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Medical Humanities Section Newsletter - April 2012

circle_arrowFrom the Chair - Medical Humanities Section Newsletter, April 2012
circle_arrowFrom the Editor - Medical Humanities Section Newsletter, April 2012
circle_arrowTwo People Talking Stars - Medical Humanities Section Newsletter, April 2012
circle_arrowGentle Radiance at Sunset - Medical Humanities Section Newsletter, April 2012
circle_arrowBrewery Tour - Medical Humanities Section Newsletter, April 2012
circle_arrowCoronary Arteries - Medical Humanities Section Newsletter, April 2012
circle_arrowFingerprints in the Mud - Medical Humanities Section Newsletter, April 2012
circle_arrowUnder a Tuscan Moon - Medical Humanities Section Newsletter, April 2012
circle_arrowWindows. Siena, Italy - Medical Humanities Section Newsletter, April 2012
circle_arrowShopping on Christmas Eve - Medical Humanities Section Newsletter, April 2012
circle_arrowtulipsarebetterthanone - Medical Humanities Section Newsletter, April 2012
circle_arrowwaterlily 1 - Medical Humanities Section Newsletter, April 2012
circle_arrowThoughts from a new doc - Medical Humanities Section Newsletter, April 2012
circle_arrowAnnual Meeting Minutes - Medical Humanities Section Newsletter, April 2012

From the Chair - Medical Humanities Section Newsletter, April 2012

Jeffrey Sankoff, MD, FACEP  

It’s funny how bad movies can often provide us with memorable lines. I am certain that I can’t be the only person saddened by the endless torrent of films née comic books streaming from Hollywood over the past several years? And how is it that bad franchises can suddenly reinvent themselves with “reboots” only to subject us to more bad franchises?  

I digress.  

At any rate, one of the early bad comic book turned movies provided us with at least one memorable line that I find somewhat relevant to the position I find myself in today as the newly minted chair of the ACEP Section of Medical Humanities; “With great power comes great responsibility.” Now if only my position came with some actual power to go with all of the responsibility! Oh well. 

Still, it is no small feat to step into the shoes of Hans House who piloted this section so admirably over the past several years. To paraphrase yet another movie quote, “I could only succeed him” and never replace him. I know that I speak for everyone in the section when I voice a huge thank you to him for his efforts. 

And while I am on the subject of thank yous, Tracy Napper and Pete Paganussi also deserve our thanks; Tracy as our ACEP staff liaison and Pete as our long-serving newsletter editor. Without them this section would cease to exist! And thank you of course to the membership for supporting me as chair; I am eternally grateful. 

And so, I am eager to help keep this section growing and relevant to its membership. Emergency physicians are an extraordinarily talented bunch and it is a privilege to work with them and for them in this section. I am very much looking forward to contributing to the section in any way that I can and especially to the opportunity to showcase my adopted hometown of Denver at this year’s Scientific Assembly. I welcome input from any and all of you for how to increase our membership and make our talented members visible and a valued aspect of ACEP. I am excited for my term!


From the Editor - Medical Humanities Section Newsletter, April 2012

Peter J. Paganussi, MD, FACEP  

This issue of MUSE is full of images. There are actual images including photographs and paintings by section members. There are also beautiful cerebral images in the poetry and prose forthcoming. They are literally a feast for sore eyes and a respite from the doldrums of winter. We offer them for your enjoyment. 

We begin with two stunning photographs from Dr. Jay Kaplan. When well done, black and white photography is visually striking. These two photos are prime examples. They speak to emotion and something visceral that is not solely visual. 

We follow with Dr. Hans House’s piece on his looking forward to visiting Denver for ACEP in October. He recalls taking a brewery tour there on a previous visit. Dr. House is a former Chair of this section and has a real flair for travel writing. You can taste the fresh suds! The bonus was the owner being the parent of an ACEP member. Perhaps they can be convinced to join our section in time for the 2012 SA?  

Next up is an evocative painting by Dr. Paul Dhillon. Entitled “Coronary Arteries,” the painting has the feel of a Jackson Pollock-meets-coronary angiogram for me. I have found myself captivated by it while preparing this newsletter. Bravo, Paul. 

