Category: General

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General Lifestyle Reflection

On Professionalism

I solemnly pledge to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude that is their due;
I will practice my profession with conscience and dignity;
The health of my patient will be my first consideration;
I will respect the secrets that are confided in me, even after the patient has died;
I will maintain by all the means in my power, the honor and the noble traditions of the medical profession;
My colleagues will be my sisters and brothers;
I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I will maintain the utmost respect for human life;
I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
I make these promises solemnly, freely and upon my honor.

-The Declaration of Geneva

My white coat ceremony changed many things for me, most notably the responsibilities I would have moving forward. I recited the Declaration of Geneva, along with my fellow colleagues. The weight of the term “colleague” laid heavily on me; those who were once classmates were now colleagues. Classmates to colleagues, such a drastic, but intentional elevation in word choice. Many things are expected of me as a medical student, but one of the top priorities is the demand to carry myself as a professional.

Professionalism can mean treating others with respect, upholding a certain academic standard, or leaving personal issues in a personal space. Cultivating a professional attitude isn’t always easy. I have screwed this up several times, like disrupting class through meaningless chatter or allowing my personal dilemmas seep into my professional work. Regardless of the mistake, I always try to learn from my shortcomings. I believe that the majority of medical students strive to act as a professional when encountering difficulty in medical school.

Recently, I wondered how this professional attitude so quickly fades when we meet colleagues of different disciplines. Although my experience is mainly anecdotal, I think we have all heard of negative interactions between physicians and nurses, physicians and physician assistants, and so on. In medical school, some of us have participated in attempts to get medical and other professional students to interact at an earlier point in their training. I personally interacted with both nursing and physical therapy students during my first year of medical school. Although I thought the reasoning behind this choice was good, it didn’t work out exactly as planned. The medical students overheard a few nursing students talking negatively about the medical student cohort. Feelings got hurt and from there the overall atmosphere worsened.

Why did this happen? I believe we forget to act professionally when outside of our immediate, comfortable setting. We know a professional attitude is demanded between colleagues within our medical school, but we don’t often carry it over to other disciplines. Yes, you could argue that interacting with other disciplines at an early career stage helps break down some common stereotypes and issues, but will early interaction really solve everything? I’m skeptical.

I believe a constant effort must be maintained throughout our training; as I stated before, a professional attitude is not easily mastered. Regardless of one’s career stage, working harder at cultivating a professional demeanor among those in our field as well as among those in others will foster teamwork within medicine. If we, as medical professionals, hold ourselves to a certain standard, then catty arguments or negative comments will never be made, because we constantly demand higher of ourselves. Hopefully, by being more self-aware and practicing on a daily basis, we will create a professional attitude that won’t break down so easily when confronted with the newness of the ever-growing medical field.

Featured image:
teamwork staffetta by Luigi Mengato

Categories
Emotion General Lifestyle

Thank you for being a patient: A reflection on gratitude and its place in medicine.

I was walking through Target a few days ago when I noticed a banner had been discarded in a pile of clearance items. “Give Thanks,” it read. Assuming that the banner was a Thanksgiving leftover, I quickly moved along to a different aisle. Later that day, I started thinking about that banner, and its lowly place in the clearance bin. Gratitude has become a seasonal commodity. From November to mid-December, we’re reminded to give thanks, be grateful, and celebrate others through food and gifts. Unfortunately, the half-off banner serves as a reminder that the notion of gratitude can become “out-of-season” as we turn the page on the calendar.

One of my personal rules for daily life is to live each and every day with a grateful heart. I think this idea comes from having practiced yoga for more than a decade, where gratitude is a foundational tenant. At the end of almost every yoga class I have ever attended, both teacher and students bow their heads and say, “‘Namaste.” Namaste is a Sanskrit word which, loosely translated, means ‘the goodness in me honors the goodness in you.’ For me, this sacrosanct moment at the end of class is what makes yoga different from any other activity I have engaged in. As the instructor thanks me for allowing him or her to share the practice of yoga, I can both thank the instructor, as well as take a moment to thank myself for taking the time to do something good for myself. In contrasting my own personal attitude of gratitude with the Hallmark-esque notion that gratitude is a seasonal commodity, I began to wonder what place gratitude might have in the practice of medicine.

