Perception

THIS POEM RECEIVED HONORABLE MENTION IN THE FIRST ANNUAL EXPRESSIONS IN HUMANISM CONTEST, SPONSORED BY THE UICOMP CHAPTER OF GHHS

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Perception

by Brittany Price, Class of 2015

Copyright Brittany Price, 2013.  All rights reserved.

It could have been the most miniscule part of your day
But through the eyes of another, their life could change.
Whether it is talking with a lonely person, or sitting with someone who is sad,
You never really know the impact you will have.
So, maintain an awareness of others
While fumbling throughout your day,

Because in some cases, you may never be able to take your influence away.
Five minutes with a piece of your heart shining through.
What could five minutes mean to you?

A Measure of Performance

THIS ESSAY WON THE FIRST ANNUAL EXPRESSIONS IN HUMANISM CONTEST, SPONSORED BY THE UICOMP CHAPTER OF GHHS
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A Measure of Performance

by Matthew Chia, Class of 2015

Copyright Matthew Chia, 2013  All rights reserved.

If there is a common axiom to modern medicine, it is that performance is discretely measurable. Throughout our premed and medical school curricula, we are judged on exam performance, letters of recommendation, or research accomplishments, each of which represent milestones that are meant to quantify our abilities and our hard work. In medical practice, there seems to be an ever-increasing number of external forces that evaluate, score, and count. Hospital administrators deliver policies and performance metrics, while Associations, Societies, or Groups deliver countless publications and guidelines. The insurance companies deliver miles of red tape, living by the rule “deny, delay, and refuse to pay.” While a physician might praise or curse any one of these, you might think that above all, a physician’s performance has been anatomically dissected into its vital components.

And so, a patient presents with poorly-controlled diabetes mellitus and depression. A physician can take his or her vast experience and apply it thoughtfully, balancing each and every one of the external forces that would test a physician’s competence.

But here’s the trick. Today, this patient didn’t present at all. She existed, and was well known to my preceptor, but I still don’t even know her name. Today, we saw her family, who came to us frustrated, tired, but most importantly, near the edge of despair. Our patient, who I will call Mrs. D, had fallen into depression and was refusing to take her 500 daily units of insulin. Her condition declined, blood glucose rising so high that her glucometer failed to even produce a number. Even as her mental status deteriorated, she refused to seek care, refused to allow her daughter to call 911, and refused to allow her husband to take her to her primary care physician, who she knows and likes.

In my mind, I was starting to quantify our inability to care for Mrs. D. I wondered about the legal ramifications of DNR, about reimbursements for hospice care, and about why we still didn’t have her chart in the room. But my preceptor didn’t balk at any of these things. He first recognized the pain the family was in, and the hardships they tackled each and every day. He carefully asked about Mrs. D’s symptoms and behaviors, and what her family had tried to do. After further dialogue, he told them that Mrs. D should get to the hospital, by the husband’s legal consent, or when she fell into a coma. But what stunned me was what he said to them last;

“Make sure to bring her here. If the ambulance takes you to another hospital, I can’t be there to take care of her.”

If that seems underwhelming, consider how anybody would measure this visit. Mrs. D received no care, and thus fails to meet policies and performance metrics that a hospital might set for diabetes patients. Her quality of care is certainly outside what the American Diabetes Association guidelines recommend. In fact, because there was no proper patient encounter, my preceptor spent more than half an hour in a way that insurance would not pay for. Ultimately, I realized that he cared deeply about his patient, whether or not his patient cared about him, or about herself. Mrs. D’s family knew that he was there to support them through this critical moment, and that Mrs. D had a real advocate. She was a case that could have been punted to another hospital, given up on, or forgotten about. In fact, I am embarrassed to say that our jam-packed schedule for the rest of that day was already on my mind. But my preceptor was properly focused on giving Mrs. D the best care he could give her.

I should now spend the rest of tonight studying about the sequelae of prolonged ketoacidosis, and the inpatient management of severely hyperglycemic diabetes mellitus. But today I saw a performance that showed me medicine beyond the rubric, medicine that exceeded measurement. It is a lesson that I will carry not on another scribbled notecard, but in my head, and in my heart.

Expression in Humanism Winners Announced

The Peoria Chapter of the Gold Humanism Honor Society is pleased to announce the outcome of its first annual "Expressions in Humanism" contest.  The winner is Matthew Chia, class of 2015, for his essay, "A Measure of Performance."  Honorable mention goes to Brittany Price, class of 2015, for her poem, "Perception.

Their entries will be presented in subsequent posts on this blog.

Linda P. Rowe, EdD
Advisor, UICOMP GHHS Chapter

"He even had her smiling"

In a recent comment on an OSF St. Francis "DAISY Award" card, it was said that student doctor Matthew Fischer (Class of 2014) "was very calm, compassionate and caring while examining [a patient]. He even had her smiling by the end of his visit."

