Fall 2012 - Creighton University School of Medicine

Vol XV No. 4 Fall 2012
WELLNESSCHRONICLE
What Lies Beneath
2012 Association for Academic Psychiatry Annual Medical Student Essay Contest Winner
Adam Pendleton
M4
Everybody lies. As cynical as it may seem, this is a fact of
life. Not everyone lies for the same reason; some people lie
to avoid shame, some lie as a way of defending themselves,
others for personal gain, others to avoid hurting someone
they care about. How, then, can psychiatrists provide a
patient treatment, support, guidance, or
personal reflection when those who need the
most help may be lying the most? The
answer lays in the art of communication that
psychiatrists must practice, a form of
communication that is sometimes harsh,
daring, or seemingly cold. However, this
form of discourse allows psychiatrists to
connect with their patients in a way that is
vulnerable, yet unopposed, and can provide
to them an opportunity to begin rebuilding
their shattered psyche, all the while avoiding
the lies in which the patient so comfortably
once existed.
Famed psychiatrist Dr. Elvin Semrad said,
“The way to deal with someone who lies is
to get into his feelings, because feelings
never lie.” This is easier said than done, in
many cases. It would certainly be surprising to walk into a
patient’s room and have them say, “Today I feel angry, let’s
talk about my feelings.” It’s not difficult to understand why
that may be: feelings are messy. Feelings can complicate,
depress, elate, pervert, or devalue any memory, thought, or
emotion. But, recognizing that feelings are a stressor, and
may be the basis of psychiatric instability is the only way to
successful rehabilitation.
Physicians are taught in medical school that rapport with
their patients is crucial in building an effective health
partnership. This rapport is simple to create, so they say:
just talk to the patients in a caring way, listen to their
concerns, validate their feelings, and provide competent
treatment. And, for the most part, this system works. Their
sick patients trust them and work with them to make their
medical illness better. This is rarely the case with
psychiatric patients.
While equally as ill as a patient with appendicitis,
psychiatry patients pose a challenge to treatment: they lie.
Not wanting to admit the hurt or guilt they are feeling, they
image courtesy of leadershipfreak.wordpress.com
construct a barricade of false emotions, imaginative stories,
and disingenuous responses. It is the psychiatrist’s job to
connect with those patients in a way that overcomes the
barricade and attacks the heart of the matter. Lies are a
product of the mesh of cortical pathways that promote
imagination and creativity. As Semrad suggests, the truth
lives beyond the mesh, in the limbic system, where true
feelings reside. To bypass the cortex and access the limbic
system, a unique approach is needed. This approach was
taught to me early in my clinical years by an attending
continued on page 2
In This Issue
What Lies Beneath
Shrink Rap
Your Stress Animal
Dreams from My Father
Professionalism
1
3
4
5
6
Resonance
Living in Ohm-aha
M3, Group F
Medical Musings
Catholic Health Care
6
7
8
8
9
Vegan Banana Brownies
Med School, Meet Yoga!
Kate’s Cookbook
Big News
9
10
11
12
What Lies Beneath, continued from page 1
WELLNESS
CHRONICLE
FACULTY ADVISOR
Dr. Michael Kavan, Ph.D.
EDITORS IN CHIEF
Catherine Weaver
Roy Norris
CONTRIBUTORS
Michael Kavan
Michele Millard
Linda Pappas
Marcia Shadle-Cusic
Kate Forrester
Ryan Miller
Adam Pendleton
Catherine Weaver
Stephen Wilkinson
Nathan Barusch
Krista Bolin
Cat Olinger
Gordon Chien
Dan Janiczak
psychiatrist, and is just as simple as the
aforementioned approach to patient rapport: if
they’re sad, make them angry, and if they’re angry,
make them sad.
To say I was appalled by this notion is an
understatement. How can I, a student of medicine,
whose purpose in life is to heal the sick that is
fueled by a human compassion, actively make my
ailing patient upset? I struggled with this for some
time. It was only until I saw this approach in action
that I understood.
The patient was in the ICU, awakening for the
first time, realizing that his suicide attempt was
unsuccessful. We were the first team to talk with
him after his extubation just thirty minutes prior.
The psychiatrist sat in a chair, just a foot away from
the head of the patient’s bed. “Hello,” he said,
“Glad to see you’re awake.” The greeting was met
with a look of despair and sadness. “Can you tell
me your name?” He could. “Can you tell me where
you are?” He did. “Can you tell me why you tried
to kill yourself?” The look on the patient’s face
mirrored the surprise on my face. “Wait, what? I
didn’t do… that,” said the patient, lying. “Oh,” was
the psychiatrist’s only response. “I mean, I had a lot
to drink, and maybe I took a couple of pills to help
me sleep. I haven’t been sleeping, my life is kind of
a mess,” the patient explains, “but I didn’t try to kill
myself. I’m just a little down, but I feel better now.”
Expecting the psychiatrist to respond in the way I
was taught, by validating the patient and showing
compassion, never came. Instead came, “Well, you
swallowed an entire bottle of pills, washed it down
with a liter of vodka, and wrote a note to your
girlfriend saying you were sorry. What did you
think would happen?” asked the psychiatrist, with a
less-than-subtle amount of sarcasm in his voice. I
stood there, stunned. “Well, I guess I thought I’d
sleep,” the patient responded. Finally, a chance for
the doctor to show some validation, I thought.
