The Childhood Joy of Reading

Nothing beats sharing a book with a kiddo.  And to boot, reading at a young age has been demonstrated to directly impact health out comes for young patients (2). Just think, something so precious and so simple, could help your family AND your patient’s grow and learn into healthy adulthood.  And as far as children’s books go, you really can’t go wrong with the beautiful illustrations and the imaginative stories.

Time Magazine has come up with its list of the top 100 children’s books, I’ve highlighted the first three below.  Please scroll through a few on amazon or stop by your local library, just remember, you’re never too old to appreciate a children’s book.

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Where the Wild Things Are, By Maurice Sendak

The adventure that has inspired generations of children to let out their inner monsters, showing how imagination allows for an escape from life’s doldrums. Its also a moving testament to family love: when young Max returns from his reverie, his mother has saved him a hot dinner. (1)

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The Snowy Day, Ezra Jack Keats

The journey of Peter through a snowbound New York City made for a milestone: as a successful children’s story focused on a black protagonist, it broke down barriers many white editors may have never noticed. But Keats’ Book is memorable too for the sheer beauty of its collage illustrations. (1)

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Goodnight Moon, By Margaret Wise Brown, illustrations by Clement Hurd

Somewhere a child is being put to sleep right now to Brown’s soothing, repetitive cadences. While the lines may be etched in every parents memory, Hurd’s illustrations, with their quirky hidden jokes, provide amusement on the thousandth reading.  (1)

 

  1. The 100 Best Children’s Books of All Time. (n.d.). Retrieved January 20, 2019, from http://time.com/100-best-childrens-books/
  2. Dewalt, D. A., & Hink, A. (2009). Health Literacy and Child Health Outcomes: A Systematic Review of the Literature. Pediatrics,124(Supplement 3). doi:10.1542/peds.2009-1162b
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A resolution to share books!

Happy (belated) New Years!

Any chance your New Year’s resolution was to read more? Maybe you resolved to bring a friend to the next book club? The 2nd week of March 2019 will bring the next occasion up for a spirited gathering with great people and delicious food! Our book for discussion will be a continuation of the winter choice Cutting for Stone by Abraham Verghese.

In the spirit of bringing the joy of reading to those who don’t typically partake, please share your favorite book (and why you love the book) in the comments below. I hope to highlight a few all-time favorites for enjoying in the beautiful winter weather or curled up in a cozy chair. Below is my favorite!

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Book Title: Bridge to Terabithia

Author: Katherine Patterson

Synopsis:

Bridge to Terabithia is a work of children’s literature about two lonely children who create a magical forest kingdom in their imaginations. It was written by Katherine Paterson and was published in 1977 by Thomas Crowell. The novel tells the story of fifth grader Jesse Aarons, who becomes friends with his new neighbor, Leslie Burke, after he loses a footrace to her at school. She is a smart, talented, outgoing tomboy from a wealthy family, and he thinks highly of her. He is an artistic boy from a poorer family who, in the beginning, is fearful, angry, and depressed. After meeting Leslie, his life is transformed. He becomes courageous and learns to let go of his frustration. They create a kingdom for themselves, which Leslie names “Terabithia.”

Why I love this book: It combines the privileged imagination of childhood against the heart wrenching realities of life through the innocent child’s eye.

Book Feature: Dreamland

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At a recent CME event for opioid prescribing, this book has come up yet again as both a non-fiction and a fascinating look at the history and progression of opioid misuse in southern California.  With echos of Arizona, consider taking a deep dive into the heroin trade all the way to big pharma with Sam Quinones’ and Dreamland.

Quinones is a veteran journalist and expert storyteller long steeped in the demi-monde of Mexican-American bordercrossings. Dreamland: The True Tale of America’s Opiate Epidemic is an intricate jigsaw puzzle piecing together his findings from intensive investigation of the unprecedented spread of heroin addiction throughout the United States over the past two decades.

