Join Section

Medical Humanities Section Newsletter - August 2008 - Vol 4, #3


circle_arrow MUSE – Paths & Journeys – Summer 2008
circle_arrow From the Chair
circle_arrow Photo: The Path of Christ – Panama
circle_arrow Table Rock Rescue
circle_arrow Eleven Weeks
circle_arrow Critical High
circle_arrow Photo: Looking West
circle_arrow Winter in April
circle_arrow Whispers: Ascoltare Il Vento
circle_arrow Updated Operational Guidelines Review

Newsletter Index

Medical Humanities Section


MUSE – Paths & Journeys – Summer 2008

From the Editor
Peter J. Paganussi, MD, FACEP
Inova Fairfax Hospital, Fall Church, VA

Welcome to our summer edition of MUSE, the newsletter of the Section of Medical Humanities of ACEP. In our last edition the "theme" was winter’s weight and whimsy. This edition has a theme of "paths & journeys." I am very excited about this particular edition and I had a lot of fun putting it together. I have always thought that emergency physicians were very active and adventurous as a group. We tend to be active in our "down time." I believe it is a specialty that attracts a certain type of individual, one with an adventurous spirit. We are the type of people who don’t just sit still or lie around. We are the types who "just do it." This is what I love about the people in our chosen specialty. So this issue is all about that sense of adventure. It is about what’s around the next corner. It’s about living life to the fullest. I believe this issue will not disappoint you. The incredible talents of the members of this section continually amaze me and they are on full display in this publication. I assure you that you are in for a real treat as you move through this edition.

There are sights (some really great photographs), brain food (some very well-done articles and poetry), and even (for the very first time) sounds. That’s right, we are including an MP3 file that contains the musical talents of Dr. Liz Mitchell. The articles fill out the other senses, so short of aromatherapy we have all of the five senses covered.

We begin with a piece from our chair, Dr Hans House who writes about a trip to the ACEP Scientific Assembly in San Francisco. In his own inimitable style he dispels an old myth and takes us to that storied city "Where little cable-cars, climb half-way to the stars…" I have always loved San Francisco and now Dr. House has given us much to think about.

Next is an excellent black and white photograph taken by Dr. Nicholas Strange while he was on a medical mission in Panama. I love this photo and it is called "The Path of Christ." It was the very first piece I received for this edition and it helped me develop the theme.

This is followed by a story from Dr. Seth Hawkins. Seth has written a stirring piece about a wilderness medicine rescue. He takes us through his involvement in wilderness medicine and I feel it leaves the reader with a true sense of excitement. Enjoy it!

The next entry is a truly haunting piece of poetry from Dr. Ron Iverson. The poem "Eleven Weeks" is about a miscarriage in the emergency department. Carrying a child in the womb is truly a "path & journey’; however, it doesn’t always end the way it should. Dr. Iverson tenderly captures the moment.

Next we have a very special piece by Dr. Janis Tupesis. Dr. Tupesis shares with the reader a very personal moment when he was diagnosed with new onset diabetes while an emergency resident. The following year he climbed in the Himalayas and includes a magnificent photo. Truly in keeping with our theme Dr. Tupesis actually sent this to me this past March, and this article along with the photo by Dr. Strange gave me the idea for our theme.

Following this is a photograph sent in by Dr. Dave Baehren. It captures and punctuates the mood and feel of this edition. It is called "Looking West."

The most exciting entry is perhaps the next one. We have included an MP3 file for your listening pleasure. It is a recording by Dr. Liz Mitchell and I have included her notes and lyrics of this truly haunting work "Winter in April." I am thrilled to be able to share it with everyone. Liz is amazingly talented and we are very lucky to have her as a member of our section. Play the file and see who she reminds you of. (Hint: She reminds me of a songstress from the 1960’s…dated Stephen Stills and inspired him to write "Suite: Judy Blue Eyes"…but, I won’t tell you who. I actually think Liz has a better voice…and better pitch.) Bravissima, bella!

Finally, I leave you with a work of my own (photos included). I am a 4th generation American of Italian ancestry with little or no ties to the "old world." In my 49-plus years this was my very first trip to the land of my ancestors. My family mostly hails from the north of Italy (ie, Parma and Piacenza) and I have always wanted to see the mountains and the lakes in the north. I present you with my very own "Alex Haley moment." Most people go to Italy for art, museums and churches. I went for hiking, scenery and food. I found them all, and a whole lot more.