While I, with medical knowledge, realize vodka
and sleeping pills was a bad combination, perhaps
the patient simply didn’t understand. I’m sure the
doctor will show some compassion. Another poor
prediction on my part. “You seem like an intelligent
guy,” the psychiatrist begins, “so either that means
you’re lying to me, or you’re an idiot.”
Immediately, the patient’s demeanor changed. “You
can’t talk to me like that!” he yells, “you have no
idea what I’ve been through!” The psychiatrist
didn’t flinch. In fact, he looked bored. Then, he
pulled the metaphorical trigger: “Well, you won’t
tell me, because you’re a liar.” In the instant that
my jaw hit the floor, the patient exclaimed, “I am
2
not a liar, you just couldn’t handle it! If you knew
the half of it, you’d try to kill yourself, too!” The
patient sat there, panting, his eyes wide and full of
tears. The psychiatrist waited a moment, watching
in silence. “Finally,” he says, with a note of soft
kindness in his words, “some honesty. Now, tell me
what’s wrong. I’m here to help.” In the next hour, I
sat awestruck, as the patient unloaded every
personal battle, fear, shame, and worry upon the
doctor. This was the conversation that the patient
needed so badly, and it was achieved only through
battle.
A connection was made that day, between
physician and patient, that was unyielding, raw, and
powerful. As I look back, I realize now that the
psychiatrist, who seemed so cold at the time, cared
so deeply for the patient that he was willing to fight
the urge to simply comply with the façade the
patient created and instead explore deep within the
patient’s emotional center to heart of the problem.
As we visited with this patient, it was obvious that
he had an unwavering trust for the psychiatrist. It
was a connection artfully and gracefully created, a
connection to which other physicians would never
be privileged.
Semrad also said, “A therapist is a kind of service
man. There are so many things a patient can want to
use you for—and if you can swallow your own
ideas of how things should be, you can perform a
real service.” A true practitioner of the art of
psychiatry forces the physician to push back against
not only the emotional defenses of the patient, but
the personal hubris of assuming he or she knows
what is best. Once those boundaries are crossed, a
true partnership can occur between the afflicted and
the healer. Feelings, while still messy, are healing.
As we left the patient on his day of discharge, he
looked at the psychiatrist, his newfound beacon of
support, and said, “Thanks, doc; you don’t know
how much I needed to talk about everything.” I
imagine it can be said, that for the first time in a
long while, truer words had never been spoken.
This essay won first place in the 2012 Association
for Academic Psychiatry Annual Medical Student
Essay Contest. He will present his winning essay at
the annual meeting of the association in October.
This year’s essay theme was “The Art of
Communication in Psychiatry: Connecting with the
Patient.” Pendleton’s essay reflected on a patient
experience during his third-year rotation at
Creighton University’s School of Medicine Regional
Campus at St. Joseph’s Hospital and Medical
Center in Phoenix, Arizona.
Shrink Rap: Leave Hibernation for the Bears
Michael Kavan
Associate Dean for Student Affairs
Fall’s Impact on Health
For those who exercise regularly, eliminating mood-enhancing
and stress-busting exercise directly impacts mental health and
may result in depressed and increased stress and anxiety. The fall
and winter months may also predispose students to Seasonal
Affective Disorder (SAD). SAD affects approximately 10 million
persons in the U.S. each year. SAD involves a pattern of
depression in which the onset and remission of symptoms occur at
characteristic times of the year. The prevalence
of
the
w i n t e r- t y p e varies with latitude
(prevalence increases in those living
at higher latitudes), age (those who
are younger are at greater
risk), and sex (no, not
whether you have it, but we
find that women comprise
60-90% of persons with
a seasonal pattern to
their depression). It is
characterized by low
energy, hypersomnia, and
increased appetite and weight gain.
The equinox⎯when night and day are pretty much the same
length. In fact, equinox is derived from the Latin meaning: “equal
night.” So, what does the equinox have to do with wellness? First,
we have just experienced the September equinox, which typically
takes place sometime between September 22nd and the 24th each
year. As such, we are now in the fall season, and with it comes
cooler temps, falling leaves, shorter days, and what I like to
consider hibernation behavior.
Do You Hibernate?
Many mammals hibernate. They eat more food
than usual in order to build up body fat, which
runs their bodies all winter. In addition, they
tend to burrow and become inactive or basically
sleep through the winter. Now, some
mammals store food in their cave or
burrow and occasionally awaken to eat
and walk around a little, but overall,
they are pretty inactive. Then with
spring comes an awakening and a
more active lifestyle.
There are anecdotal and scientific reports of human hibernation.
These include an 1850 account tells of an Indian fakir who was
buried alive for several months and who was returned to
consciousness, a 44-year-old Swedish man trapped in a freezing
car for two months and surviving, and a 1998 physiology paper
that describes two Indian yogis who “hibernated” for 10 hours and
8 days, respectively, with no ill effect. Although these do not
convince me that humans do or even can hibernate, I do believe
that many of us fall into hibernation-like behaviors as the fall and
winter months come about. These behaviors include burrowing
into our apartments or homes, engaging in less activity, and eating
more⎯often while watching television. After all, who isn’t
tempted by sitting down with a big bag of pork rinds while
watching a day-long telethon of “Here Comes Honey Boo Boo?”
Shorter days and longer nights make it difficult to maintain the
typical level of summertime activity that we have grown
accustomed to in the warmer months. Longer days allow for more
opportunities to run, walk, or cycle in the hours before and after
school. As the days get shorter we tend to put off that walk or run
knowing that doing so in the dark may create both logistical and
safety concerns. As such, we often abandon attempts to get active
and instead resort to filling free time with TV watching, video
gaming, and snacking. Also, by being in class most of the day, our
ability to expose ourselves (now, be careful) to sunlight is limited
as well. The result is decreased exposure to sunlight, decreased
activity, and increased caloric intake.