Through participant-observation involving interviews with addicts and their relatives, Mexican farm boys turned entrepreneurs, narco-bosses, lawmen, pioneering drug researchers, doctors, and other public health personnel, Quinones weaves together a haunting account of how the underground drug culture of addiction surged like wildfire with the complicity of the medical profession and Big Pharma. (1)

  1. Gates, M. (2015, April 21). Dreamland: The True Tale of America’s Opiate Epidemic. Retrieved December 2, 2018, from https://www.nyjournalofbooks.com/book-review/dreamland

Book Feature: Complications

Complications, written by well known author Atul Gawande describes the gritty parts of Dr. Gawande’s surgical training which comes across as a series of gracefully complied short stories.  If your looking a new perspective on the razor edge of medical reason and instinct, consider Complications and a cozy cup of cocoa this winter!

For a quick preview, check out this excerpt from The Guardian:

It begins with a bullet wound in a young man’s buttock and ends with a woman whose leg is almost destroyed by flesh-eating bacteria. It documents messy tracheotomies, a stomach-stapling operation on an obese man and a surgical procedure to help a woman who cannot stop blushing. Atul Gawande’s account of a trainee surgeon’s career has been a bestseller in the US, but Dr Finlay’s Casebook it certainly is not.

One of the most striking features of Complications is the unsparing detail about what happens in the operating theatre. The book is also about split second decisions that could mean life or death and the limits – often unsuspected by the patient – of both doctors and medical science. There is the surgeon who left a large metal instrument in a patient’s abdomen, where it tore through the bowel and the bladder wall. There is the doctor who biopsied the wrong section of a woman’s breast, delaying a diagnosis of cancer for months. Mistakes are sometimes solved by surprisingly low-tech solutions, such as marking the patient’s leg with felt-tip to ensure that the correct limb is operated on.

The first time Gawande is called on to make an incision, the senior surgeon draws a six-inch line on a sleeping patient’s abdomen and hands him a knife. Human skin, he discovers, is thick and springy and he has to make two attempts to get through. ‘The experience was odd and addictive,’ Gawande admits, ‘mixing exhilaration from the calculated violence of the act, anxiety about getting it right, and a righteous faith that it was somehow good for the person.’

This sentence touches on the paradox at the heart of the surgeon’s profession, which requires him or her to perform acts that would, in another context, constitute an assault. What are the psychological effects of cutting open the unconscious bodies of patients you have talked to and in some cases come to like? Although Gawande has a philosophical turn of mind – he studied PPE as a Rhodes Scholar at Oxford before training as a surgeon at Harvard – these are not questions he chooses to pursue. (1)

  1. Smith, J. (2002, November 17). Observer review: Complications by Atul Gawande. Retrieved December 2, 2018, from https://www.theguardian.com/books/2002/nov/17/biography.scienceandnature

Winter Book Discussion, a Summary

Our 2018 Winter Book discussion will take place next Monday November 26th!  Come enjoy a lovely (warm and filling) lasagna with veggie options including gnocchi with white sauce with Cesar salad!

Our selection was a long one this quarter, so please join us even if you haven’t had time to finish– a plot summary is included below!