Dr. Ron Iverson delights the reader with his impressions of a trip to Slickhorn Canyon, a side canyon off the San Juan River in Colorado. You can clearly see the fossilized fingerprints Dr. Iverson examined while there. They conjure images of ancient human ancestors carving a life from nature. 

Yours truly has contributed two photos from my last trip to Italy. My wife and I stayed in the very heart of Tuscany in the eclectic little village of Panzano. Located midway between the cities of Florence and Siena, Panzano is located in the fabled Chianti region and produces some of the finest expressions of that storied wine. Photos are of the full moon rising over the olive groves and vineyards of Panzano. The other is a random look at windows in the ancient city of Siena.  

Next we have the poetry of Dr. Frank Edwards. The imagery contained within its lines evokes a modern Christmas brilliantly. Once again, Dr. Edwards shows why he has certainly become one of my favorite poets.  

Two vividly colored paintings by Dr. Gary Moreau follow this. Beautiful in their cacophony of color, they remind us that spring is just around the corner. 

Finally, I feel like I have saved a gem for the final piece. Dr. Nicki Mylnski contributes a wonderful piece on what it’s like to be a young emergency physician in community practice. Her musings touch us all at some level, wherever we practice and wherever we are on the timeline of our careers we can relate to her thoughts.  

Minutes of our last meeting at the 2011 SA in San Francisco can be found at the end of this issue. Please enjoy the talents of our most excellent section and as always thanks to those talented members who contributed to this issue. 


Two People Talking Stars - Medical Humanities Section Newsletter, April 2012

 talkingstars 
 Jay Kaplan, MD, FACEP 


Gentle Radiance at Sunset - Medical Humanities Section Newsletter, April 2012

 radianceatsunset 

 Jay Kaplan, MD, FACEP 


Brewery Tour - Medical Humanities Section Newsletter, April 2012

Hans House, MD, FACEP 

Only 28 miles away but in an entirely different world. 

In October 2012, the ACEP Scientific Assembly will be held in Denver, Colorado.  While you are there, I must recommend a short side trip to Boulder. My first visit to Boulder came this year when I attended a USC football game in November. 

I drove from Denver to Boulder and, nearing my destination, I came over a ridge and suddenly I could see the whole community below me. The entire mood of the world changed when I came into that view. I had struggled through maddening traffic in the ugly sprawl of apartment buildings and big box stores in Denver. Now, the traffic fell away, the setting sun reflected off the newly fallen snows on the Rockies rising above, and the urban sprawl shifted to fields and pastures. The trees were mostly bare with occasional late autumn leaves, even adorned with a falcons sitting on their branches.      

I checked into the hotel, a seedy motel just off the interstate. It was one of those places that is really cheap but tries to look classy by adding fake, plastic stained glass and wood paneling that is crumbling and dating from the mid-60's. I quickly put my stuff away and got on the bike path to the campus. I wasn't here for the hotel; I had come for something much more important: beer. . . er . . . uh . . . I mean football! 

I walked through campus to the stadium with a couple of other alums. The campus is beautiful; a meandering collection of sandstone-colored buildings around serene, well-kept quads. It must be absolutely amazing in the springtime- the occasional brooks would be filled with snowmelt, wildflowers would mingle among the evergreens, and the occasional afternoon thunderstorm would dance along the towering Rocky Mountains above the town.  At the time we visited, Boulder was just recovering from its first winter storm of the season; puddles and mud everywhere, partially melted snow, and the brown leaves were mostly shaken from the trees. But it was easy to see the beauty lying within. 

One striking feature of Boulder and the Colorado University (CU) culture is their sometimes obsessive dedication to environmentalism. It took a little getting used to, but the many steps they have taken towards sustainability is a big part of why Boulder is consistently rated at the top of most livable city and most healthy city indexes.  We walked on a bike path towards the stadium because it happened to run directly from the hotel to our destination. But as slack-jawed tourists gazing at the campus and the tailgating scene, we forgot that these paths are efficient thoroughfares to encourage bike riding for commuters. The local bikers were obviously inconvenienced by me consistently forgetting where I was and having to jump out of their way as they plied their road. I thank them for being very cool about it and not yelling at me. The campus architects tried to account for dumb people like me and designated lanes for bikes and for pedestrians. 