Countering the Hibernation Tendency and SAD
Rather than burrowing in for the winter, there are several things
you can do to establish health habits now.
• First, get active or stay active. Establish an exercise routine
that you can carry through the fall and winter months. Get
outside on weekends and do what you can to exercise several
times a week before or after school (preferably with friends
for safety and social support reasons). Exercise also combats
SAD.
• Find time during the day or over the lunch hour for a short
walk or exercise regimen. Even 15-20 minutes may enhance
mood and burn a few calories.
• Surround yourself with healthy snacks such as fruits and
vegetables. If high-caloric and fatty foods are not available,
you won’t eat them.
• In order to combat SAD, do what you can to expose yourself
to light. Open your blinds each morning, study by windows
during the day, and get outside during the day to take a walk.
Even on cold and cloudy days outside light can decrease SAD
symptoms.
• Finally, if you continue to struggle with anxiety, depression, or
SAD, our Office of Academic Support (402-280-2905 for an
appointment) can assist with light therapy and the University’s
Center for Health and Counseling (402-280-2735 for an
appointment) can provide other counseling resources.
3
Your Stress Animal
Linda Pappas
Academic Success Consultant
This fall semester, if you are an M1, you have been working to do
well in both Anatomy and MCB. If you are an M2, you first navigated
ID, then Cardio and onto Hem/Onc. The M3s are discovering shelf
exams, and the M4s are scrambling to get everything done for the
Match. Experiencing the pressure to do well is normal; it is how we
choose to react to that pressure that makes the difference. The MyersBriggs Type Indicator helps me to understand how people, including
myself, experience that pressure. The MBTI measures self-reported
life preferences. When we are unable to use our preferences because
of our current circumstances, we may react in certain ways that reflect
our personality type.
The first set of preferences is where we get our energy: Extraversion
is gathering our energy from other people and things, and
Introversion is gathering our energy from internal thoughts and
processes. Under stressful conditions E’s may become very “talky,”
and I’s may withdraw more and more.
The second set of preferences is how we take in information:
Sensing is initially focusing on the details, while Intuitive is first
focusing on the overall idea or concept. Under stressful conditions S’s
may become overwhelmed by all the details, and N’s may get caught
up in all the possibilities and become overwhelmed.
The third set of preferences is how we make decisions: Thinking is
taking the “task first”-oriented route of decision making, where
Feeling is deciding by focusing on “relationships” with self and
others. Under stressful conditions T’s may become negative or critical
of self and others, and F’s may become emotional about disappointing
self and others.
The fourth and final preference set is how we like to manage our
lives: Judging is preferring an organized, planned way of living, and
Perceiving is preferring more spontaneity and “go with the flow” way
image courtesy of
belleairekennelsdownersgrove.com
of living. Under stressful conditions J’s may become rigid, and P’s
may be chaotic. When these individual four preferences combine into
each of the sixteen types, then certain behaviors may become more
apparent.
When under stressful conditions, if a person is aware of
tendencies toward these behaviors, he/she can watch for them or
listen when others point them out. It is wise to explain to those close
to us how our behaviors may have nothing to do with them; it is our
preferences acting out, and we are attempting to monitor and
minimize those behaviors. If we see them occurring, it is time to
remember our stress reduction strategies and take time to use those
(playing sports, going for a run, doing yoga, listening to music,
talking to a good friend, etc). Also don’t forget that first line of
defense against stress; practice good sleep habits and continue
exercising and eating healthy. Take care!
TYPE
INTROVERT STRESS-COPING BEHAVIOR
TYPE
EXTROVERT STRESS-COPING BEHAVIOR
ISTJ
Become stubborn and irritable
ESTP
ISFJ
Become panicky and attempt to organize everything
Become antsy and begin to talk rapidly or too bluntly
ESFP
Become compulsive or scattered and experience difficulty with memory
ENFP
Become forgetful, sarcastic, and disorganized or compulsive
ENTP
Become frustrated, mouthy, and irritated with others’ incompetence
ESTJ
Become critical, negative, somber, or quiet
ESFJ
Become negative, lose self-­‐esteem, or experience physical stress symptoms
ENFJ
Become cranky, self-­‐critical, remote, or short-­‐
tempered
ENTJ
Become anxious, insensitive, lose control, or have tunnel vision
INFJ
Become quiet and start over personalizing
INTJ
Become impatient and outwardly appear unfeeling
ISTP
Become irritated and forget to show appreciation
ISFP
Become avoidant of stressful situations and undervalue self
INFP
Become anticipatory of all negative possibilities and feel inadequate
INTP
Become reticent and not pay attention to detail and follow through
4
Dreams from My Fa!er
or
WHY YOU NO DOCTOR YET?
Gordon Chien
M1
personal Santa, only he’s Asian and brings bagfuls of airplane snacks,
pirated DVDs, disposable hand warmers, and outdated Taiwanese
presidential election scarves as presents.
It has now been twenty years since he made the very difficult
decision to separate himself from his family and stay in Taiwan to see
patients six days a week while his wife and children enjoyed the
luxuries of a San Francisco Bay Area lifestyle and education.
Growing up with this kind of old-school sacrifice is why my hat will
be forever off to military families.
