian Studies conference, the meeting anybody who is anybody in the field attends annually which I have avoided like the plague, being the impostor that I am.  

Nine years of burrowing in the carrels of Widener Library, I am giving up my PhD in East Asian Languages and Civilizations. In my defense, I know colleagues at Harvard who are in their 14th and 17th year of their candidacy, but in their defense, they aren’t quitting.

To parse a 4-line poem in Classical Chinese, which is a dead language none of the billion people in China can read today, I’d have to consult a half-dozen dictionaries, looking up each word not by a simple 26-letter alphabet, but by the 217 radicals that make up the zillions of Chinese characters. This task takes me a day or so.  So now the nine years is beginning to make sense.

To do my isolative work which I am perfectly ill-equipped to do by my outgoing nature, I have to step into a 12 by 12 heavy gauge steel mesh cage set in the middle of the basement of Yenching Library where all the Vietnamese books are locked. Vietnamese is a neglected stepchild of the department.  The Chinese, Japanese, and Korean volumes are not locked in a cage.  To challenge me more, the dusty Vietnamese books are not lined up by author or title, but by size. 

I am tired of being reminded every day that I am illiterate or as the Vietnamese say mù chữ (mù meaning “blind” and chữ meaning “word”) in Mandarin, Classical Chinese, Japanese, French, and most of all, in Vietnamese.  

My practical mother says, “You’re three-quarters of the way done with your dissertation, why not just finish it?” But I can’t. 

There is sheer fear of having to face my father’s disappointment that I will not become a scholar contributing to the field.  He is a prolific linguist who is considered the dean of Vietnamese language and literature. Every literate Vietnamese knows my father because he writes Vietnamese-English and English-Vietnamese dictionaries.  He is the Webster for us.

So before leaving the field in defeat, I decide that giving a talk at the AAS would be a fitting face-saving move. I apply and am accepted to a panel.  

I look out at the standing-room-only audience at the Boston Marriott. I recognize some of the faces. Most are strangers looking very much like they belong in the field and are ready to pounce on me. 

I am the last speaker. The distinguished chair of the panel who is impeccably dressed in a seersucker suit and his trademark bowtie gets up to introduce me and my stomach drops with intense anxiety. I hear him dropping this tidbit, “By the way, she happens to be daughter number 2.” 

Now that he acknowledges in public that he’s my father, I feel more pressure that my performance has to not be terrible.  

I give my talk and move to sit down, but hands in the audience shoot up, wanting to reveal what a non-contributing-to-the-field scholar I am.  

After I stumble through the Q & A, I shakily (in those awesome heels) sit back down next to my father who whispers "được" which in Vietnamese is like the French passable or you could translate this in English as “not bad” which is high praise coming from him.

My father owns student visa number one from Indochina to America in 1948 but (or because of this) is an uber-traditional Confucian Vietnamese father who only 2 other distinct times ever does anything obviously supportive of me à la Western modern parenting methodology. 

Once as a teenager in a small college town, I plaintively asked him why did he have us here in America when we had to be so Vietnamese? And why didn’t he ever praise us to our faces? He was dismissive and impatient, “You are so ignorant, why, don’t you know the most basic things?  Vietnamese parents never praise their children to their faces. That’s an American habit.”

This is the story of my switch to medicine from literature, never having the approval of this father who was an actual celebrity scholar who said medicine was mere “carpentry.” This is the story of how I told him to come to my renowned school and hospital for his cardiac by-pass surgery because he’d be in the best hands. This is the story of how my father who expected to be back at his desk in a week to finish an article he was working on, died at the hands of those I trusted to care for him. This is a story of how I am still breathing after my father went from 47 breaths per minute (incompatible with life) to zero.

 

Dr.  Francesca Monn, MD MPH, is a Reconstructive Urology Fellow, at Eastern Virginia Medical School Department of Urology. “Evolving” was written during a MedMuse Virtual Writing Workshop. 

May 20, 2020

Evolving
By Francesca Monn MD

Planted gingerly as lockdown went into place in a jaggedly cracked, ceramic planter. No leaves. Short, scraggled, dry roots. More twig than future tree. Rooted now in a strange apartment with a wall of a window and two feline predators. Slowly developing into this new world. Sprouts appear but remain minuscule. The gnarled, solid branches remain steady.  

But suddenly the buds flourish. After four weeks of tender care, soft singing voice, curious purring, eyes peering, water nourishing. And they unfurl gloriously. With palmate-lobed, fuzzy leaves brilliantly colored as if to camouflage Amazonian frogs yet shaped as an emerald hand ready to grasp. Each day expanding and multiplying, forever gazing to the window where the sun adoringly falls upon them, beseeching them to continue evolving into their fullest selves. 