I hope you have as much fun reading, and listening, to this edition as I had putting it together. As emergency physicians we are on a continual "path & journey." Below you will find some that I am sure you can relate to, and others that will touch your soul. Here’s to our paths and journeys, wherever they may lead us. After all, it’s not about the final destination, it’s all about the getting there and what may occur along the way.

Ciao, i miei amici.





Back to Top

From the Chair

Coldest Winter
Hans House, MD, FACEP
University of Iowa, Iowa City, Iowa

It is hard to not be inspired to write when I am sitting 31 stories into the sky at a desk set before a panoramic view of San Francisco Bay. I am at the Marriott Hotel, the headquarters for the ACEP Scientific Assembly in 2004, watching the mighty Pacific marine layer slowly pull away its veil from the water and bridges of the bay. Each day, the ocean rolls tendrils of cool mist across the city and most afternoons it releases its icy grasp to give the citizens of San Francisco a few hours of sun-drenched relief. This cycle of cool morning fog and hot afternoon sun is a pain for city dwellers but a blessing to the grape vines in the valleys to the north. Without it, we would never know the smooth buttery-oak flavor of a good Napa Chardonnay.

The biggest problem with San Francisco’s unusual weather patterns is that it actually gets colder in summer time. That can be quite a shock when you step off a plane from Iowa where it’s just above 80 during the day and just below 80 at night. Dressing for that weather is fairly straightforward: just grab a pair of shorts and a t-shirt and you’re good to go all day. But in a San Francisco summer your attire ranges from jeans and a fleece for your morning stroll to Starbucks to short-sleeved shirt at the farmer’s market in the afternoon, and back to windbreaker in the evening when that bitter wind comes sweeping off the bay. No wonder Mark Twain wrote, "The coldest winter of my life was the summer I spent in San Francisco."

Just one problem: he never wrote that!

According to and a Mark Twain biography site, no evidence of that quote has ever been found among his works. However, in 1879, he did write that last time "he could recall such a cold winter was last summer." Unfortunately, he was referring to a summer in Paris, not San Francisco. With all due respect to America’s greatest humorist, I have been to Paris in summer and found it to be quite pleasant. Cool, yes, but pleasant. San Francisco is not.

Mr. Twain (er . . . Mr. Clemens) certainly would have known about the weather in San Francisco, where he worked as a newspaper correspondent starting in 1864 with the San Francisco Daily Morning Call. He gained national attention the next year when his story, "Jim Smiley and His Jumping Frog" was published in the New York Saturday Press. From there he went on to publish other travel-related stories in newspapers and magazines until his first book was released in 1867. The rest, as they say is . . . well, you know.

Mark Twain was in San Francisco for that city’s 1865 earthquake (not the "real" great one of 1906). Here’s how he described his experience:

"A month afterward I enjoyed my first earthquake. It was one which was long called the "great" earthquake, and is doubtless so distinguished till this day. It was just after noon, on a bright October day. I was coming down Third street. The only objects in motion anywhere in sight in that thickly built and populous quarter, were a man in a buggy behind me, and a street car wending slowly up the cross street. Otherwise, all was solitude and a Sabbath stillness. As I turned the corner, around a frame house, there was a great rattle and jar, and it occurred to me that here was an item!–no doubt a fight in that house."

I am sure Twain rushed back to his desk to write his newspaper story, but I wonder what he had for a view to inspire him. I can be certain that he didn’t have the vantage I am enjoying from 31 floors up in my hotel. Yet back in Twain’s day there were some hotels with spectacular views.

One of these fabulous old hotels is the San Francisco Fairmont. Perched atop Nob Hill, a ridge straddling downtown and Chinatown, the Fairmont, along with its antique twin the Mark Hopkins, enjoys an ideal location, assuming you don’t have to walk up to them from far below in Union Square. My wife Kristi was fortunate enough to have a business dinner event in the Crown Room at the Fairmont, a room with by far the best view in the house. She sipped a flight of Napa wines as day turned to dusk and dusk turned to night. To her left, the Golden Gate Bridge was bathed in the rays of the setting sun as it valiantly held the icy marine layer at bay for a few more precious hours. Ahead stood the Transamerica Pyramid, Coit Tower, and all the lights of downtown stirring to life as the sun faded from the sky. And to her right lay the Oakland Bay Bridge, the arts district of SoMa (South of Market) and Pacific Bell Park . . . er. . . AT&T Park, the home of the San Francisco Giants.