Despite having spent almost no time with my dad, I somehow
picked up many of his attributes. We are both huge film buffs, we
have a passion for helping others, our severe sarcasm knows no
bounds, and of course, I was not spared from the hypertension that
runs in the family. Sometimes it scares me how much I really am my
father's son.
Which brings me back to the interview question. I talk to my dad
once every couple of weeks (because it takes him about that long to
remember how to boot up Skype). Through these brief conversations
with him, I’ve learned that he is a man of few words. Part of it stems
from the fact that we have spent no time together; we simply have
nothing to share. Of course, his exhausting work hours don't help.
Because I rarely have the chance to communicate with him, I've
always taken his advice rather seriously.
"Son, I have to be honest with you. You're old enough now to
understand that nobody is on this mortal coil forever. Pretty soon,
your mother and I will be gone too."
"Geez, baba. This is a terrible way to start a conversation with your
son from the other side of the world. Do you want to try starting
over?"
"Hush and let me talk. God put us all on this Earth for a reason. And
everyone has a different purpose."
"You're not trying to get me to go back to church, are you?”
"No, I'm pretty sure you're a lost cause to God. What I'm trying to
tell you is this: nobody makes it alone. You made it with the help of
your mother, your sister, your friends. And so did I. None of us got to
where we are today without help. We owe them everything. So you
are obligated to give back to your community in whatever way you
are best fit. I'm glad that you've discovered that through music and
that you have a passion for performing, even if it's not for a career.
But music is fleeting joy. You can do more. Educate. Find a cure for a
disease. Cook for the masses. Heal with your hands and heart.
Whatever it may be, reach out and do what you can to help others.
Remember, you owe them everything.”
"Um. This is, like, the absolute deepest level of Asian Parent Guilt
you've ever dumped on me."
"I know. Good luck with that one. Now put your mother on."
And therein lay my answer to that interview question. Thanks, dad.
Being a first-year medical student hosting bright-eyed, hopeful
interviewees when I was in their shoes just eight months ago is a
refreshing exercise in self-reflection. We all know that every
interviewer asks the question, "Why do you want to become a
physician?" This is one of those basic med school interview tests that
could bury you if you don't have a good answer. Several applicants
asking me about my experience with that question led to the article
you are now reading.
The problem with this question is that every answer under the sun
has been used at one time or another. They've been doing this for a
long time, and you better believe that they've heard it all. You have to
find other ways to make yourself memorable among the hundreds of
worthy applicants being interviewed for the incoming class.
There are two big ways to make yourself stand out. First, how nongeneric is your answer? If you go with the good ol', "Well, I like
science and I like to help people, so being a doctor is the perfect
combination," you might get a polite smile and an unconvincing look.
If, however, your interviewer missed the bus that morning and had
not yet had his morning coffee, he will inevitably retort with, "Then
why don't you want to be a nurse or dentist or P.A.? Heck, why not a
science teacher?" This is the point where you wish you had brought
your DeLorean while you sheepishly try to defend yourself because
you hadn't done your homework. Responding to this question with a
fully fleshed-out answer that shows maturity and depth of thought
truly does matter.
The second key is the Oscar-worthiness of your performance in that
interview room. Nobody cares if your answer is some epically deep
life-affirming statement that the Dalai Lama told you in a private
meeting two years ago. If you can't look your interviewer in the eye,
smile, and respond coherently without blubbering like Porky Pig,
your answer doesn't matter because you’re exposing your lack of
patient interview skills and bedside manner. Shameless plug: if any
pre-meds reading this want practice, you may hire me and my jazz-atmidnight, radio-ready baritone voice for $2.00 per minute.
When faced with the "Why" question, I always talked about my
father, a physician who lives and works in Taiwan. I won't deny that
hanging around his clinic when I was a wee lad in Taipei definitely
influenced my decision to enter the medical field. Warning: if you
invoke Dr. Parent as an influence, you might be asked to defend the
question, "So are you entering medicine because you want to, or
because your [insert doctor parent] wants you to?"
Every time I was asked that, I almost wanted to respond, "Have you
met my father?"
My dad is a visibly aging sixty-year-old who is allergic to smiling
and visits his family in America once a year. You could say he’s our
5
Professionalism: Life Support
Michele Millard
Academic Success Consultant
resident make a joke about a patient, the disrespectful attitudes
toward professors by classmates. . . . they all speak volumes about
the person behind those actions. Because “unprofessionalism”
draws our attention, it may be easy to think it’s rampant⎯and
actually feed into more unprofessional behavior.
However, because attention is drawn in that direction, the view of
reality may be skewed. The truth is that professional behaviors and
attitudes are all around⎯within your professors who work with
you, the residents whom you observe, the preceptors in clinic, your
peers as they study and perform community service. . . . all of
which speaks volumes about the person behind those actions. If we
define professionalism and develop an awareness of
professionalism around us, that in turn will feed into the
development of more professionalism.
There are several core values identified within the profession of
medicine and include:
• Excellence
• Duty
• Respect
• Compassion
• Integrity
• Altruism
• Accountability
So, see if you can find positive examples of those professionalism
ideals around you. Watch your peers⎯how do they treat each other
and your professors? How do they manage their academic life?
How do they manage their social life? With your professors⎯how
do they treat each other and the students? Within the clinics and
hospitals⎯how are other healthcare professionals treated? How are
the patients treated? How is conflict managed? How are challenges
met? Identify positive examples of professionalism that are all
around⎯it will change your perspective!