The Buffaloes made great hosts; very welcoming. I would put them on par with Arkansas and Notre Dame as some of the friendliest schools to visiting teams (not quite the level of Nebraska, of course. Nothing can ever match Husker Hospitality!).  This is a good thing, because I was expecting to be sitting in the CU alumni section.  

That's because I had made this trip without having a ticket for the game.  

Allow me to explain for a minute my approach to the art of scalping a ticket. I have gotten into some amazing games without a ticket ahead of time. My greatest coup had to be the 1997 USC-Notre Dame game. I passed on the $200 offers from the pros on the street and eventually landed a $40 deal from a Domer fan heading into the stadium. It turned out to be a field pass! It's fairly easy to get into any non-championship game when one is alone. It’s also not too hard for pairs. Any more than that and you can't expect to sit together. Each stadium has an area where the scalpers tend to gather. It is never adjacent to the stadium gates, and you can expect it to be relatively free of police presence. It is best to seek out the common approach to the stadium from the major street, not the alleys and quads used by students. Don’t buy from students. At CU, I walked along a driveway from the largest parking lot to the stadium. Hold your hand with fingers indicating the number of tickets you wish to purchase- above your head is best. If you have tickets to sell, hold the tickets in the same way. You will be approached with offers. A few certainties here: the salesman will always say, "These are great seats" (they won’t be). They will always start high and will be ready to haggle. Don’t take the first offer. Most importantly, know what the market value of the scalped tickets are before you go to the game. Check StubHub.com and see what the prices are (yes, you could just buy them from Stub Hub, but where's the fun in that?)  In this case, the value was not great because CU was doing so poorly; I estimated $60 would be a reasonable value to pay. Also, the price will go down the closer to kickoff (see Notre Dame field passes above). On Friday, I got lucky and found a seller at my pre-established price almost immediately (after the first deal fell through, see rule above). I never expect scalped tickets to be any good, but karma was shining on me again; they turned out to be 35 yard line, halfway up. Very cool. 

I entered the stadium early, eager to see CU's famous mascot Ralphie the Buffalo. It's a shame the game was at night, because the view of the mountains surrounding the town must be amazing. The Buffs are happy to embrace their mountain home; they proudly display the altitude of Folsom field on the scoreboard (5360 ft). I suppose it’s a not-so-subtle reminder to the visiting team that they will feel more winded sooner and serves to intimidate them into keeping the high altitude in mind.   

I found my seats, coincidentally situated next to a couple from Iowa! They are from Davenport but their daughter attends CU. We swapped Iowa winter stories and smiled amusingly while Southern Californians shivered and huddled in the 40-degree weather (really, folks- it was dry and no wind. Hardly a winter night by any means!  These Trojans need to pack on some extra fat like we Iowans do to get through the cold!) The folks from Colorado, used to enjoying cocoa on the slopes of their many ski resorts, enjoyed frequent visits to stands from the hot chocolate vendors. These guys were awesome; they carried trays of dozens of cups of cocoa along with a can of whipped cream ready to top off each purchase with a fresh dollop of milky goodness.   