Humanism Every Day

Just an obvious reminder—humanism and compassionate care should be there 100%, 365 days a year.

L. Whittaker, Jr MD, FACS

Families of Patients Appreciate Compassion in Care

One of our senior medical students shared this inspiring story about an Emergency Medicine physician's expression of how he was touched by a dying patient http://m.cbsatlanta.com/w/main/story/85029303/

In turn, his revelation of an emotional connection provided some measure of comfort to the patient's family.

Although this story did not happen in Peoria, I think it could have.  Over the years I have read letters in the newspaper and heard comments from families who deeply appreciated the compassion and caring shown by our local emergency room physicians and nurses during some the darkest moments in their lives.  I am grateful that our students are able to train with such inspiring role models.

Linda Rowe, EdD
GHHS Chapter Advisor
University of Illinois College of Medicine at Peoria

Pediatric Surgeon Goes Above and Beyond

My daughter had numerous admissions to the children’s hospital between the months of November 2011 until December 2012. This included too many surgeries to keep track of.  We had the utmost privilege of having Dr. Mark Holterman involved in her care from day one. Not only was he relentless in finding the cause of her pain, he was also relentless in keeping her happy and safe.

After a major surgery, Steph asked why he left his starbucks in the hall.  He stated that it wouldn’t have been polite to drink in front of her since she was NPO. He then offered to bring her one when she could drink again and asked her favorite kind. The next day, he asked his PA to get Steph what she wanted.  Around noon, Dr. Holterman himself showed up in our room with the Starbucks she had ordered, that he personally had went and purchased.  Talk about making a kid’s day and a good doctor/patient relationship scaled to the next level.

It is just the little things in life that keep it human in the medical world. 

We are forever grateful for those little things that mean so much to a teenager trapped in pain and in the hospital

M.L.

OSF St. Francis Medical Center

More than a Doctor

For the last few weeks of my internal medicine rotation, I traveled more than an hour away from Peoria to work with Dr. Mark Fernandez in his outpatient office. As I prepared to see my first few patients, I pored over their medical records, gathering every detail, lab result, diagnosis, and other relevant historical information. After interviewing the patient and gathering my thoughts, I would locate my preceptor to present my findings. Before each of my presentations, without fail, rather than delving into the intricacies of their illnesses, Dr. Fernandez preferred to tell me about his patients - not in reference to their medical conditions, but rather with respect to their lives. He would say something like, "Oh, Don is here today? He's been my patient for a long time. He's a really great guy! I see him at the gym and our kids are in scouts together." Time and again, it impressed me how well Dr. Fernandez knew his patients. No matter how many appointments he had scheduled on any given day, he would always take some time to update me on how amazing his patients were as indviduals, then would turn the ensuing clinical interview into a conversation between friends.

The most remarkable enounter I witnessed was with an elderly patient with multiple problems. The patient's son was a fairly close acquaintance of Dr. Fernandez. It quickly became apparent to me that the patient's health was deteriorating rapidly. The gentleness, care, respect, and compassion that Dr. Fernandez showed this patient was more than a doctor-patient relationship; it was something akin to how a son would treat his ailing parent. Through it all, I could see in the patient's eyes that Dr. Fernandez was more than a doctor; he was part of the family.

As my time in the office came to a close, Dr. Fernandez left me with this final thought: "My patients don't come to this office to see the doctor. They come to see me." the most brilliant and intuitve doctors can effectively treat diseases, but true success and satisfaction come from treating patients. In the end, that's what it's all about.

Christian Nunez
Class of 2013
(some details in this story have been altered to protect privacy)

I will Fix You

A Human Connection in the Trauma Room

"Excuse me," I shouted, barely avoiding running into two nurses as I jogged down the long, dimly lit hallway. The trauma pager had beeped at 2:15 AM, waking me from a light sleep in one of the call rooms on the opposite side of the hospital. As I continued my half run, my brain was still waking up. Injured people from a motor vehicle accident involving a semi-truck and a SUV had  been transported to our hospital. My imagination was kicking into full gear. Entering the trauma room, I found the charge nurse and scribbled the information I needed on my pad of paper. The doors burst open as the driver of the SUV was rushed in with the emergency transport team. The whole room erupted into chaos as I did my best to stay out of everyone's way.

After thirty minutes of tubes, fluids and continuous CPR, the patient was no longer breathing. There was no pulse on the monitor and most of the staff had stopped running around frantically. Suddenly, the doctor applying chest compressions yelled out, "Where's the medical student? Medical student?"  I rushed over with my paper and pen in hand, ready to transcribe. To my surprise, he handed me a pair of gloves, stepped down from his stool and instructed me to continue with the chest compressions. I frantically pulled on the latex gloves, tripping up the one-step stool, unprepared for what was about to occur. As I began compressions, I looked down into a face whose eyes stared into mine with no feeling and no warmth, but what appeared to me to be a pleading not to stop, not to give up. "1...2...3...4...5," I counted in my head as I pushed with all my might, wishing I could somehow push the life back into his eyes. This individual whose life was unknown to me had become in that moment everything that I cared about.