Resonance
This fall saw yet another “doctor” television show on the “what to
watch” list. Since medical students don’t have a lot of time to watch
TV, I’ll provide a synopsis. “A Gifted Man” is a show about a
neurosurgeon who fulfills an oft-misconstrued stereotype of a
physician who is egotistical, money-driven, self-centered, and taskrather than people-oriented. Fortunately, the storyline is the process
of him being transformed into a gifted physician who is altruistic,
patient-centered, and respectful to colleagues through none other
than the ghost of his ex-wife. He somehow missed the “course” on
professionalism, empathy, and emotional intelligence in med school
and has to depend on the supernatural to help him along.
By definition, professionalism is the set of values, attitudes and
behaviors involved with becoming an excellent physician that starts
on day one of your medical education and continues throughout the
rest of your life. From your first day of medical school, the
importance of professionalism has been emphasized. It’s evident
that professionalism is an important part of being a physician⎯that
beyond becoming competent in medical knowledge, it is also
imperative to become a professional in the way that medicine is
practiced⎯with integrity, empathy, altruism, and respect. Ralph
Waldo Emerson once said, “What you do speaks so loudly that I
cannot hear what you say.” What are your attitudes and behaviors
saying to you and others around you? Professionalism is evident
when a person’s values are actually fleshed out with their treatment
of others and in the ways that they make decisions.
While we talk a lot about professionalism, we rarely define it. It’s
almost easier to recognize the absence of professionalism rather
than when it is present and practiced. Those unprofessional
attitudes and behaviors seem to jump out⎯observing an attending
being dismissive of another healthcare professional, hearing a
Krista Bolin
M2
Have you ever studied mechanical vibrations? You haven’t?
Me neither. While I am not a mechanical engineer, I happen to
have acquired a fact or two about it. In the field of mechanical
vibrations, there is a concept called resonant frequency. Every
object/room/thing has one. In engineering terms, this is the
frequency at which an object resonates at its maximum
amplitude. In laymen’s terms, this means that once an object
is vibrating at a specific rate, everything about the object says,
“Yes, this is it!” and begins to shake uncontrollably.
I can’t help but think we as humans each have our own,
unique resonant frequency. When this resonant frequency is
discovered, we awaken a part of our innermost self. We
become in touch with a force that drives us and propels us
forward with such intensity and passion that everything inside
of us says, “Yes, this is it!”
So, what does this resonant frequency look like when
embodied in human form? Jack Kerouac, in On the Road,
describes it best:
“…the ones who are mad to live, mad to talk, mad to be
saved, desirous of everything at the same time, the ones who
never yawn or say a commonplace thing, but burn, burn,
burn, like fabulous yellow Roman candles exploding like
spiders across the stars, and in the middle, you see the blue
centerlight pop, and everybody goes, ‘Awww!’”
These individuals are found in unexpected places and make
the ordinary appear to be extraordinary. They believe the
impossible tasks are possible. They are unafraid to fight in a
losing battle. They will not ever work a day in their life. They
inspire us.
What is it about these individuals that inspires us? Perhaps it
is the energy of their inner resonance that begins to stir up that
which is within us. They leave us with a desire to search for
and discover where our own resonant frequency lies.
What’s your resonant frequency?
image courtesy of athletics.psu.edu
6
Living in Ohm-aha: A Letter to the M1s
It Gets Better (and Worse)
Nathan Barusch
M3
day of M3 is better than the best day of M2.” Ask anyone who is
finishing an 80+ hour week of surgery, and they will tell you what a
lie that was. My first week of M3 year, I had a 28-hour weekend
trauma call. In the first hours of that night, I spoke to the family of a
teenager who had a potentially very serious brain injury. I held the
hand of a drug-addicted woman who had been beaten beyond
recognition as an exhausted intern spent hours sewing her broken
flesh back together. She begged god to let her die, and all I could
think to say was, “I’m so sorry this happened to you.” I saw gunshot
wounds, drug overdoses, motorcycle crashes…all in one night. A
normal person would need months of therapy to process the sight of
just one of these things, and I was expected to get up the next
morning and do it again. I don’t want to overly romanticize any of
this, but after the first two years of medical school…thank god. This
is real. Memorizing which proteins do what all day isn’t. So M3 year
has that going for it.
But before you think M3 year will be like living an episode of ER,
there are less glamorous challenges to the clinical years as well. You
will receive harsh and unfair feedback and, even more painful, harsh
and completely true feedback. You’ll learn to smile politely as you
hear it. You’ll work under some of the best and worst people you’ve
ever met. You’ll be ignored; you’ll be overworked; you’ll be sent on
more than your fair share of scut work. You’ll see patients treated in a
way you strongly disagree with and be afraid to speak up, oh and the
feelings of incompetence don’t go away.
Things to look forward to…you have tons of resources at your
disposal. Academic advisors for study tips, Marcia for hugs and
candy, your classmates, your friends from home, your family. I’d like
to throw my hat in the ring. There is no role I
cherish more than that of a mentor, and I’d be
honored if any of you sought my
EXTREMELY sage advice. I’m a proud med
school malcontent, and I promise you there’s
no fear or angst you’re experiencing I haven’t
been through. I, and the rest of the
upperclassmen, would love to tell you what
you’ve just gotten yourself into: the joys, the
frustrations…and for the truly disenchanted,
the alternatives (ask me what I’ll be doing in
London next year). I know I’m a stranger
1,000 miles away, but feel free to shoot me an
email at [email protected]. If
not me, reach out to someone when you feel
you need help or guidance.
You have just started an excellent adventure.