Next up was the much anticipated run of Ralphie the Buffalo. As a Trojan, it’s hard to admit that there could be a better live mascot than Traveler, the elegant and spirited white Arabian horse that celebrates every USC touchdown with a march down the sidelines to “Conquest.” But having a half-ton buffalo lead your team onto the field chained to 5 sprinting underclassmen is a very dramatic sight. On this night, she (yes, Ralphie is a girl buffalo, a boy buffalo would be just too big) got so excited she broke free of her handlers and made the last half of her run unaided, scattering cowboy-hat-clad boys across the field. She knew the routine well and headed straight into her waiting trailer; she was obviously content to put on her show, get the crowd fired up, and head for home. She didn’t need any wranglers trying to cramp her style! The reaction from the crowd was unanimous- we loved it! I can best describe the feeling as watching an ancient Roman gladiatorial game and rooting for the lion! As the game was winding down, I grew increasingly thirsty. I headed out on a quest for a fine handcrafted beer made with local Rocky Mountain Spring water (no, not Coors). Enter “Brewery” and “Boulder” into Google maps and you get no less than 9 entries in the general downtown area. My plan was to try a flight at each, which soon proved to be an impossible task. But a selective sample was reasonable. I started with Walnut Brewery, an orderly, well-appointed pub with lots of room. Their Irish Red was good but overall unexciting and their Nut Brown was fairly standard. I learned later that Walnut was recently purchased and is now operated by Gordon-Bierch. Like you might expect from a commercial chain operation, the service was efficient and the décor inviting, but the beers lacked that dramatic, homey, individualized taste I was seeking. 

Next up was BJ’s Brew House. This was exactly what I had in mind. I sat at the end of the long bar, set up in front of a dozen small beer tanks, and asked for a flight of their beer choices. The bartender was friendly and knowledgeable, and quickly served me a flight of 10 flavors complete with tasting notes. The Piranha Red and the seasonal Pumpkin were both out of this world. Delicious, smooth, and unique; a real joy to drink. By the end of the flight, I was starting to get a little winded- the altitude was getting to me (or I had just drank 40 oz of beer in a few minutes, I’m not sure  which).  Knowing that I was nearing the end of my rope, I resigned myself to one last stop. With so many left on my list I asked the bartender for a recommendation. He directed me to the Mountain Sun Pub and Brewery.   

The Mountain Sun is a quaint, tiny, corner bar and restaurant that obviously believes in three things: progressive, pro-environmental politics, indulgent takes on organic dishes, and independent unique home-brewed beer. This place was very hippie. It is also very popular, packed solid at 12:30 am. I tried the XXX Pale Ale, promising an extra dose of hops and barley. I got all that and more; it was the kind of ale you eat with a fork.  mpressive and overwhelming. The rest of their beer menu can be viewed at: http://www.mountainsunpub.com/beer_menu.pdf Also, one brew pub I missed on my tour that I will be trying next time is The Kitchen. They specialize in pairing fine food with a diverse beer selection. Best of all, the owner is the son of an ACEP member! Here’s their beer menu: http://www.thekitchencafe.com//artman/uploads/New2009Menus/New_Long_BistroList_BEER.pdf  

The last stop on my beer tour was Illegal Pete’s, a local institution serving the best burritos available at 1 am. I needed some sustenance to soak up the yeast and barley churning in my stomach. I inhaled the carnitas burrito in a few swallows. Food always tastes better when you’re hungry. And tired. And drunk.   

The hotel is on the south edge of the campus. The stadium is in the north end of the campus and downtown is a few blocks to the northwest of the stadium. So I was a long way from my bed; a challenge normally solved with a simple cab ride. But the friendly lady on the other end of my call to Yellow Cab enlightened me that there was at least an hour wait for a ride. Ouch. Against my better judgment (and really, who would actually have good judgment after an evening of football and three brewpubs), I walked back to the hotel. I am actually glad I did. The weather was tolerable, the campus was worth another look, and the stadium gates were wide open, allowing me another stroll through the stands. I hardly noticed the time and found my hotel soon enough, collapsing into a deep, dreamless sleep to begin the recovery.   

I know this: Boulder makes for a great road trip and I can’t wait to come back. The Buffs have a dedicated fan base, a tremendous mascot, and a gorgeous campus, not to mention being in one of the friendliest and most beautiful towns in America. Take a look when you are in Denver this year. And try BJ’s, Mountain Sun, and The Kitchen.  And make sure you have a sober ride back to Denver! 