“The story is told by the protagonist, Marion Stone. He and his conjoined twin Shiva are born at Mission Hospital (called “Missing” in accordance with the local pronunciation), Addis Ababa, in September 1954. Their mother, Sister Mary Joseph Praise, an Indian Carmelite nun, dies during childbirth. Their father, Thomas Stone, the English surgeon of Missing, abandons them and disappears. Orphaned at birth, the pair grow up in the household of two physicians of Missing, both from Madras, the obstetrician Kalpana Hemlatha (Hema) and Abhi Ghosh, who fall in love while caring for the infants. Hema names them Marion (after J. Marion Sims) and Shiva (after the Hindu deity). Ghosh teaches himself surgery to replace Stone. The tissue link between the twins has been separated at birth and the two grow up together being very close initially. Both are exposed to the changing political environment in Ethiopia. There is an unsuccessful rebellion by Haile Selassie’s bodyguard, General Mebratu. Ghosh is imprisoned, then released, in the aftermath of the coup, due to his friendship with Mebratu. Through their parents, both boys are exposed to medicine and taught at the hospital. Over time, though, individual differences begin to become pronounced. When entering puberty their relationship to Genet, the daughter of Rosina, a domestic help, finally tears them apart. Marion is in love with Genet and intends to marry her, but it is Shiva who, interested in sexual pursuits, deflowers her. Marion feels betrayed. Rosina forces Genet to submit to female genital mutilation and commits suicide shortly thereafter. Genet will later join the Eritrean liberation movement. While Marion goes to medical school, his brother stays at Missing. Focused on the repair of birth-related fistulas, he takes up his surgical training with Hema eschewing a formal medical education. On his death bed, Ghosh has three wishes for Marion – to get the best medical education, to find Stone, and to forgive his brother.

When Genet and her comrades hijack an Ethiopian Airlines airplane in 1979, Marion is on a list of her connections. To avoid arrest he flees the country overnight to Kenya. He goes to New York City where he finds a position at Our Lady of Perpetual Succour, a hospital in the Bronx. There, he enters a surgical residency. One day, assisting his senior in a complicated trauma operation, an unknown surgeon enters looking them over the shoulder. It is Thomas Stone, by now a well-renowned liver surgeon from Boston. Marion’s encounter with his biological father redirects his life leading to a painful reconciliation and reunion with his estranged brother.” (1)

 

  1. Wikipedia. (2018, March 03). Cutting for Stone. Retrieved from https://en.wikipedia.org/wiki/Cutting_for_Stone

 

Parenthood and Emergency Medicine

Hema’s transition into motherhood, her revelations on a crashing plane and in a hopeless OR really spoke to an ongoing discussion in medicine regarding parenthood and career balance. This practice of pushing aside, or putting off parenthood, ‘just till I start my career,’ or ‘ after I finish my training,’ etc is something I’m sure is not unique to medicine.  Interestingly that tension was exemplified by a series of articles published in Emergency Medicine News not too long ago in mid 2017.

The first commentary was printed in July 2017 describing the balance between treating patients and being present for family medical emergencies.  Dr. Sandra Scott Simmons describes her experience:

The conflict between our core values as parents and as EPs creates significant cognitive dissonance. Receiving a text with a photo of an ankle looking like Cole’s looked that night would make most people drop everything to be with him in the ED, but I still showed up to work. I’ve never felt so much inner turmoil during a shift. Parenting may be first on our priority list, but our careers don’t always allow us to realize that ideal. Physicians valiantly do what it takes to meet the high expectations placed upon us, but we’re far from invincible. The cognitive dissonance produced by choices we are forced to make will ultimately affect all of us and our families.” (1)

In a letter to the editor, Dr. Geoffrey Martin offers his response on this long debated balance:

Certainly many families feel the pain of mothers trying to fulfill both roles with equal expertise while suffering terrible “mommy guilt” when significant events occur in their families’ lives. In the end, it’s a choice. Those natural mothering tendencies don’t have to disappear when you become a physician, but you can plan a little differently so that you can experience the richness and fulfillment of both. While you can’t reasonably expect everything simultaneously, with planning and pragmatism you can have both, in their season at their time.

If you’re planning to tilt your lance at a windmill, maybe take on the lie that women should be everything all the time to everyone. Be a mom, be a wife, be a doctor, but each in its season. Don’t expect to do them all simultaneously with expert ability and no pain. It’s in very few women’s nature, and there’s almost always pain.” (2)

And again, Drs. Tintinalli, Kass and Wolfe Respond to ‘Parenthood and Medicine, Each in its Season’ in Emergency Physicians Monthly.  Tintinalli’s commentary concludes:

Does a Dad feel any different than a Mom in a situation like this? No way. The seasons change with age – your age, your children’s ages, your parents ages – but the tender feelings never go away.