Adventures are not always fun. Sometimes
you wish you’d just stayed home. You never
know exactly where you’ll end, but you will
definitely have some stories to tell. Be well ~
Nathan.
I remember an arrogant version of myself proudly proclaiming to
newfound friends two years ago that “we are made men; we’ve
cleared all the hurdles, and now we’re set for life.” It wouldn’t take
long for med school to humble me. It turns out M1s still have a few
hurdles left. M1 year was one of the most challenging years of my
life, academically and emotionally. Looking back on the last two
years…it hasn’t really gotten any easier. But perhaps I’ve gotten
better at hardship. Medical school will push you to the breaking point,
and if it doesn’t, too bad; you’ll miss an excellent opportunity for
personal growth. I’m in Phoenix this year, and it makes me sad that I
won’t get to meet this year’s flock of M1s. With your wide-eyed
optimism, unstained white coats, and the alcohol tolerance of
undergrads…So I thought I’d use this column to say hi and offer a
few words from my very limited wisdom.
So much of our angst is self-imposed. I have no doubt that many of
you are fearing you aren’t cut out for medical school. You see
yourself struggling to get by, as your classmates seem to have an
inhuman ability to memorize the minutia being fire-hosed at you. It’s
cliche to say “Don’t fret; you’ve made it this far; you’ll make it if you
keep at it.” (All of that is true, by the way). But what I want to remind
you is you aren’t alone. You have a better poker face than you realize,
and so do your classmates. When they look at you, they see what you
see: someone who isn’t struggling with the load. You don’t know
your classmates well enough to read them; that will come with time.
But believe me, almost all of us struggled. I wish more med students
would be emotionally honest with each
other. Consider being the one to take the
initiative and say “this is really hard,” “this
isn’t what I expected,” “I REALLY hate
biochemistry,” “I’m really scared.” People
will be grateful to you for showing them
that they aren’t alone, and that is how true
friendships are made. Try to find meaning in
your hardship. These challenges will make
you stronger. I fully remember how stressful
anatomy was, but if I were to retake it with
the skills I had when it came time to study
for boards…it would have been a breeze.
It’s also important to take into account how
much you will grow when looking ahead.
Boards, third year, and residency seem
impossibly daunting looking forward, but
when you arrive, you will be stronger than
you are now. The benefit of being pushed as
hard as you can bear is you grow more than
you could have imagined.
Now for things to come. I remember the
M3s of years past promising that “the worst
image courtesy of thejuniordoctor.blogspot.com
7
An Ode to Clerkships: M3, Group F
Stephen Wilkinson
M4
Some time ago, I asked Jan Stawniak about the large painting
hanging behind the desk in the CAC. She told me that Eric, one
of the standardized patients we all know, had painted it. I was
impressed. Then she asked me if I did any art, as she was
looking for more with which to decorate. I quickly answered that
the only real artwork I do is stained glass. My response led to an
invitation to make a window for the CAC. And who can say no
to Jan?
This last spring, I built that window. I decided to title the piece
M3, Group F. Each of the six panels represents one of the core
third-year clerkships.
From top to bottom, L to R, there is (1) Psychiatry—the
colors, of which there are more than in any other panel, represent
the different parts of the brain, the relationship between the brain
and the mind, and the variety of experiences students have during this
clerkship; (2) OB/Gyn—an ultrasound being performed with the blue
and pink in the background representing the anticipation of
discovering the sex of the child; (3) Pediatrics—the handprint of a
toddler boy and the footprint of an infant girl represent the patient
population and the developmental changes seen in this field; (4)
Family Medicine—a family surrounds the staff of Aesculapius, the
staff, an ancient symbol of medicine, connecting generations of the
family; (5) Internal Medicine—a vial of blood, a prescription bottle,
and an EKG line, represent the challenge of integrating diagnostics
and therapeutics in medicine; and (6) Surgery—the surgeon’s cap and
a sutured incision represent the unique nature of the OR and the
ability of surgeons to mend the broken. The blue and white double
helix bordering between the panels is representative of Creighton as
well as the basic sciences that tie all of medicine together.
I’m grateful that I took the time to build this piece. It was a
wonderful way to balance my rotations with a bit of creative
expression. As the third year is a shared experience, it is my hope that
this window will evoke deep, good, and joyous memories for those of
you who have completed M3 rotations, and that it will inspire those of
you who have not with hope and anticipation for your future
experiences.
Medical Musings: Dansko Dilemma
Ryan Miller
M4
ankle ligaments. About 8 hours later, it felt like I was standing on
something harder than concrete, and I found any excuse to slip my
feet out of these torture devices and stand on a hard concrete floor.
By the 12-hour mark, I wasn’t sure I’d make it to the next morning.
Okay, I know I didn’t follow the shoe store lady’s advice. But any
$120 shoes that are way less comfortable than my $30 Converse All
Stars ought to start comfortable and stay that way.
Every couple days I would give the clogs another chance to
impress me, only to once again toss them aside. As of now, I’ve
stood in them for about 100 hours, and cursed under my breath for
about 95. Lately, they must be conforming to my feet because I will
say they are about as comfortable as the cross trainers I used to
wear in the OR. Plus, they do seem to be easier on my lower back.
Of course the trade-offs include looking silly, being less mobile (it’s
especially hard to run in them), risking an ankle sprain, torturing
your feet for several days, and being out $120.
So, if you’ve considered Danskos these are some things to think
about. Maybe my expectations are too high, or maybe everyone else
is more indifferent to horribly painful footwear break-in periods.