A fig tree it is rapidly becoming.

Chwen-Yuen Angie Chen, MD is an addiction medicine specialist integrating chemical dependency services within Stanford primary care.

May 13, 2020

The End of Twenty Nineteen
By Chwen-Yuen Angie Chen MD

Bob Dylan said:

I watched His head, 

  explode 

In a Murder Most Foul 

In the telly that moment

   as Camelot faded

We stepped through the looking glass;                                 

this funneling wormhole 

emerging, half-century passed,

when the world stood still

and we all fell down

    the children all grown,

Trapped on the other side said— “good bye, good bye, I love you good bye...” through the window

     there’s nowhere to hide.

Dr. Khushboo Sheth is a Rheumatologist and Clinical Assistant Professor at Stanford and at the VA in Palo Alto. 

May 6, 2020

Hope
By Khushboo Sheth, MD

I am a rheumatologist. I am NOT on the front lines of the pandemic, yet, but I AM scared.

I am scared for myself. I am scared when my husband and I discuss our advanced directives as he awaits a ‘deployment’ to the Intensive Care Unit. I am scared for my family, my friends, my colleagues and my patients. I am scared for the new normal.

I cope. I cope by maintaining a level of normalcy by conducting tele health visits. I cope by attending virtual yoga classes, making fresh pizza, doing silly dances with my nephew and listening to music. I am fortunate to be able to cope with all the above.

I break. I break when I learn my patient’s wife passed away from COVID-19 after visiting Disneyland. I break when I hear about my friends and family members working on the front lines without adequate personal protective equipment. I break because patient’s family members are not able to say goodbye to their loved ones. I break because there is a story in each death which has instead become a statistic.

I try. I try to examine for synovitis on a video visit. I try to calm my friends down when they call in the middle of the night, concerned they have contracted COVID-19. I try to stay optimistic.

I rage. I rage when my lupus patients cannot get hydroxychloroquine. I rage when people do not follow social distancing guidelines. Sometimes, I rage without a reason.

I grieve. I grieve each time I hear the news. I grieve at the loss of the warmth of a hug.

I am thankful. I am thankful for everyone who puts their life at risk to save us. There are way too many people to be thankful for. I am thankful for the altruism and love that surround me.

I cry. I cry because the enormity of the situation is too difficult to absorb. I cry at the surge of cases around the world and the surge of emotions inside me.

I contemplate. I contemplate about life, death, the uncertainties and the future. I contemplate about the collective experience we are all going through, courtesy of an invisible virus.

I contemplate about my identity as a rheumatologist and my role as a physician during a pandemic. My conscience pulls me to be on the front lines and help my colleagues. Dr Louis Lasagna mentioned in the modern Hippocratic oath, ‘I will remember that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug’.1 I do my part by being there for my patients and by commiserating; I heal myself in the process.

I hope. I hope that once on the other side of the pandemic, undoubtedly damaged and scarred, to be more appreciative, humble, grateful and thankful.

I adapt. I persevere. I trudge onward.

Originally published in the Annals of Rheumatic Diseases.

Henry A. Curtis, MD, FACEP, FAAEM is a member of the Medicine the Muse Program Steering Committee.  He is a clinical assistant professor and medical humanities program lead in Stanford’s Department of Emergency Medicine. 

April 29, 2020

Seeing past today, futurizing tomorrow
By Henry Curtis, MD

We will look back at our role in history and know that we did everything we could.  We valued each other and ourselves.  We prepared.  We donned PPE.  We rushed to the side of the critically ill.  We telehealthed to the stable.  We worked as a team.  We attended to the needs and wishes of our patients and when they could not express them, their family members.  We basked in their stories and saw them as more than just COVID positive or COVID negative room numbers.

We will remember our feelings.  We felt the frustration of practicing shifting, evidence-based medicine in an evidence poor environment.  We felt the loneliness of doffing our work clothes when arriving home.  We felt the incertitude when sharing stories with our loved ones, wondering if they really got it.  We felt the tragedy of those who fell ill.  We felt traumatized by those who died.  Despite daily uncertainty and intense emotion to attend to, we still got out of bed and returned to the front lines.  

We will gaze upon this reshaped, post-pandemic landscape.  We will doctor the wounded.  We will restock our resources.  We will treasure the good and fight the bad, as is right.  We will place our humanity out front and work towards a new vision of ourselves. 

Anu Gorukanti is a third year pediatrics resident at Stanford University in Palo Alto, California. She is a proud Midwesterner at heart and is most recently from St. Louis where she completed her undergraduate training in Neuroscience and Public Health as well as her medical school training. As her residency comes to an end, she is excited to pursue her passions for public health and community medicine with the goal of addressing systemic health inequities. When not in the hospital, Anu enjoys spending time with her husband, (who is also a resident), photographing landscapes and pretending to be a good hip-hop dancer. You can follow her on instagram at @anug_photography. 