Dr. Geoff Martin seems like a fine guy (based on a video on vitals.com). He seems proud to be an emergency physician. He gives food for thought when he writes “you can plan a little differently so that you can experience the richness and fulfillment [of both].” But change the words “women” or “moms” to “men” or “dads,” and you get the same angst. 

We all make choices. When we realize the pressures and choices become unbearable, time to re-calibrate. Emergency medicine provides us with a world of professional choices:  full-time, part-time, hardly-any-time, high-intensity, low-intensity. We are lucky. We are doctors. We are parents, sons, daughters, friends. We do the very best we can.” (3)

What has been your experience?  How do your priorities, family or otherwise, balance your sense of responsibility to your career?  Does it take a crashing plane and a medical disaster, like in the story of Hema to take a fresh perspective on the debate?

  1. Simons, S. S. (2017). ER Goddess. Emergency Medicine News,39(9), 6. doi:10.1097/01.eem.0000524788.36561.5f
  2. Martin, G. (2017). Letter to the Editor: Parenthood and Medicine, Each in Its Season. Emergency Medicine News,39(8), 21. doi:10.1097/01.eem.0000522233.73773.41
  3. Tintinalli, J. (2017, August 22). Drs. Tintinalli, Kass and Wolfe Respond to ‘Parenthood and Medicine, Each in its Season’. Retrieved from http://epmonthly.com/article/three-women-respond-parenthood-medicine-season/; Emergency Physician Monthly

How do we ask for help in Medicine?

There are so many deeply emotional and tragic moments as the birth of the twins and the struggle between heartbreak and medicine for several of the doctors at Mission.  Stone is frozen, outside of his medical knowledge and paralyzed by his innate connection to the person that is now on his table.  But how often do we, as medical practitioners find ourself in high stakes situations when asking for help seems like the right albeit impossible choice.

Edna Shenvi is a surgery resident recalls in blog Kevin MD:

“Have a plan,” said one attending, “If you don’t know, just guess.” And another, in a teaching session, “Just guess, even if you’re wrong.”

From a chief resident during an awkward pause when a junior was put on the spot: “Just guess; it’s OK.” When someone dares to ask a senior about the next step planned for a patient, the response often is “You tell me” or “What do you think?” In other words: If you don’t know — guess.” (1)

She begs the question, what are we teaching, what are we expecting of our colleagues when we ask coworkers (typically junior colleagues) to guess at the risk of not having an answer. She goes on,

Of course the intention has merit. But for being the behaviors we are inculcated with during our formative years, I think there are dangerous consequences. We now hear that medical errors are the third leading cause of death, it takes decades for evidence-based practices to be implemented, there are huge health care quality disparities within our country and pressure for performance is contributing to physician burnout and suicide. Is any of this really a shock?” (1)

When we “grow up” as residents and enter the “real world” of independent practice and a question arises, are we going to guess? Are we forever supposed ‘fake it till we make it?’ What can we do as teachers and evidence-based practitioners to avoid blind guessing and know when to ask for help and where to look for it?

  1. Shenvi, E., & Kevin MD.com. (2017, November 28). Medicine isn’t a guessing game. Always ask for help. Retrieved November 11, 2018, from https://www.kevinmd.com/blog/2017/12/medicine-isnt-guessing-game-always-ask-help.html

ANNOUNCEMENT!

Our Winter Edition discussion of Cutting for Stone will be held on Monday, November 26st at 6p at Casa de McElhinny, see your email for additional details.

Feature Book: Atlas of Men

From our own Dr. David Sklar, check out his new novel fresh off the press last week and right out of conference: Atlas of Men

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Amazon books gives us a brief description: “Files from a secret research project show up on Dr. Robert Thames’s doorstep, forcing him to think about something he’s been avoiding – the degrading “study” at Danvers Academy, especially the naked photos of each student, including himself, taken at his prep school. He tracks down four close friends from school, and together they uncover the terrible truth of what was buried by the faculty, the school, and the boys themselves.”