I’m not sure. I guess at this point I’m holding out for the years of
cloud-like comfort I was promised if I only hold out a little bit
longer. Time will tell.
They’re hard to avoid. The black, thick-soled clogs reminiscent of
the wooden Dutch klomp. The classic Dansko clog seems to have
superseded Crocs as the most popular footwear item for healthcare
workers. I never assumed I would give them a try myself, since I’m
more of a cross trainer/running shoe type of person. But online
reviews were so positive I simply had to see what I was missing. So
here’s my experience so far.
With 3 months of ortho externships lined up beginning at the end
of July, I decided to get the standard black Dansko clog to keep me
comfortable standing for hours at a time. For $120, they at least
smell like there could be some real leather in there. The lady at the
shoe store recommended I wear them for a few hours at a time, in
order to break them in. I’m about as likely to take her advice as I am
to use the instruction manual for something from Ikea, so I went
ahead and wore them for 30 hours straight on an overnight call. Not
such a good idea.
I think it was my first or second step that I rolled my ankle.
There’s close to no lateral support, and the sole is about 2” thick.
The upside of that is that I now know what it’s like to be 2” taller.
That’s at least good for getting a better view in the OR, if not my
8
Catholic Health Care: A Vocation of Love
A Frontrunner in the Advancement of Health Care, the Catholic Church Participates in Christ’s Healing Ministry
Amber Dolle
Submitted by Marcia Shadle-Cusic, Chaplain
What began as a dangerous voyage across the ocean to a foreign land laid the foundation
for a thriving health care system that today serves the U.S. population with compassionate
care. On Aug. 7, 1727, twelve Ursuline Sisters set sail from their cloistered convent in
France to New Orleans. After overcoming many difficulties, the sisters opened Charity
Hospital, the first privately owned Catholic hospital in what would become the United
States. Thus began the tradition of Catholic health care in America, which has since devoted
itself to helping those most in need.
Much has changed since the Ursuline Sisters took their maiden voyage in 1727. Today,
there are approximately 60 Catholic health care systems throughout the United States,
including more than 600 Catholic hospitals. Together, they serve some 90 million patients
each year. According to the Catholic Health Association of the United States (CHAUSA),
one in six patients is cared for in a Catholic hospitals, and Catholic facilities account for
more than 20 percent of admissions in about 20 states across the country. Furthermore,
Catholic hospitals and practitioners regularly care for individuals that have nowhere else to
turn. The Catholic Church views health care as a basic human right and, from its
introduction into American culture, has consistently protected that right.
“As this country was beginning, there was a great need for health care⎯especially from
the immigrant community⎯and the Church responded to that need,” said Sister Carol
Keehan, a Daughter of Charity who is president and CEO of CHAUSA. “Religious sisters
were on the front lines of this response, caring for the individual’s medical, emotional and
spiritual needs. As Catholic health care workers, we must always adhere to the Gospel
mandate to serve the least of his people,” explained Sister Keehan. “When we do, we are
truly serving Christ.”
As the new Catholic affiliation, Alegent+Creighton, moves forward, here is an article that gives a brief look at the
Catholic Healthcare tradition in the United States. This piece is excerpted from an article that originally appeared
in Columbia Magazine, August 2009, and is reprinted here with permission from the Knights of Columbus, New
Haven, CT.
Vegan Banana
Brownies
2 cups whole wheat flour
2 cups cane sugar
3/4 cups of unsweetened cocoa powder (can substitute carob powder)
1 tsp baking powder
1 tsp salt
1 cup mashed ripe bananas
1/4 cup soy or almond milk
1/4 cup canola oil (can substitute coconut oil)
1 tsp vanilla extract
1 cup dark (dairy free) chocolate chips
Cat Olinger, M2
1) Preheat oven to 350 F. 2) Lightly oil a 9x13 baking dish and set aside. 3) Combine flour, sugar, cocoa powder, baking powder and salt in a large mixing bowl. 4) In a separate bowl combine mashed bananas, soy milk, canola oil and vanilla extract. 5) Add wet ingredients to dry in two batches, mixing until just combined. 6) Fold in the chocolate chips. 7) Bake for 25-35 minutes, allow brownies to cool, and enjoy!
Brief History of
Catholic Health Care
in the United States
Since the 18th century, religious communities and
other
Catholic
institutions
have
been
instrumental in the development of the U.S.
health care system. By 1872, there were 75
hospitals operated by the Catholic Church in the
United States; within 50 years that number grew
by more than five-fold. Today, there are more than
600 Catholic hospitals and nearly 1500 Catholic
long-term care ministries across the country.
1727 Ursuline Sisters arrive in New Orleans. A
year later, they founded the first Catholic hospital
in the United States
1842 Sisters for the Holy Family, a religious
community for women of color, is founded. The
sisters establish Lafon Asylum of the Holy
Family, the first Catholic long-term care facility
in the United States.
1847 The Sisters of Mercy open the world’s
first Mercy hospital in Pittsburgh.
1861 President Abraham Lincoln charters
Providence Hospital, operated by the Daughters
of Charity in Washington, D.C.
1886 First Catholic nursing school in the United
States opens at St. Joseph’s Hospital in
Springfield, Ill.
1900 St. Rose’s Free Home for Incurable
Cancer, the first U.S. hospice, is founded in New
York by the Dominican Sisters of the
Congregation of St. Rose of Lima.
1915 Catholic Hospital Association is founded.
Its name is later changed to the Catholic Health
Care Association of the United States in 1977.