April 22, 2020

Dr. Anu Gorukanti’s wrote this epistolary response to a Writing Medicine Workshop prompt: Write yourself a letter two weeks into the future

Dear Self,

I wish for you, two weeks for now, to be filled with the same gratitude, drive, and desperation that fills your heart now, taking up space in all of your cells. I hope you remember how it feels to know that one person can make a difference, no matter how small. That all the phone calls, emails, pleading tones to make changes in your residency program mattered.

Our world feels so immense and us, just a tiny piece. I shudder to feel both the magnitude and the minutia.

Every day, may you continue to feel this way: deeply grateful for those in your life who are safe, devastated by those who are suffering, angry for those who are not willing to hold others as highly as themselves.

I hope that anger shifts into kindness but that your drive and passion remain intact: a preserved space in the middle of the chest unaffected by the turbulent storm around it.

You matter, no matter what you do or do not do.

You are loved, no matter what you do or not do.

And you will look back at this time knowing that you were who you wanted to be in the midst of the crisis. And you are doing what you are meant to do.

Continue to be kind to your parents as they learn to let go of the life they had envisioned for you and as they struggle with loneliness that they can’t define for themselves.

Continue to reach out to your friends and family to check in, as you’ve always done, outside of this pandemic.

Fill yourself to the brim with kindness and self-appreciation so that the love you feel for yourself can overflow to others.

Love,
Anu

Erick Messias grew up in Brazil where he finished medical school and practices primary care in rural areas. After residencies in Psychiatry (Maryland) and Preventive Medicine (Hopkins), he taught in medical schools in Brazil and Augusta, GA, before heading to Arkansas where is now Professor of Psychiatry and Associate Dean for Faculty Affairs at the University of Arkansas for Medical Sciences in Little Rock. He is also the founding editor of the UAMS’ Online Literary Journal, Medicine and Meaning

April 15, 2020

We Are All Immigrants Now
By Erick Messias MD

We are all immigrants now
No matter our color, no matter our creed
We are all immigrants
Bodies thrown in a new land with old memories
Welcome to the new country
Here the streets look different
Here the words have new inflections
Here the people greet each other differently
You will miss the old country
For that's how it will be known from now on
You will miss how people were
You will miss its parties and its gatherings
You will find yourself saying "in the old country..."
You will also make new friends in the new country
They will look different, keep their distance
They will greet each other with funny gestures
In the new country
There are no old country roads leading back anywhere
Nothing but old memories from the old country
Those may survive in your selfies, phones, stories and songs
We are all immigrants now
Learning together a foreign tongue in an alien geography
New choreographies to work and to love
Until one day the new country is just our place
Where we work together
Eventually learning
To love one another

Nasir Malim is a first year Internal Medicine Resident in New York City. He is originally from southern California where he pursued an undergraduate education in African American Studies and later a Masters in Public Health (MPH). When not in the hospital, he enjoys reading and thinking about mitigating racial health disparities and achieving a more just health system, or watching and rooting for the ex-Oakland Raiders. You can follow him on Instagram and Twitter @thedoctornas.

April 8, 2020

Returning to the front lines of COVID-19 in NYC:
My First Day Back at the Hospital

By Nasir Malim

Tonight will be my first night shift in the Medical ICU (MICU) since COVID-19 began ravaging New York City. I was on the hospital floors as an internal medicine resident during the early period of the COVID-19 pandemic reaching New York City, before it became this ubiquitous.

At that time it became obvious how rampant the virus would become, but there was still a sense that with adequate preparation perhaps we could mitigate much of the loss. That hope, perhaps naïve, is now a fleeting remnant of a former life. Since then my clinic block was cancelled and I was placed on sick call to fill in for others. I felt uneasy in the days leading up to my return to the MICU, and the hours before, were filled with angst.

6 hours to go before my shift:

I try to nap so I don’t tire out of sleep deprivation overnight but feel too anxious and just lie in bed for an hour. How do people sleep at a time like this?

3 hours left before going in:

It’s hard for me to do anything productive. I convince myself to do a quick home workout before taking a shower. I then do something I’ve been dreading for days. I shave my beard. My beard has existed in one form or another for over a decade. It’s hard to recognize the face now staring back at me in the mirror, without the beard that provided a centering element for me both religiously and physically.

2 hours left:

Dinner time before the 12 hour shift. Cooking is now one of the few things I can control.