In my brief time as a student doctor, I have witnessed patients struggling with complex challenges that I never even considered prior to medical school. It’s true that many patients will visit us when they have a stuffy nose or an itchy rash, but just as important are patients who see us when they are struggling to quit addictions, deal with a major life change, or manage their own healthcare on a limited budget. It is these patients, especially, with whom it is imperative that we as healthcare providers work with to build trusting relationships. I believe that the first step of building such a relationship is an expression of gratitude. I want to thank patients for being brave, for reaching out, and for asking to get help. I want to tell them how very grateful I am that they have respected themselves enough to value their health, and for trusting me, or one of my colleagues, to help them make very important and potentially challenging life changes. Essentially, I want to say Namaste.

As we leave behind the snow-dusted magic of the holiday season, we should not let gratitude melt away like a snowman. Gratitude should be a part of our daily lives and a cornerstone of our medical practice. It only takes a moment to let our patients know how thankful we are for being part of their journey to wellness, but I predict that the impact it has on our physician-patient relationships will be long lasting.

 

Featured image:
The Stethoscope by Alex Proimos

Categories
General Opinion Public Health

The Policy on Policy: Why Medical Students Need to Learn About Healthcare

A 27-year-old woman is woken up by a sharp, stabbing pain in her lower right abdominal quadrant. She feels feverish, nauseous and weak. If you’re a medical student, you want to get a thorough history and test for a positive Murphy’s sign or rebound tenderness. You’re thinking it sounds like appendicitis. If you’re a doctor, you want to examine the patient and consider an appendectomy as a treatment option. You’re thinking of all the cases of appendicitis you’ve seen, and how well your education prepared you to diagnose and treat this condition. Except, none of that happens if this patient is never seen by a doctor. None of that happens if this patient instead, uninsured and unemployed and alone, decides to wait it out because it seems like her only option. None of that training in diagnosis and treatment makes any difference if that patient doesn’t have access to the care that could have saved her life.

The issue of healthcare policy is complicated, and oftentimes controversial, especially when presented in the framework of a political debate. As healthcare providers, however, the issue becomes less of a political one and more of an ethical one. The reported number of uninsured Americans ranges from 29 million1 to 45 million2, with tens of thousands of preventable deaths caused every year by lack of access to care3. That could mean a young woman dying of sepsis when her appendix ruptures, or an inmate asking a parole board to keep her in prison so she can continue to receive cancer treatment, or any number of similarly startling stories being told every day, across the country, about people who we know how to treat if we’re just given the chance.

A good resource for information on healthcare policy is the Commonwealth Fund’s 2014 analysis of our healthcare system compared to 11 other industrialized countries.3 The U.S. spends the most on healthcare per capita each year ($8,745), yet has the highest rate of potentially preventable deaths (96 per 100,000 people) and the highest infant mortality rate (6.1 deaths per 1,000 live births). Given the state of our broken system, it seems strange that medical students are essentially unaware of these issues until they enter the working world. Why are we not exposed to the struggles of healthcare policy in medical school? While it is certainly true that students are already saturated with information, it seems there are few subjects more universally applicable to graduates than learning about the system they will be working in.

To get an expert’s thoughts on the matter, I spoke with T.R. Reid, a leading author and journalist in the field of health policy. His bestselling book, The Healing of America, explores foreign models of healthcare and how we can learn from those systems to reform our policies at home. He currently serves as the chairman of the Colorado Foundation for Universal Health Care, which has recently placed an amendment on the 2016 ballot that would create the first state-initiated universal healthcare system by opting out of the Affordable Care Act.

 

Why do you think it is important to teach health policy in medical school?