The view from the Fairmont is certainly wonderful now. But it was not so pleasant when it first opened. It just so happens that the hotel opened in 1906, only a couple of weeks before the "real" great San Francisco earthquake (and two years after Twain’s death). The structure survived the quake but was damaged by the fire. Her grand opening was to be delayed one full year, when the gala event featured 300 lbs of turtle, 13,000 oysters, and fireworks over the bay. Why did they serve turtle? I have no idea; I’m sure it made sense to them at the time. Kristi was not served turtle; she enjoyed grilled vegetable risotto and a white chocolate tulip with fresh raspberries. But she says she would have been happy to try the turtle and oysters.

Where was I during this enchanting spectacle? Her dinner was not open to spouses, so I was on my own for those couple of hours. In case she decided to leave the dinner early, I chose to make myself available at a moment’s notice by taking up a perch on a barstool in the same building. I hurried through the night up Nob Hill from Union Square (when I say up, I really mean up- see "crappy location of Fairmont," above). I had expected to wait in the lobby bar- an opulent yet sterile and predictable ambiance of neo-classical extravagance. But when I arrived at the hotel I was intrigued by the name of another bar, this one in the basement: the Tonga Room.

At a glance, I knew the Tonga Room was my kind of cheesy. Tiki figures, bamboo walls, thatch roofs over the tables, a pool with floating boat, and even a simulated thunderstorm with flashing lights and rain from overhead sprinklers every 30 minutes. The dance floor is decorated like the deck of a sailing ship- complete with rigging and part of a sail. What is kind of cool is that the rigging and wood railing is actually from a real ship: the SS Forrester. The Forester was one of the last tall ships to make regular trips between San Francisco and the South Pacific. She would carry California lumber and other products to exotic Pacific ports and return with coral, crafts, and tropical hardwoods. And now its gutted remains sit mostly unrecognized in this tourist trap of a bar.

I settled into a corner barstool, ordered a daiquiri, and amusingly took in the wonderfully cliché surroundings. I about fell off my barstool laughing when my drink came- complete with one of those tiny paper umbrellas! The extreme irony that I would find such a wonderfully cheesy place in the heart of San Francisco’s most prestigious hotel kept me smiling all night. To continue the tropical drink theme, I next ordered a Mai Tai.


A word of caution to those seeking to imitate this travelogue: don’t order the Mai Tai unless your single goal of the evening is to become intimate with the underside of your table.

Kristi found me an hour later curled up on a couch in the lobby. No, I am not quite sure how I got there. But I do remember purring contently as I nestled into the 400 thread count throw pillows while listening to the antics of three teenagers from France on the next couch over. Kristi rescued me from my stupor and poured me into a cab for our ride back to our own hotel. Next time, we should stay at the Fairmont. I gotta try another one of those Mai Tais!




Back to Top

The Path of Christ – Panama

Nicholas Strange, MD
Akron General Medical Center, Akron, OH







Back to Top

Table Rock Rescue

Seth Hawkins, MD, FACEP
Mountain Emergency Physicians, Morganton, NC

It was in the last 5 minutes of my EMS office hours that the pager sprang to life. As an emergency physician, I have very little call responsibility, so my pager is usually a plastic annoyance that gets in the way when negotiating close seating in restaurants. However, when it does erupt into an insistent cacophony of beeps, it usually represents an emergency for our wilderness EMS rescue team and pre-empts anything else going on. At those times my world shrinks to its iridescent screen, which may suddenly dictate the remainder of my day.

"Hiker, fallen on climb at Table Rock, Spec Ops medics needed," it read this time. Spec Ops is our EMS Special Operations program, which certifies a select group of paramedics to perform technical rescue and wilderness medical interventions. They perform about sixty missions a year, and as the oldest EMS-based wilderness rescue service in NC, have built up a reputation that has continued to attract some of the best medics in the region. I, on the other hand, represent a new addition as a medical director, and as a physician may be a help or a hindrance. I suspect the jury is still out in their minds.

It is hard to adequately serve both paramedics and patients during an ED shift, so I dedicate a few hours a month – "office hours" -- to sitting in our county Emergency Operations Center, exclusively available to paramedics. These office hours were just wrapping up, so I figured I could make this call. I walked over to the dispatch center at the other end of our building to find out the details before I headed out. Sometimes these calls end up being a stuck coon dog (no joke, our most recent call) or a standby, and the pages can be cryptic. A little early investigation can sometimes prevent later frustration, such as finding I’ve responded to a miscoded call for a patient with a stubbed toe and no gas money to get to the hospital.