1933 St. Mary’s Infirmary in St. Louis is
dedicated as a hospital for African Americans,
becoming the first in the area to accept black
patients. St. Mary’s Infirmary School of Nursing
for Negroes opens the same year.
1939 Alcoholics Anonymous is co- founded by
Sister Mary Ignatia Gavin, C.S.A., at St. Thomas
Hospital in Akron, Ohio.
Adapted from Catholic Health Care Association of the
United States, www.catholichealthcare.us
9
Med School, Meet Yoga!
Dan Janiczak
M1
Attention Creighton Medical Students! Medical students report that
the demands of medical education increase burnout and decrease the
ability to connect with patients (JAMA 2010). Looking for an easy
way to keep your empathy limber while relieving stress, increasing
happiness, and gaining a bit of psychological and physical flexibility?
Yoga! More than 15 million Americans practice it. Research shows
yoga, with its emphasis on exercise, breath control, and mindfulness,
is effective in curbing stress. While yoga sessions for medical
students are not unique (Georgetown and University of Connecticut
offer them), educating students on the potential physiological and
neurological effects of yoga is a novel concept. Enter Mind-Body
Education and Development Yoga (MedYoga).
What is MedYoga? With our coping abilities under the ultimate
challenge, it seems appropriate to offer an outlet to cultivate
compassion and a vehicle by which to maintain resiliency and release
stress. Research shows mind-body practices like yoga, with emphasis
on exercise, breath control, and mindfulness, are effective in curbing
stress. The MedYoga program will provide a special platform for
stress-coping strategies, enhancing self-awareness, and sophisticated
understanding of the neurophysiological effects of yoga. Between 10
and 14 sessions are planned for a semester. One or two sessions are
held a week, likely on Tuesday and Thursday evenings. A yoga
session will include at least 50 minutes of yoga postures with
emphasis on breath followed by 10 minutes of discussion. Students
will be taught a strong physical practice, lifting and lowering the
heartbeat, increasing the versatility and resiliency of the autonomic
nervous system (ANS). The practice is enhanced by slow, deliberate
movements that aim to soften and relax the nervous system response
to stimuli. Breathwork is crucial throughout and again aims to
balance the nervous system. Discussions will include reference to the
relationship between breath and heart rate variability, the ANS, and
the CNS. Finally, students are trained in how to explore the habits and
feelings that arise in the body and mind through a mindfulness
activity. Richard Saper, professor of family medicine and director of
integrative medicine at Boston University, helped develop the
program and says a session “targets the unique challenges and
stressors medical students face as well as offers a fairly advanced
level of intellectual content appropriate for the medical students.”
I have been working with Heather Mason, yoga therapist and
founder of Yoga Therapy for the Mind, on initiating this yoga
program specifically designed for medical students. In order to cater
to the “unique challenges” medical students face, Heather provides
special training to the yoga instructor before each session. This is
exemplified in the format discussed earlier. Heather Mason
implemented the first-ever MedYoga program at Boston University
Medical School. It was in Chicago at an integrative medicine
conference where I was introduced to BU students who collaborated
with Heather Mason. The students explained how their classmates
have found the breathing techniques helpful to calm themselves in
stressful situations. The students have also gained methods to block
outside stimuli in favor of becoming “centered” at times when
concentration is key—studying, exams, long days in the clinic or
hospital. Popularity has exceeded expectations. The class is now even
offered as a for-credit elective.
Why not learn an effective means for coping with the inherent stress
of medical education and develop a skill that pervades any
environment? Why not gain a skill to help in
juggling family and social life with a busy
and successful career as a Creighton-trained
physician? Student involvement and interest
is crucial. Help Creighton become the next
school in the country to yet again be one step
ahead in progressing onward and upward in
the ever-evolving field of medicine. Once a
yoga instructor and place for practice are set,
I will send out a notification to students.
What will such a skill that lasts a lifetime
cost you? Expect only a small fee per
semester (between $20-$30). In the
meantime, I will also be gathering
information on student interest. Stay tuned!
Please
email
me
at
[email protected]
with
questions, comments, and suggestions. Be
well friends.
Santa Catalina Monastery,
Arequipa, Peru
Photo by Catherine Weaver, M4
12
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13
co
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Julie Kelkar (M4) and Ben Quick
Engaged: June 21, 2012, Mount of the Holy Cross, Colorado
Wedding: October 5th, 2013, Tulsa, OK
Big News
Jamil (M3) and Sumaya Neme
Wedding: June 23, 2012, Detroit, MI
Foster Thomas Grauman
Sarah (M3) and Bob Grauman
Tom Hendricks (M4) and Jen Bischoff
Engaged: July 24, 2012, Omaha, NE
Wedding: April 27, 2013, Omaha, NE
Born: September 1, 2012
Weight: 5lb 10oz Length: 19.5 in
Jaya Maewal (M4) and John Schwerkoske (Class of 2012)
Engaged: July 6, 2012, Omaha, NE
Wedding: June 1, 2013, La Jolla, CA
Jessica Canning (M3) and Andy Rice
Engaged: March 10, 2012, Healdsburg, CA
Wedding: May 2014
Firepit!
Newest Member of Phi Chi Family
Adopted: May 11, 2012
Height: 5 feet
Weight: enough for two grown men
Andrea Milne (M4) and Greg Wenderlich
Wedding: June 23, 2012, Rochester, NY
20
Maria Bye (M4) and Stephan Linnaus
Engaged: June 27, 2012
Wedding: May 11, 2013, St. Paul, MN