The United States has the most complicated, the most inefficient, and the least equitable healthcare system of any rich country. Doctors are graduating into it and they don’t know what a mess it is… I think we need to prepare doctors for what they’re going to face. The second reason is, as a country, we need to fix our healthcare system. It’s ridiculously expensive, it leaves 33 million people uninsured, and the impetus to change has to come from doctors.

Health policy can be very broadly defined. What is the most important element of policy to incorporate into medical education?

The most important point is that a decent, ethical society should provide healthcare for everyone who needs it… In almost all other rich countries, healthcare is considered a basic human right and if you think about what a human right means, a human right is something the government is obliged to provide for you. You have a right to an education. You have a right to vote. If you get charged with a crime, you have a right to a fair jury, a fair judge, and a defense lawyer. We provide that because we’ve decided those are basic rights that every American ought to have. All the other countries say that’s also true for healthcare. If you’re sick and need medical care, you should get it and we have to provide it. The United States has never made that commitment… If you don’t make the basic moral commitment to provide healthcare for everybody then you end up with the American healthcare system, where some people get the world’s finest care in the world’s finest hospitals with no waiting, and 33 million people barely get in the door until they’re sick enough to go to the Emergency Room.

What changes do you foresee in the next ten years, or how do you think the current healthcare landscape will change by the time current medical students are actually in practice?

In the first place, I’m absolutely certain that we will get to universal coverage in our country and I believe we’re going to do it at a much lower cost than what we’re spending now. I’m quite optimistic that we’re going to improve our system. I think that’s going to happen… I don’t think we’re going to get there nationally. I’m convinced the way we’re going to get there is state-by-state…That’s how we got to interracial marriage, that’s how we got to same sex marriage, that’s how we got to female suffrage, that’s how we got free public education. It all starts in two or three states, the rest of the country sees that it works, and says ‘let’s do that’… The reason I’m confident in this is that we’re about to do it in Colorado. We got the initiative on the 2016 ballot. When people see a good idea working in some states, they copy it. Colorado is going to prove to the country that this can work, I hope.

As you’ve been campaigning in Colorado for universal healthcare, have you noticed that misconceptions about socialized medicine are still pervasive in public opinion? Does this influence people’s level of support or questions they raise?

The notion of limited choice and long waiting times in Canada is an issue for us…Our critics say ‘they’re going to bring Canadian medicine to the United States.’ Well, Canada covers everybody, they spend half as much as we do on healthcare, they have significantly better population health, they live longer, they have lower rates of neonatal mortality. But they still keep people waiting. I think it’s wrong to say we’re going to put the Canadian system here but that is a powerful argument…My answer is in fact Australia and South Korea have exactly the same model and they have shorter waiting times and broader choice than the United States.

In your book you examine foreign models of healthcare in detail and you described in a 2009 article in the Washington Post several ‘myths’ the American public believed about health care abroad4. Do you think American misconceptions have changed at all since the passage of the Affordable Care Act?

I think Americans still don’t like socialized medicine. Even if they don’t know what it is, they know it’s bad. That’s still true. Many Americans think other countries have limited choice and long waiting times, which is true in some countries, but many countries have broader choice and no other country has the kind of in-network, out-network business that our insurance companies have created. No other country does that…American companies and device makers say government intervention stifles innovation. I think there’s no question that in other countries regulations drive innovation. Cost controls drive innovation because they have to innovate to make their products cheaper.

If medical students are interested in health policy, how can they get involved and learn more, especially as things change?

The best way is what several medical schools have done, which is to put into the curriculum a course on health policy… I say this to every medical school dean I ever meet, ‘you ought to have a course on health policy’ and many of them say ‘I wish I could do that’ or ‘I’m thinking about it’ but some say ‘I’ve got four years to teach the entire human body and everything that can go wrong with it, don’t get me into that mess. It’s beyond our jurisdiction.’

Final thoughts?

Everybody who is sick should have access to healthcare in the world’s richest country. We have to fix this system and your generation of young doctors is going to be a powerful force for change.