It was thoughts like this that occupied my mind as I heard the office door close behind me. Damn – rookie move. This hour of the day the doors lock behind you and I had no key to get in. The office had my jump bag, including climbing helmet and gear. Rookie.

The dispatchers, buried in their subterranean cave like high-tech gnomes monitoring and directing the day-lit action aboveground, confirmed that it was in fact a "real" call: a hiker had fallen on Table Rock Mountain, tumbling down one of the climbing routes and coming to rest on Lightning Ledge, about halfway down. I checked en route with them and jogged out to my car.

Emergency response to a wilderness scene is a somewhat strange thing. There’s an initial spurt of urgency, but usually a long and relatively uneventful trek to get to the impromptu command center, let alone the patient. Even driving with lights and sirens it is at least a 30-minute drive up to the Linville Gorge Wilderness Area and Table Rock Mountain. Half that drive is on treacherous hairpin-turn gravel logging roads. It is a testimony to the restraint of wilderness rescuers that there are so few crashes among responders on these roads.

The gravel slapped my SUV’s undercarriage and my emergency lights turned the leaves into fall colors as I flung myself through the woods. My mind drifted to what brought me here. This road was like so many others that had lead, one onto the other, towards a dream that there could be such a thing as a wilderness physician. A love of the outdoors, early training and volunteer work as a rural EMT before I’d even considered medical school, and a sincere desire to help people in distress had pointed me to medical school. Like so many medical students, sometimes it was only mentors, role models, and continued dreams about what I wanted to do with my degree that pulled me through dark times in my medical training, when it seemed I’d lost my way. And, driving up the dirt road to Table Rock, I still wasn’t sure that I had yet arrived, or that this dream of serving patients in the wilderness as a doctor was even feasible.

Eventually I pulled into the parking lot command center. Few people appreciate the logistics that go into a rescue of this sort. The patient had hiked up one of the back trails to the summit, and was walking near the climbing routes on the other side when she stumbled and fell. In an urban system, an ambulance would have come, splinted anything that hurt, treated her pain (or not, if you believe the literature!), and transported her to the hospital. They’d be back in service in thirty minutes. Move that same stumble to a remote rock climbing ledge, and the same initial mechanism of injury in this case lead to a consequent tumble down a rock face and an extraordinarily complex multidisciplinary operation ultimately involving eight agencies, more than 6 hours, and over fifty providers spread out across the wilderness area.

The command team was sorting out resources and the patient’s status. I walked over to Sean*, the incident commander. "Oh, hey doc," he said distractedly. "Good to see you. The patient’s a girl who fell over the edge onto Lightning Ledge. There’s a friend up there now who was able to talk to her. She thinks she lost consciousness but doesn’t seem to be bleeding and her back hurts. We’ll need to decide whether she stays there or goes down tonight."

This is one of the hardest roles for a wilderness command physician. Emergency physicians are trained to direct paramedics remotely and make decisions about patient care over the radio. However, this type of care almost always assumes the patient is or will be shortly en route to a hospital. In this case, the underlying question Sean was implying was whether or not she would spend the night on the ledge, and whether we would get a helicopter. The sun was going down, and technical high-angle rescues are orders of magnitude more difficult -- and dangerous – by headlamp. If the patient was stable, there was really no reason a medic couldn’t rappel down to her with food, water, and sleeping bags, and spend the night until the sun came up. Of course, if she had a head injury, this could be a fatal decision. Our team had performed a helicopter nighttime high-angle pickoff – the first ever in NC – one year earlier, and this could be an option as well. But nighttime helicopter operations were even more dangerous than a technical lowering operation, and a crash could be enormously catastrophic in all sorts of ways. We put together all the clinical reports we could get, and decided to send in a team and bring her down as soon as possible without a helicopter.

But even the simple act of putting together a response team can be complex. In the post-9/11 world, "typing" emergency resources has gained even more emphasis. Despite this, on most large wilderness medical operations, a grab bag of operatives show up. The challenge to an incident commander is to put together functional teams from individuals whose background is sometimes unknown. Resource typing has not completely reached rural areas, and wilderness medicine is notoriously unregulated and in many ways lacks standards and universal terminology. In cases of specialized rescue, usually personnel are needed from multiple jurisdictions, and when they show up you hope their home agency has sent the right folks – or that they sent them at all, and that the responders are not just overly ambitious "civilians" with a scanner. I like to joke that resource typing in a wilderness EMS operation often amounts to looking at the stickers on a responder’s car, but this is an exaggeration. Somewhat.