This one memory has taught me many things about medicine and the value of people. What was it about this man that drove me so much, emotionally and physically, to bring him back from death? Previously, I would have said this was due to the altruistic nature that resides within most medical professionals, the reason we claim to be in this career from the beginning. While this is still true, I believe there is something deeper that drove me and pushes others to give everything they have to save a complete stranger: the human connection. As people, we are blessed with the capability to comprehend that there is more to a person than what we simply perceive with our senses. We are a collection of our parents, friends, and family. We embody our achievements and failures, our hopes and dreams. These are things most everyone can share and appreciate with one another. The human connection allows us to look past the exterior and see a little of ourselves in everyone we meet. For me, I looked into this stranger's dying eyes and wanted to not only rescue this man, but myself as well.

"Didn't you hear me?" the doctor shouted while grabbing my shoulder. He had been speaking, trying to tell me the time of death had been announced and all efforts for resuscittion were to be stopped, including chest compressions. I backed away from the table, filled with questions that were impossible to answer. What did I do wrong? Why didn't he live? Why did they let him die? While my mind understood there was nothing more that could have been done, especially by me, my emotions overruled the logic of the situation. At the end of that clerkship, I left with an understanding of the human connection, the bond we as practitioners have with patients that drives us to be physicians. During a few short hours, I learned a lesson that I will continue to reflect upon and use to enrich not only the lives of my patients but mine as well.

Samuel Abebe
Class of 2013

The Power of Bedside Manner

Most medical students have more time to spend with patients than do higher-level providers. This encourages me to take the time I have with each of my patients to truly get to know them and how their lives affect their abilities to take care of themselves. Something I came to learn throughout my third year clerkships (and that I did not value as much before) was the power bedside manner has on the outcome of a patient's care. I have seen a direct correlation between good bedside manner and patient cooperation and health outcome. Observing this correlation has not only made me aware of how I should and should not approach my patients, but has also encouraged me to ask for feedback from residents and attending about my bedside manner - not just about my clinical knowledge and presentation skills.

Oluchi Ukaegbu
Class of 2013

GHHS Member Oluchi Ukaegbu

Oluchi Ukaegbu is a highly respected leader among her peers. She helped develop the aforementioned GUIDES program - just one of many community service projects for which she volunteers. Oluchi serves as an officer for several student organizations including Student Government, the Student National Medical Association and the Christian Medical and Dental Association. As such, she is a strong and effect advocate for students.  She is also a strong and effective advocate for patients. Reflecting on Oluchi’s rotation through the Heartland Community Health Clinic, one of its physicians said, “[she] has an enhanced ability to combine confidence, humility, and knowledge with graciousness to all those around her that results in a sense of being at ease with her – as if she has been a friend for a long time. I noted that our staff enjoyed her and patients are willing to share their concerns with Oluchi, no matter their backgrounds.” Oluchi’s family came to the U.S. from Nigeria. During many of her formative years, they lived in the state of Wyoming. She is a graduate of the Communication Sciences and Disorders program of Northwestern University.

Linda P. Rowe, EdD

GHHS Advisor

GHHS Member Sandy Tun

Sandy Tun is from Spring Valley, IL and earned her bachelor’s degree in biology at Illinois Wesleyan. She is also active with GUIDES and many other community service projects and extracurricular activities, including the a cappella singing group and the dodgeball club. She has coordinated presentations for fellow students on topics such as social and racial health disparities. In supporting Sandy for this honor, one of our faculty members noted Sandy’s strong academic performance while observing that he believed that “Sandy’s motivation to succeed in medicine is inspired by her desire to serve others with the greatest care. In patient rooms, I often observed her ability to put patients at ease and to relate to each person on an individual basis. It is rare to encounter a student with the enthusiasm, thoughtfulness, and sincere dedication I see in Sandy.”

Linda P. Rowe, EdD

GHHS Advisor

GHHS Member Pradeep Singanallur

Pradeep Singanallur was one of only four University of Illinois at Chicago students to win the President’s Volunteer Service Award for 2012. The award goes to undergraduate or graduate students whose volunteer activity substantially addresses a distinct need in the community.”  Pradeep was recognized for founding GUIDES, a student-run community service project that mentors youngsters at Peoria’s Quest Charter academy and encourages them to excel academically.  His resume of service is matched by intellectual and clinical achievement. As one internist said, “he has a calm and soft demeanor which is extremely comforting for patients who interact with him, and he develops a bond and is a noticeable advocate for their well-being at all times.”  Pradeep, who has a strong interest in neurosurgery, earned his Bachelor of Science from the University of Illinois at Urbana-Champaign.