 

Sources

  1. CDC National Health Interview Survey Early Release (2015)
  2. Institute of Medicine, National Academy of Sciences (2009)
  3. Commonwealth Fund (2014)
  4. Reid, T.R. “Five Myths About Health Care in the Rest of the World” (2009)

Featured image:
Healthcare Reform Initiative Announcement by Maryland GovPics

Categories
General Lifestyle

Medical Grind

It’s 6 a.m. and your hand doesn’t quite make it to the alarm clock before the voices in your head start telling you it’s too early, too dark, and too cozy to get out of a bed.

Another voice says that there’s a reason your alarm is going off. You take a deep breath, sit up, put your feet on the floor, and get to work.

This is the grind. You have a commitment. The words normal and comfortable have been traded for unexpected and demanding. You’re in a fight towards a finish line without a ribbon and the reward outweighs any medal around your neck.

On this journey to achieve a challenging goal, it’s OK to negotiate with yourself. You’ve wanted to quit many times, but you don’t surrender. Believe the voice that says “it’s OK you didn’t do as well on that exam” or “you will eventually get through to your noncompliant patient” and “you can survive these last two hours on shift.”

Keep focused on what it takes to reach the next step in the journey. Now that you’ve headed down this path, the transformation is taking place. Don’t lose heart. Remember that this is the grind.

Featured image:
vintage alarm clock / thermometer by H is for Home

Categories
General Lifestyle

Let’s do Better for our LGTBQIA Patients

A special thanks to the panelists and physician who inspired this article.

Recently, I was involved in a collaboration between the American Medical Women’s Association (AMWA) and the American Student Medical Association (AMSA) at my school to help our students learn more about the LGBTQIA population. To clarify, this community includes individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex or asexual. We invited a board-certified OB/GYN and reproductive endocrinologist to our school, along with a few of his patients. The LGBTQIA patient population has its own unique set of challenges and understanding their struggle is vital.

Unfortunately, many members of this community have anecdotes of times in which they were disrespected, turned away, or not understood by medical professionals. One of the transgender panelist had difficulty finding a fertility physician who was willing to work with him and his wife to have him carry their child. Yes, you heard me correctly. This panelist was willing to go off testosterone in efforts to regain his menstrual cycle and carry his baby. Many physicians were unwilling to assist this couple. These stories have to be put to an end; we can do better. I hope we can challenge ourselves to be more open-minded and accepting of all those who seek our help. It’s not a physician’s job to deem what is right or wrong; rather, it is our job to serve our patients in whatever capacity we can.

Having a patient panel allowed us to hear some moving and emotional stories from these brave people. I hope other LGBTQIA members can share some of their stories with medical students around the nation because it is important for us to hear these first-hand. In addition to hearing about fertility challenges and life paths, we also heard of changes we as physicians can make to better serve this patient population. I felt the need to share these with others because I realize many students never get the chance to have an open conversation with someone who identifies as part of this community.

  1. On medical intake forms, leave the sex and gender fields blank so the patient can feel comfortable telling you his or her identity here, rather than only giving them two choices.
  2. Ask the patient what his or her preferred name is. Some patients are transitioning and may not prefer their given name.
  3. Ask the patient his or her preferred pronoun and make note of this. The last thing we want to do is keep referring to someone as “she” if they have never felt like a she.
  4. Connect with the LGBTQIA community. Unfortunately, many of these patients face discrimination. Even though it seems “sufficient” to just accept them when they come to our practice, we can do more. The patients on the panel expressed that it would be nice for physicians to reach out to their community and let them know you are welcoming to their group and want to serve them. If one of your patients happens to identify as part of this community, ask them if they can connect you to other people who may need care.
  5. If you have a patient who wants to transition, be sure to at least mention fertility issues. Someone transitioning may not have thought about having a family yet, but it can be very difficult to go off hormones and later become pregnant (if transitioning from female to male). In addition, the patient panelists mentioned that it would have been nice to know more about egg and sperm donation and the costs and barriers associated with those processes. Obviously we don’t need to push our patients in either direction when it comes to transitioning, because it is their choice. But it is our job to inform them and help them understand the potential issues that may arise if they do decide to transition at a younger age.