So we all signed in and met each other and put together a response plan. One guy, after telling everyone frequently and insistently that he was a former Army Ranger, began hopping from one foot to another like he desperately needed to pee. "Let’s go let’s go let’s go let’s go," he began chanting in an irritated fashion. He was not alone. One of the premier wilderness experiential education schools is in our county, and we often depend on them for technical assistance during high-angle rescues. Their climbing instructors are some of the best in the country. But there is still a disconnect between their style of climbing, which values speed, simplicity and self-rescue, and a formal rescue operation, which privileges safety and organizational control. They couldn’t understand why we didn’t just immediately rappel down to the patient and lower her down. Mr. Former Army Ranger apparently agreed.

It wasn’t until we were hiking in and close enough to him that we could smell the unmistakable reek of alcohol. His behavior suddenly made sense in a terrible way. He was discreetly and rapidly removed from the insertion team. Goes to show: formal resource typing can only go so far. Ultimately, it is a dynamic art of on-scene size-up, not a cold detached review of certifications. Like medicine, Incident Command is an art as well as a science.

So, our modified insertion team continued the hike up to the site where the patient had fallen off the edge. Len*, a tall, strapping paramedic with a frank and infectious enthusiasm for wilderness medicine and rescue, had thrown the backboard we were carrying in on to his shoulder, and refused to allow anyone to help him. The rest of us stretched out behind him. It felt like any other hike, until we suddenly cleared the woods and stepped out into a breathtaking vista. The sun was setting over the Linville Gorge skyline and the Pisgah National Forest beyond was painted in various shades of purple and blue. The outlines of the team in front of me were suddenly cast in silhouette against a backdrop that has stunned human beings since they first explored these ancient Smoky Mountains. In the front was the tall outline of Len and the backboard, with responders in uniform spread out behind him. I swallowed hard with that sudden insight that hits you all once, not in stages, but like God is smacking you in the face like the dummy you suddenly realize you are. I was a doctor, I was hiking along the spine of a gorgeous ridge, with specialized rescuers I had helped train, to come to the aid of an injured hiker. It had happened. I had arrived at the place I had been dreaming of, and headed towards, since before medical school.

Hours later, Len and I lay back against the now-cool rocks at the top of the climb. It was now midnight and the bright moon had helped the operation. The patient was just reaching the ground and seemed to be fine. We were relaxing into that peculiar post-mission zone, where you talk about everything and nothing, and just let the emotions wash off you until you feel absolutely clean and whole. We had a panoramic view of the entire valley, and I could see my town twinkling in the distance. I imagined I could see the lights of my hospital, where I would be starting a shift in just a few hours. I knew that I would step outside sometime that morning, out into the ambulance bay and walk towards the helipad, and stare out at the South Mountains. I would still apply all the skill and compassion I could muster in the ED, but I would know my dream job – my heart – had been left up here in the mountains, where my meandering, joyful, painful path had finally delivered me. I had arrived.

*All names have been changed




Back to Top

Eleven Weeks

Ron Iverson, MD, FACEP
University of Wyoming, Casper, Wyoming

Eleven weeks
You carried your child
Within your womb
You nurtured this wonder
You thought of names
Decorated rooms
And dreamed

You dreamed of the birth
The cries, the smiles
Of dirty diapers
And tantrums, perhaps

You dreamed of him growing
Becoming his own
One day a child
The next day a man

You followed him through
College and more
He found his true love
And grandchildren for you to hold

He cradled you close
On your dying days
He laid the wreath
Upon your own grave

He’d carry you on
In his memory
Forever your son
The love there to be

Instead you are here
On a cold hospital bed
And with a burst of pain
A gush of blood
Your dreams come to an end

I hold your child
But four centimeters long
And I see your hopes
And your dreams are all gone

And now I know
Yes, I understand
I feel, as you cry
I am your physician
A tear in my eye

--Ron Iverson © 6/19/01




Back to Top

Critical High

Janis P. Tupesis, MD, FACEP
University of Chicago, Chicago, Illinois

 I looked at the digital readout in disbelief. "Surely an error," I thought to myself. I glanced down at the small drop of blood that had collected on my finger and then back to the glucometer. Another finger – another critical high value.