Coronary Arteries - Medical Humanities Section Newsletter, April 2012

 coronaryarteries 
 Paul Dhillon, MD  


Fingerprints in the Mud - Medical Humanities Section Newsletter, April 2012

Ron Iverson, MD, FACEP   

Sticks and mud press together in the shadows of this high, sun-baked sandstone ledge, clawing into the recesses of the rock, clinging to it, holding tightly together in defiance of time and the elements which conspire to turn them to dust. These sticks and mud bear the bony impressions of fingers–fingers belonging to those who once lived here, those who meticulously pressed the mud into the sticks to form walls to keep out the cold winter wind. These fingerprints are what is left of those who lived here 700 years ago. They attest to the determination and skill of these people who met nature as did the wolf, fierce in its desire to defy death. 

As the only earthly creatures clearly cognizant of our own mortality, we are cursed with the knowledge that one day we shall die. It is our instinct to strive to achieve immortality. Immortality found, if not in the flesh, then by other means. The ancient ones have left behind remembrances of themselves in their structures, in their art, and in their fingerprints. 

I am on a sandstone ledge in Slickhorn Canyon, a side canyon of the San Juan River in the Colorado Plateau. The canyon is in shadow but for this ledge. There is no perceptible movement 300 feet below. There is no sound but a tiny trickle of water in distant unseen grotto. The sticks and mud remain motionless, timeless, in the shadows. The fingerprints have given these ancient people immortality.  

Immortality is what we seek. It is what drives us to write, to sing, to tell stories, to work for solutions to problems like global warming, environmental destruction, poverty, and to dance the hokey-pokey.                                               

It is what drives us to leave fingerprints in the mud.


Under a Tuscan Moon - Medical Humanities Section Newsletter, April 2012

tuscanmoon 
Peter Paganussi, MD, FACEP 

 


Windows. Siena, Italy - Medical Humanities Section Newsletter, April 2012

windows 
Peter Paganussi, MD, FACEP 


Shopping on Christmas Eve - Medical Humanities Section Newsletter, April 2012

Frank J. Edwards, MD, FACEP  

K Mart , Eleven PM,  Christmas Eve
May be the loneliest outpost in the Universe,
Not a place of vacuum and dark matter
(For what could be lonely about that?)
But here where the dulcet voice of Karen
Carpenter floats down
Like tinsel
From speakers above the
Ceiling squares
Upon the heads
Of we few
Plodding the barren isles,
While a skeleton crew of clerks
Eye the clock.

We are here tonight for many reasons.
Perhaps we had simply tried too hard
To find the perfect gift 
Several weeks ago
And failing that,
Had put it out of mind. 

Now, with the snow turning to slush
In the forlorn space of parking outside
We’d settle for anything
Not frankly cheap or mean. 

But even that hope shrivels as we pause again
Before the shelf of decorative clocks,
The rack of felt slippers,
The parade of audacious action figures
From some parallel universe,
While Karen Carpenter plumbs the depths
Of I’ll be home for Christmas. 


tulipsarebetterthanone - Medical Humanities Section Newsletter, April 2012

 tulips 
 Gary Moreau, MD, FACEP  

 


waterlily 1 - Medical Humanities Section Newsletter, April 2012

waterlily  
Gary Moreau, MD, FACEP 


Thoughts from a new doc - Medical Humanities Section Newsletter, April 2012

Nicki Mlynski, MD  

I am the first physician of my family- the first generation, actually, to go to college.  Maybe that contributes to my ignorance. Or maybe it's the secret tree-hugging hippie that lives inside of me. Regardless of the etiology, I went into residency thinking that I would be able to make some people feel better. I finished residency and actually had the notion, “I am a physician. I am a healer.” 

It's only my second year out in practice and I'm starting to wonder if maybe I need to redefine my self-proclaimed title. 

The percentage of times that I actually make a diagnosis "go away" is dismal, at best. Maybe your occasional chronic abdominal pain ceases momentarily with a fill of Dilaudid and Benadryl coursing through veins.  

Splint a broken bone... okay, a temporary fix. 

I do often reassure… the atypical jaw pain that started after doing morning push-ups, you super healthy, buff young father with a negative treadmill stress test one week ago- actually, yes, you're having this thing we call an NSTEMI. Let's call cards.  