It is difficult to learn about this population because each member is different and unique. In a struggle to find medically relevant information for health care providers, I found two good resources I found for more information are from American Medical Association (AMA) and AMSA. Click the links below to find out more about the LGBTQIA population in the medical context:

http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/glbt-resources.page?http://www.amsa.org/advocacy/action-committees/gender-sexuality/

Featured image:
Pride Flag 1 by Ant Smith

Categories
General Public Health Reflection

Are you listening? Using the doctor-patient relationship to curb community violence.

If you’ve paid attention to the news recently, you might share my concern that mass shootings are becoming a normalized part of American culture. According to data collected by the United Nations, America leads the developed world in firearm homicides.[1] As a college student in Washington, DC, social justice was an inextricable part of my education. I volunteered, protested, and campaigned for issues I felt strongly about. Assuming you weren’t a student in our nation’s capital, let me tell you that these are all pretty typical parts of the DC college experience. In fact, my zeal for progressivism in the arenas of health and wellness contributed to my desire to become a physician. Unfortunately, it wasn’t until two of my friends were murdered within six weeks of each other this summer that I felt compelled to take a closer look at how, as a medical student, I could better integrate my passion for social justice into my education and clinical practice.

As medical students, our education becomes our lifestyle. It’s demanding, consuming, and vigorous. My support system likes to remind me that I’m not Atlas and that I can’t hold the weight of the world on my shoulders. They tell me to keep my nose in a book and stay focused on my studies. It’s difficult for me to comply with these directives when I feel like I’m neglecting the part of myself that is aware of the world beyond medical school. It took this summer’s tragedies to remind me that even as a student doctor, I need to hold myself accountable for working to reduce social injustice, particularly community violence. What I’ve realized is that while my activism efforts may not reflect those I experienced as a college student, I can still make simple adjustments in my current practice to potentiate positive change.

Since this summer, one of the modifications I made, in an effort to merge my medical and activist identities, is to ask my patients to rate their stress on a scale of one to ten when I take their social history. On the surface, this might not seem like a significant exercise. After all, I’ve been asking my patients about their life stressors since I started school last year. What I realized is that while most people can easily spout off a list of things that make them feel strained (bills, student loans, family responsibilities, looming deadlines, etc.), it’s an entirely different exercise to ask patients to evaluate their stress from a holistic perspective. Though this practice correlates stress level to a numerical value, I have found that I can actually get a better qualitative picture of a patient’s mental and emotional wellbeing and self-awareness by using the one-to-ten stress scale. Perhaps by using this scale, we will be able to gain awareness of and provide support for struggling patients before they feel compelled to turn towards violence.

I encourage you to employ the one-to-ten stress scale into your history taking routine in the hope that it can open the door to bigger, more important conversations about wellness and lifestyle with our patients. Please feel free to let me know how the scale works for you. I look forward to spending the rest of my medical career advocating for those who are underserved by the medical community, but for now, I hope that having these conversations can be a first step in helping patients deal with problems before they resort to violence. In the weeks and months that have followed the deaths of my friends, I find myself thinking a lot about the people who committed the violent acts that claimed their lives. I wonder if they had medical professionals in their lives who they felt comfortable talking to, and I wonder what they would have said if we, the medical community, had been listening.

References:

  1.  Global Study on Homicide. (2011). United Nations Office on Drugs and Crime. https://www.unodc.org/documents/congress/background-information/Crime_Statistics/Global_Study_on_Homicide_2011.pdf

Featured image:
Brother by Fabrizio Rinaldi

Categories
General Reflection

Scholarly Pursuits

Growing up, my father didn’t get home from work until nearly 10:30 pm.  He worked full-time at Allstate Insurance while also working part time as a realtor. There were days I didn’t see my father because he had been working all day. He told me to be grateful for what I had and where I was in life. I didn’t fully understand him, until now.