In retrospect, I should have seen this moment coming. The frequent trips to the bathroom that I thought were just a little too much morning coffee. The craving for anything liquid – water, juice, soda … it really didn’t matter. The slight change in vision I attributed to my glasses getting old. Even though I was only an intern, I should have seen this coming.

It was spring. Instead of worrying about my upcoming ICU rotation, I was worrying about things like Lantus vs. 70/30, One Touch Ultra vs. One Touch Elite. Long forgotten terms filled my head – Hemoglobin A1C, c-peptide, anti – islet cell antibodies. I kept thinking of how I should be worrying about finishing residency instead of how many times a day to check my blood sugar.

Fast-forward one year. A new set of terms now fill my head. Namche Bazaar, Sagarmatha National Park and the Khumbu Valley. The trek in from Lukla has taken two weeks. It has led me here, to the top of the Nepalese mountain Kala Patar. In the distance I see the morning sunlight illuminate the giant massif of Mount Everest. Tomorrow, I will set up at Base Camp; it will serve as my home and clinic for the next two months. But now, at 18192 feet, I am higher than at any point in the continental United States. "Critical high," I think to myself. CRITICAL HIGH.

Written May 15, 2005


Janis Tupesis



Back to Top

Looking West

David Baehren, MD, FACEP
University of Toledo Medical Center, Toledo, OH





Back to Top

Winter in April

Elizabeth Mitchell, MD, FACEP
Boston Medical Center, Boston, MA

This song was written on my birthday. I was living in Colorado at the time and there was an incredible snowstorm (in April). It was shortly before I moved to Boston, and all sorts of changes were going on in my life. I was looking forward, looking back, and looking at that beautiful moment in time.

Winter in April

A birthday of grace
A white hair a wrinkle
It’s snowing I’m laughing
It’s winter in April

Time trundles by
I roll along with it
The body my lover
To take what I give it

The passions unpossessed
The dreams that still haunt me
Oh all the lovers I’ve lost
The demons that taunt me

It’s not the lines round my eyes
Not the weather of summer
But your love
That will push me along

A birthday of grace
A white hair a wrinkle
It’s snowing I’m laughing
It’s winter in April

Listen to Winter in April on MP3






Back to Top

Whispers: Ascoltare Il Vento

Peter J. Paganussi, MD, FACEP
Inova Fairfax Hospital, Falls Church, VA

In general I would describe myself as a man of science. I am not especially "mystical" in nature. I believe that what most people see as mystical by and large are things or phenomenon that can be easily explained by science. In my experience science ultimately provides the answer, always and truly. History is replete with examples of this. Carl Sagan wrote his final book around the concept that, "Science is a candle in the darkness." I have generally ascribed to this philosophy all of my life. As a physician, I have made applied science my life’s work.

This is not to say that I am not a spiritual person. Spirituality is not belief in ghosts, hauntings, Sasquatch, magic numbers, the Loch Ness Monster, bridge trolls, crop circles, alien abductions or channeling the dead. These reside in the mystical realm. Spirituality to me is a combination of morals, ethos (both societal and personal), and belief that we each have a "spirit" that somehow intertwines with the universe; either through belief in an "afterlife" (ie, may be loosely defined) and/or a "supreme being/entity" (ie, may also be loosely defined). We are each made of "stardust" quite literally, so I do believe that melding this concept with the laws of the thermodynamics we are all immortal in a sense, thus we are all truly one with the universe. Again it is science that helps me to rationalize and explain this. I can equate theology with spirituality, whereas mystical and spiritual to me are two different things. At least I thought so. Recently I have had a few experiences that have made me seriously rethink my whole stance on all things magical and mystical.

It all began high in an alpine meadow in the mountains of Northern Italy. I was on the vacation of a lifetime. I was hiking along a trail that followed the ridge of a mountain formation in the Italian Alps that is set between Lago D’Orta (Lake D’Orta) and Lago Maggiore (Lake Maggiore). I was with my wife Julie, her partner Paul, his wife Lesley, and 17 other people on this organized jaunt across the Lake District of Italy.