Linda P. Rowe, EdD

GHHS Advisor

GHHS Member Kristen Schmidt

Kristen Schmidt, who is from Minnesota, majored in English at the University of California at Berkeley, completed her master’s degree at the University of Chicago and worked as a teacher and administrator before deciding to pursue a career in medicine.  Kristen has distinguished herself academically here in Peoria.  Her achievements earned her a place in the college of medicine’s James Scholars program, an academic honors program focused on in-depth study and research.  Kristen has also distinguished herself in the clinical setting for, as one clerkship director put it, “superlative humanistic behaviors on a daily basis.”  Another faculty member illustrated Kristen’s compassion by pointing out how she listens to the concerns of patients and families and then goes out of her way to help them with information and resources. The faculty member wrote, “it was evident that [to Kristen] patient care was more than a clinical task … she connected with patients on a personal level. Her questions addressed ways to improve comfort as well as provide exceptional evidenced based care.”     

Linda P. Rowe, EdD

GHHS Advisor

GHHS Member Christian Nunez

Christian Nunez is well known for his warm personality and his energetic contributions to a wide range of volunteer service programs – especially those related to pediatrics, such as the annual Halloween party for children with diabetes and the Exergaming for Health program.  He can also be seen and heard on YouTube harmonizing with fellow students in their a cappella singing group!  Christian’s second-year classmates elected him to receive the Gloria Arndt Award for being the “kindest, most compassionate, and most altruistic” of their peers.  I think you can tell a lot about someone by who they choose as role models. In Christian’s GHHS essay he wrote about working with a small-town physician that he admired: “Before each of my presentations … rather than delving into the intricacies of their illnesses, Dr. F. preferred to tell me about his patients – not in reference to their medical conditions, but rather with respect to their lives.” Christian completed his undergraduate work in psychology and philosophy at Washington University in St. Louis.  

Linda P. Rowe, EdD

GHHS Advisor

GHHS Member Samuel Abebe

Samuel Abebe earned his bachelor of science in brain, behavior and cognitive science at the University of Michigan – Ann Arbor. He credits his childhood in Ethiopia with giving him a foundation for understanding and appreciating the needs and perspectives of people from diverse cultures.  Samuel is active in a wide range of college and community service activities here in Peoria, including the Student Government Association. He is a co-chair of the Student Advocate Program. But it is the capacity for compassionate patient care that is of paramount importance in earning this honor. As one faculty member said, “I am always impressed by how much compassion [Sam] shows when he talks about his patients – to him each one of them is a real person, and not just an interesting or complicated set of clinical findings … his generosity of spirit … will make him a wonderful and caring physician.” Samuel plans to become a pediatrician.

Linda P. Rowe, EdD

GHHS Advisor

Acknowledging a Patient's Anger

The woman stood by her elderly mother's bedside glaring and visibly upset. She suddenly shouted, "I am not putting my mother through any more suffering!" The attending physician, three residents, and I had just entered the hospital room for rounds. The four of us froze where we stood, taken aback by the woman's outburst. Without waiting for a response, the woman immediately launched into her list of grievances. She accused the nurses of having given her mother the wrong treatment; she stated that she had been waiting the entire evening and morning to talk with a "real doctor," and that she had not been updated about the results of overnight blood tests. At the end of this she leaned back against the wall, out of breath and exhausted, her face flushed with anger. Her eyes scanned each of our faces suspiciously.

Nurses had warned us before entering the room. The daughter, they said, had been adamant about eschewing the current treatment plan. We were told that both the patient and the daughter had been consistently rude and demanding to nurses and staff. We had been told that they were "non-compliant" and "difficult." We were also told that, during the night,  the daughter had gone so far as to hurl a container of a prescibed topical drug at a nurse's head.

 Several seconds of silence lapsed after the woman's outburst. Her words hung in the air. The anger was palpable and raw. Then I heard the physician's voice. It was soft, but steady and calm - "You have been through so much. If I were you I would be angry, too."  The woman blinked, taken aback by the statement. Her face, which only a moment ago had been set with a steely and hardened glare, softened. She nodded quietly and looked away.  For the next 45 minutes the physician laid out the plan for care and treatment, agreeing to compromise in the face of some of the patient's concerns. At the end of this discussion, the patient and her daugher apperared exhausted, but relieved. The stress from months of cancer treatment showed clearly on their faces, now unmasked by the dissipated anger.

Humanism in medicine involves the recognition that patient's are more than their diagnoses and lab findings. Physicians who embody humanistic medicine are realistic about the limitations and challenges of patient care. They do not seek to impose medical knowledge and advice upon patients and their families. Instead they strive to serve as a partner and guide in navigating the uncertain terrains of health and illness.

Sandy Tun
UICOMP Class of 2013