My father was unable to complete his education. He had planned to become an engineer, but his dad fell ill and the responsibility for the family fell entirely upon him. My father had to pay for his sister’s wedding and his younger brother’s education. In order to do this, he quit college and started working full-time.

I look at myself now and see how dramatically different my life is compared to his. I have everything I could dream of and more. My father is willing to work hard so that I can, today, pursue my education at the best of institutions. In fact, since preschool, I have studied in private institutions and grown up in a world that is in diametric opposition, in terms of the opportunities and expectations placed upon me, to the world that my father grew up in. He has tried to prevent me from even getting a glimpse of the hardships he endured when he gave up his dreams to serve his family. I am humbled by and grateful for the opportunities my dad’s efforts have allowed me to pursue. I know that my father did not have many of the same opportunities. As the timeless and enduring quote goes, “with great power, comes great responsibility”- I know that having the access and opportunity to seek and find knowledge comes with expectations- to serve the community which has so selflessly flung all its needs and desires to serve the needs and desires of my generation. I have had the opportunity to attend both engineering and medical school. The knowledge I have gained by attending both these schools has not only empowered me, but has also reminded me of what I owe to my community and my family- the responsibility to give back.

Whenever my father sees me with a calculus or physics book, a smile comes across his face. He begins chanting the trigonometric functions and formulas he remembers. But that smile often fades as he remembers the past. My father has never talked openly about the hardships he endured while he was young, but his eyes convey it all. There was this silence that followed that chanting and smile. I knew that my father was thinking back to his past and the educational endeavors he never had the opportunity to pursue. Despite this, my father is able to provide more than enough for our family on many levels, financial and emotional.

However, despite my dad’s success, there is still a part of him that wishes he could finish his education. I have grown so much from my father’s experiences. Although he did not have the opportunity to finish his education and pursue the engineering career he had dreamt of, his sacrifices came to yield. Family has always been incredibly important to him, and the efforts and sacrifices he has made on his family’s behalf have added immeasurable value to his life.

As I tread through my final months of medical school I’ve come to realize more and more just how fortunate I am. Every day is a reminder of the advantage and opportunities I was granted due to my father’s sacrifices. I am now the same age that my father was when he left school, and I am fully aware of the advantages I have over him. But with these advantages come additional responsibilities. I will forever remember his efforts and sacrifices and do my best to honor them.   It is this passion that is the driving force of my life and my scholastic pursuits.

Featured image:
Opportunity by Susan Frasier

Categories
General Lifestyle

Semper Fi

In early medical practices, the translating of ailments into Latin and Greek amalgams created a language that set doctors apart from the general society. This boundary signified the value that doctors provided and created a group that could identify with each other because they held similar values and had comparable educations.

The use of the phrase “Semper Fidelis” in the Marine Corps serves a similar purpose.  More than just a slogan, it is a way of life for a select population. United States Marines are admired for their dedication to each other, their service, and their country. Marines are a group that is separate and unique from any other. “Semper Fi” translates to “Always Faithful.” This statement symbolizes the ability of common people to become part of a brotherhood that demands more of its members than any other comparable group.

We don’t have to be Marines to achieve the same discipline. As medical students, we can make this a practice as we transition into our careers. Marines are trusted to make significant, split-second decisions in an environment more dangerous and confusing than those in which most doctors operate. The battlefield is chaotic and information often unreliable. In a medical environment it is important to develop effective means of communication balanced with ongoing decision-making. In practice, however, this standard of communication is rare. Empowering front-line practitioners is vital to the success of the medical system. This is parallel to what Marines do. The Marines have standards; a reputation of excellence. There is a sense of being part of something much bigger than simply an organization. What the Marines understand is the same thing that the best doctors understand- success happens through failure. There is a sacrifice that comes with joining the Corps or becoming a physician. Not only must we surrender our weekend plans and sleep to meet the physical and mental demands of our chosen paths, but we are weighted with the notion that our everyday activities affect the lives of others. No matter how good our intentions, as doctors or Marines, we will not be able to overcome the problems caused by poverty, war, the spread of infectious disease, famine, or climate change. That doesn’t mean we can’t try to help people afflicted by these events. 