1 hour left:

The depth of emotions really starts to settle in. I don't want to move, I can’t bring myself to get off the couch, and I certainly don't want to go in to the hospital and fight what feels like a losing battle with death. This feeling is terrible, this risk I’m about to place upon myself feels surreal. Every single bed in the MICU is filled with COVID-19 positive patients struggling for their lives. I know the limitations we have with adequate protective equipment because of severe shortages, and I know the current policy of reusing masks and gowns just makes it that much easier to spread viral particles to my body, my hands, and to my face. What if one of those particles reaches my lungs? It is not outlandish to envision myself in an ICU bed as a result.

30 minutes left before the shift:

I hug my wife extra tight for what must have been a minute but felt like mere seconds, for what feels like one final time. I wonder how risky it will be to hug her after tonight. I change my clothes at the door into a pair of hospital green scrubs, carefully placing one arm and leg into the scrubs at a time, avoiding touching anything else. This will be my new routine leaving, and upon returning, diligence to an extreme of scrubbing down every surface of my body and personal belongings, removing all clothes and objects which touched the ICU air, and scrubbing every inch of my body down right after in the shower before I can truly consider myself home.

Time to go:

My heart is pounding and it is difficult to take a full breath in and out. I can’t describe the sensation in my chest, it’s something I haven’t ever experienced before. I know I'm scared, but is this also anxiety? Everything is so hard to do, my body feels heavy and it takes my focused efforts to walk to the doorway. Putting on my shoes is now a challenge as I fumble to get my feet in. I put on my hospital badge around my neck, which now feels like an out of place metal weighing me down. I enter the elevator in my building to leave, it’s just me and my racing heart. There is not a sound except my quick shallow breaths. I cross the street to the hospital and enter what now feels like a foreign space. I’ve spent what has felt like years here, why am I now afraid to walk its white halls without running back outside?

I hurry to a different part of the hospital where an N95 mask was set aside for me, putting it on for the first time, now beardless and wondering if the fit is appropriate. “This better work,” I think to myself. I get to the MICU where my co-intern is ready to sign out the current patients so I can take over for the night.

"This is a 54 year old patient, no past medical history, COVID-19 positive with acute respiratory distress syndrome.

Next is a 38 year old, no past medical history, COVID-19 positive with acute respiratory distress syndrome…

29 year old, no past medical history, COVID-19 positive here with acute respiratory distress syndrome…

73 year old, history of hypertension, COVID-19 positive here with acute respiratory distress syndrome.”

The only thing that breaks this monotony is the rapid response called overhead for another part of the hospital, within just a few short minutes of my shift beginning. Someone, mostly likely a COVID-19 positive patient, given the reality of the current hospitals in New York City, is in the process of dying or is already dead, and a team of doctors and a respiratory therapist is rushing to attempt to save them. It may just be a matter of time before this happens to one of the patients in front of me. I finish my sign out, as I watch the rise and fall of my N95 with each breath.

I make a quick round to visualize the patients from behind the glass wall enclosing them in solitude and glancing at the number outputs from the various machines connected to them. The entire unit is sedated on medication for comfort, nearly all of them have a breathing tube in. I rejoin my senior resident who has fielded phone call after phone call from worried families requesting information about their loved ones, answering every question with a soft and comforting voice that provides me some relief. I cannot imagine the fear they experience knowing someone dear to them is on the brink of death secluded from the rest of the world. As I monitor my patients and do my tasks, each minute feels drawn out but somehow two hours have passed, with the quickness of my breathing also now normalizing.

There is a young patient who is on a breathing machine though his body is still struggling to get enough oxygen despite this. We are nearing the end of medical options that can help him improve. We decide to turn him from his back onto his stomach to help his lungs get more oxygen, but before doing so I try some osteopathic manipulative therapy a doctor friend showed me from a clinical trial. There are no more medicines to try, so I decide to try whatever I can offer with my hands.

I go in first to try the therapy, with the rest of the team watching from outside the room. I try to be as careful as possible to make sure my gown and gloves cover my entire skin as I approach his bed. Time feels as if it has halted, and my body is now in slow motion. My desire to preserve life as a doctor is somehow overcoming my fear, as I maneuver myself and begin the manipulations. I see the beads of sweat running down his face, almost as though each bead is timing the duration of my therapy. By the time one flows from his forehead and reaches his chin, I should move on to the next. I do as much as I can with the position he is in, and other doctors and nursing staff join me to help flip him over safely.  As we finish I notice the TV on in the corner, tuned to CNN. Anderson Cooper is talking about how today was the deadliest day from COVID-19 in the country to date with over 500 deaths. I return my gaze back at the 29-year-old in front of me, he is my exact age.

I cannot recall the total number of rapid response codes called overhead that night, there were too many to count.

 

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