 

Check it out and support a local author and fellow EP!

Another Book, with a Twist

You may have seen advertisements for the new NBC Show New Amsterdam, and while Grays Anatomy I can argue with a quote from its signature scene:

“You do know the whole system’s rigged, don’t you?,” says Dr. Reynolds, who does not want anyone to see just how much he really cares. “They ‘re not going to let you come in here and just – help people.”

 

“So let’s help as many as we can before they figure us out,” says Dr. Goodwin. (1)

Maybe its the just the grind of year two of residency, but man does that premise, that perspective, that spunk, feel refreshing. Now I know this is the Copa Book Club and I just introduced you to a new TV show, but have no fear, the show is based on a novel by Dr. Eric Manheimer’s memoir Twelve Patients: Life and Death at Bellevue Hospital .

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“Using the plights of twelve very different patients–from dignitaries at the nearby UN, to supermax prisoners at Riker’s Island, to illegal immigrants, and Wall Street tycoons–Dr. Eric Manheimer “offers far more than remarkable medical dramas: he blends each patient’s personal experiences with their social implications”” (2)

 

So whether you’re prone to cuddle up with a new book or snuggle in for a few episodes on your lap top, take time to appreciate the magic in medicine once again.

  1. Lloyd, R. (2018, September 25). Review: Two looks at hospitals and healthcare come to TV with ‘New Amsterdam’ and ‘The Mayo Clinic: Faith – Hope – Science’. Retrieved October 18, 2018, from http://www.latimes.com/entertainment/tv/la-et-st-new-amsterdam-mayo-clinic-faith-hope-science-review-20180925-story.html
  2.  Amazon. (n.d.). Twelve Patients: Life and Death at Bellevue Hospital. Retrieved October 18, 2018, from https://www.amazon.com/Twelve-Patients-Death-Bellevue-Hospital/dp/1455503878
  3. Blanton, K. (2018, September 25). How ‘New Amsterdam’ Gives Real, Neglected Patients A Platform To Be Heard. Retrieved October 18, 2018, from https://www.bustle.com/p/new-amsterdam-is-based-on-a-true-story-that-gives-neglected-voices-justice-11978881

The pause.

I’ve just started out on our newest read Cutting for Stone and already the theme of mortality is strong on my mind.  As second year residents we get to captain our first codes. I was fortunate to be part of a well-run code run by another resident and after an unsuccessful resuscitation there was a moment of reflection, a pause.  Not only was this colleague skilled in resuscitation but also understood the importance of acknowledging a death and dedicated with a thoughtful debrief. As first years we spend several days learning ACLS, ATLS, PALS, all the advanced life support techniques and algorithms. We learned how to do and to fight death and not once acknowledge the toll an unsuccessful resuscitation can have on healthcare workers involved.

In an NPR article Johnathan Bartels of University of Virginia Medical Center describes adapting “the pause” into his practice:

“So the next time we worked on another person who didn’t make it, I decided to be bold and stop people from leaving,” he says. “I just said, ‘Can we stop just for a moment, to recognize this person in the bed? You know, this person before they came in here was alive — they were interacting with family, they were loved by others, they had a life.’ ”

The team did it. Standing together silently, they stopped — just for a minute.” (1)

The practice of honoring a life is not exclusive to emergency medicine, check out how University of Vermont Medical Center honors their organ donors.

 

  1. Lofton, K. (2015, September 27). Trauma Workers Find Solace In A Pause That Honors Life After A Death. Retrieved October 10, 2018, from https://www.npr.org/sections/health-shots/2015/09/27/443104073/trauma-workers-find-solace-in-a-pause-that-honors-life-after-a-death