Why do we do all of this? Because we take pride in what we do.  Moreover, Marines and doctors alike truly care for the welfare of the human race. Veterans Day was November 11, a celebration to honor America’s veterans for their patriotism, love of country, and willingness to serve and sacrifice for the common good (Dept. of Veterans Affairs). 

 

Featured image: Marine Week Boston, 2010: A Bell UH-1N SuperCobra attack helicopter flies by in front of pinkish cloudy blue skies by Chris Devers

Categories
General Literature

A farewell to Oliver Sacks

In my life, I haven’t had many heroes. Yes, I have been fascinated with some athletes, scientists, artists, and people around me, but I cannot say that I have had many true role models. In terms of science and medicine, one soul in particular stands out – Oliver Sacks.

In my introductory histology & embryology course, a professor mentioned a funny story during a rather uneventful lecture concerning ocular histology. The story told of an interesting “optical illusion”, and the lecture suddenly became much more engaging. He briefly mentioned that the clinical tale presented was described by Sacks in “The Man Who Mistook His Wife for a Hat”[1]. I often leave many off-side notes, and in this instance I scribbled: do check this guy out. While revising my histology notes for the exam, I spotted this side-note in my “trademark” hieroglyphic handwriting and decided to follow up on it. With that, a new influence in my life began.

Most articles will state that Sacks was a British neurologist, physician, scientist, and prolific author. Although he was born in London, he spent most of his life in New York City. Sacks was a meticulous examiner and analyst of neurological disorders, and he devoted his life to patients who suffered from these debilitating conditions. Many of his works became classics and best-sellers in the arena of popular medicine.

Sacks’ book “Awakenings” was used as a scenario for a major Hollywood motion picture [2] . In this true story, Sacks used a new experimental drug, L-DOPA, to treat patients in a state of total paralysis due to “encephalitis lethargica”. The treatment looked promising, as patients seemed to be resurrected and displayed dramatic improvements over their original condition. Unfortunately, the patients eventually regressed, once again falling into despair; once again drifting through the abyss of mere existence, which is what they had been enduring for years before the L-DOPA treatment briefly brought them out of it (the infamous “on-off” pharmacological feature of L-DOPA/Levodopa [3]). This was only one of many adventures that Oliver Sacks embarked upon and described in his novels. He was an intelligent, witty, compassionate, and truly unique writer and clinician who knew how to transpose the emotions, atmosphere, and feelings he encountered during his medical career.

In medical education, we explore different avenues – from basic to clinical sciences, bench to applied medicine, bedside to operating room, small rural ambulances to comprehensive medical centers. We try to reach a correct diagnosis. We try to adjust and find a sweet spot in our therapeutic modalities. We do our best to cut out what is sick and preserve what is still functional. Likewise, we are all attracted to different things. My “thing” is the nervous system and it has been for quite some time. If I was ever in doubt about such a choice, people like Sacks were there to remind me of my passion. Sacks’ stories of neurology and intricate brain puzzles consumed my attention on a daily basis. A few of his books, in particular, made a profound impression on me.

In “Musicophilia”, Sacks writes about the relationship of music and neurological disorders [4]. I was impressed when I learned how different clinical neurologic entities like stroke, cerebral hemorrhage, or head trauma can modify the processing of the sound and even alter someone’s musical inclinations. Likewise, in his book “Hallucinations” he talks extensively about how hallucinations can be generated as a consequence of trauma, drugs, or other physiological alterations [5]. Reading through Sacks’ books, I am continuously re-fascinated by his scholarly capacities alongside his humble and gentle nature. If the equation of human ego equals 1/knowledge, then Sacks had a miniscule, irrelevant amount of ego within himself. I rarely encounter such a trait these days, especially on the wards in daily clinical routines.