Or don't worry, mom, your 13-year-old daughter is neither pregnant nor plagued with appendicitis; go on home and get some sleep. 

But when do I heal? I offer up that question to the folks who are seasoned (and love their job because I'm already over the pessimistic "I don't get paid enough for this crap" docs whose complaining I often listen to). 

I really do enjoy my job, but it's more about the other stuff, don't you think? 

Today, a 93yo DNR/DNI woman presented with acute onset AMS. It took a few hours, but the MRI confirmed a large pontine stroke. Gazing about the room, she couldn't use her arms or legs in any acceptable fashion, and last night she cooked dinner for her entire family. There was no saving, no healing. I held her hand, looked her in the eye and told her the diagnosis. Then spent the rest of nine hours trying to “place” her because medicine wouldn't "waste the bed on her," the hospice nurses were all gone for the night and the family was a bit overwhelmed to just take her home as is. 

I spend so much less time chest thumping than is advertised. Less maverick-ing, less healing. I am a glorified triage person some days, but I am so okay with that phrase. I'm an advocate, a good listener, and still a stickler for detail like dropping the ACE inhibitor for that chronic dry cough. I am a fresh set of eyes. 

And, I don't get paged in the middle of dinner. Ever. I make a really amazing salary, especially compared to the fact that a quarter of the people I know are un- or under-employed. I am the first line to a major disaster, which I am happy are few and far between. I leave my job most days thinking that although I didn't “crack any chests” and save several lives, I still came out ahead. 

Nicki Mlynski finished residency at Emory University and spent a year as faculty there before starting a short stint as a locums doctor. She’s currently working in a tiny ED in the far reaches of Northern Washington state.  


Annual Meeting Minutes - Medical Humanities Section Newsletter, April 2012

American College of Emergency Physicians 
Section of Medical Humanities  

October 16, 2011
San Francisco, CA 

MINUTES  

Participating in all or part of the meeting were: Judith Dattaro, MD, FACEP; Hans R. House, MD, DTMH, FACEP; Jay A. Kaplan, MD, FACEP, ACEP Board liaison; Cindy C. Bitter, MD, FACEP; Robert C. Solomon, MD, FACEP; Andrew Parker, MD

Others participating: Tracy Napper, ACEP staff liaison. 

Agenda 

1. Call to Order                                                                                                                                               

2. New Business                                                                                                                                 

  • “Open mic” discussion                                                                                                        
  • Officer elections                                                                                                                  
  • Web site development/newsletter expansion                                                                        
  • Writing Award for 2011
  • Humanities Curriculum

3. Adjourn                                                                                                                                      

 Major Points Discussed  

1. The meeting was called to order by Hans R. House, MD, DTMH, FACEP, immediate past section chair/acting chair 2010-2011.  

2. New Business 

  • “Open Mic” – Dr. Amber Crowley is organizing the performers again this year. We have secured a sponsor, Hagan Benefits, for this year. The $3500 sponsorship pays for the piano, a/v technology, food, and cash bar. Members are reminded to come to the event and to bring guests. Ways to advertise the event were also discussed. We will add photos to the section Web site as well.
  • Dr. Jeff Sankoff was elected to the chair position. Dr. Paul Dhillon is the new councillor; Dr. Judy Dattaro is the alternate councillor. Dr. Peter Paganussi will continue as the newsletter editor.
  • Ways to increase membership attendance at the section meeting were discussed. The meeting may be moved to just prior to the Open Mic event next year to encourage participation. Members were reminded to submit items for the Web site and newsletter. These can be emailed directly to Pete Paganussi. 
  • The Writing Award for 2011 was given to Dr. James Fleming for his excerpt from his novel, “Tengo Sed.” Dr. Fleming was unable to attend. Articles will be solicited for the sixth annual award in June 2012.
  • The section has long wanted to promote a humanities curriculum. Dr. Bitter has volunteered to write a newsletter article describing the components of a humanities curriculum and the benefits to residents of such a curriculum.

The meeting was adjourned. 


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