The last day of the August was humid and I had just returned home from a beautifully refreshing swim. I was soon struck with the news that Sacks had passed away. I was overwhelmed by the feeling of sadness. The world lost an outstanding individual, a soul that will be dearly missed by many. A few months earlier, in his New York Times column, Sacks wrote that he was diagnosed with metastases originating from his ocular melanoma. In this farewell piece, Sacks sensed his end was near and reflected on his life, which was well lived by any standard [6]. He announced that his final work, an autobiographical sketch of his life entitled “On the Move: A Life”, would soon become available [7]. His life was one of compassion and dedication; he was a source of warmth and kindness for those who were in need. He genuinely understood human suffering and worked to alleviate it to the best of his ability. Although I lived in New York City during my college days, I did not have the privilege of meeting Sacks. Regardless, I can find some consolation in the fact that he only departed physically – his writings, works, and grand opus will continue to inspire generations of minds to come. Goodbye, dear Dr. Oliver Sacks and thank you!

References

  1. Sacks O. The Man Who Mistook His Wife For A Hat: And Other Clinical Tales: Odyssey Editions; 2010.
  2. Sacks O. Awakenings: Knopf Doubleday Publishing Group; 2013.
  3. Lloyd K, Davidson L, Hornykiewicz O. The neurochemistry of Parkinson’s disease: effect of L-dopa therapy. Journal of Pharmacology and Experimental Therapeutics. 1975;195(3):453-64.
  4. Sacks O. Musicophilia: Knopf Doubleday Publishing Group; 2008.
  5. Sacks O. Hallucinations: Pan Macmillan; 2012.
  6. Sacks O. My Own Life New York, NY: The New York Times; 2015 [cited 2015 02/19/2015]. Available from: http://www.nytimes.com/2015/02/19/opinion/oliver-sacks-on-learning-he-has-terminal-cancer.html.
  7. Sacks O. On the Move: A Life: Knopf Doubleday Publishing Group; 2015.
Featured image:
oliver_sacks by Mars Hill Church Seattle
Categories
General MSPress Announcements Public Health Reflection

“Fulfillment in Practice”: Dr. Howard K. Koh, 2015 Commencement Address of the Yale School of Medicine

We are excited to publish the final contributor to this year’s Commencement Archive, Dr. Koh’s 2015 commencement speech to the Yale School of Medicine, “Finding your calling.”

Howard Kyongju Koh is the former United States Assistant Secretary for Health for the U.S. Department of Health and Human Services (HHS).  

Screen Shot 2015-10-06 at 8.08.49 PMDr. Koh oversaw the HHS Office of Public Health and Science, the Commissioned Corps of the U.S. Public Health Service, and the Office of the Surgeon General. At the Office of Public Health and Science, he spearheaded programs related to disease prevention, health promotion, the reduction of health disparities, women’s and minority health, HIV/AIDS, vaccine programs, physical fitness and sports, bioethics, population affairs, blood supply, research integrity and human research protections.

Dr. Koh graduated from Yale College and earned his medical degree from Yale University School of Medicine. He has earned board certification in four medical fields: internal medicine, hematology, medical oncology, and dermatology, as well as a Master of Public Health degree from Boston University. 

Dr. Koh previously served as the Harvey V. Fineberg Professor of the Practice of Public Health, Associate Dean for Public Health Practice, and Director of the Division of Public Health Practice at the Harvard School of Public Health.  

Dr. Koh begins his speech by advising students to find meaning and fulfillment in medicine, regardless of external expectations,

“Please listen carefully to your inner soul so that you can discover your own sacred calling.  Doing so will help you express yourself, not just prove yourself. Doing so will help you determine in your life what is ultimate versus what is merely important.”

He continues by reminding students that patients will be teachers as well, and may be key factors in finding that calling,

“One way to learn more about meaning through your journey is to respect how your patients find meaning in their own. They can teach you in unexpected and profound ways. Sometimes the patients who will educate you the most will be the ones you couldn’t cure, no matter how hard you tried.”

He concludes and advises students to enjoy every step of the way,

“So please pay great attention to how you live your lives, not just as doctors, but as individual human beings.”

Visit the Medical Commencement Archive to read Dr. Koh’s full speech here