As an American of Italian ancestry I am almost embarrassed to admit that it took me just shy of 50 years, but I finally visited the sunny peninsula of my ancestors. I sincerely regret that I waited this long. But the trip was more than worth the wait. It brought me a strange sense of peace, and a renewed sense of the preciousness of life. It taught me the true concept of la dolce vita. It also left me weeping with my face covered in soft rain and caressed by a gentle northerly wind off Lake Maggiore. We had just hiked on a steep, stone-covered trail, sections of which were once a Roman road about 1,500 years ago. We had hiked on it for roughly 5 miles, ascending approximately 1,000 feet over that distance. It took us to alpine meadows high above the timberline. They were a picture right out of Heidi or The Sound of Music. There were large cows with huge clanging cowbells leathered around their necks. Some were slowly meandering while others were lying in the tall grass as the weather began to shift quite dramatically from cold, cloudy, windy and rainy, to sunny with a warm breeze that had now shifted and was coming from the south.

As I hiked across the meadow it was as if the weather could not quite make up its mind. It was stuttering from cold and wet towards warm and dry. The wind that had been gale-like from the north during the early part of the ascent was softening and starting to shift direction and began to come from the south. As the weather did this I stopped to remove my rain jacket, slip off my pack and get a drink of water. Despite the rain and cold I was sweating, so I needed a breather. My wife and the lead group had gone on ahead, and a slower moving group was still a ways behind so I found myself in this breathtakingly beautiful meadow all alone. I had it all to myself. Over my left shoulder Lake D’Orta lay and on my right was Lake Maggiore that was just beginning to twinkle and sparkle in the newly breaking sunlight. Smells of sage, wisteria and wet barley grass overwhelmed me. The clouds were breaking and the sun began to warm my face. It was then that the whispers I thought I was hearing began to get very loud. I could no longer ignore them.

They seemed to begin earlier while we were still walking through the forest at lower elevations. We hiked through lush stands of aspen, pine, olive trees and white birch. We slipped past one stunning waterfall after another. As we walked I thought I could hear voices. They were whispers really. Cynically I thought to myself that perhaps I had developed latent schizophrenia and was having the first in a series of auditory hallucinations. I even stopped once to ask my wife "Did you hear that?" She tossed her head and laughed, just in that way that I love she does, and said, "Of course I did, it’s the cowbells. Aren’t they great? They are magical aren’t they?" This place seemed so special that she felt it too. But I knew at that point that the whispers were meant only for me. I began to slow my pace and deliberately fell behind the lead group. I wanted to try to hear what the whispers were. I was not frightened by the whispers rather I was profoundly intrigued by them. I allowed my mind to wander. I let go of everything it seemed.



The author and an alpine waterfall in the 
 Lake District of Northern Italy.

Over the next mile and a half it was as if I was able to shed away all the things that life has hurled at me: the good and the bad. It seemed like none of it made a difference anymore. I was slowly shoving off the ballast of life that I had accrued in my 49-plus years. It seemed like all that mattered was the here and now. And here and now I began to hear these whispers, that turned into voices, that became a revelation, and ultimately brought me such an amazing sense of peace, the likes of which I had never felt before. It seems odd to me that the peace came after I cried big tears that ran down my cheeks in rivers and had left my body shaking and wracked with sobs. I can’t recall ever being so emotional, so thoroughly alive. I tingled with a type of electricity that seemed to grant me magical powers. I felt like I was hardwired into the land.

I could hear the cadenced footsteps of the Roman soldiers who walked these stones millennia ago. All around them I could smell the smoke from their camps and their sweat as it mixed with the leather straps that held their weaponry. I heard them utter to one another in conversational Latin as they moved passed me. I was walking with them and amongst them. I was one of them. I could feel my sword as it dangled at my side and I felt my helmet grow hot and heavy in the approaching noon sun.

Soon the soldiers faded and were replaced with cows, goats, dogs and shepherds. I was tending after the flock, ever wary of i lupi (ie, the wolves). I felt anxious about the animals like I do my patients in the ER. I needed to protect them and to keep them safe. They are my livelihood, my personal charges. I became wary and vigilant. Nothing would get past me. I suddenly felt stronger and more fearless then I ever have. The whispering got louder. "We are here. You are here. We have waited long for you. Welcome to your home. Welcome back."

The land rose before me, and the whispering was now becoming vaguely intelligible. The only Italian I ever learned was from an introductory course during my freshman year of college. No one really spoke it in my family except my mothers’ father Grandpa Louie and my great-grandmother Regina who we all called "Nonna." But suddenly the language came very easily to me. It seemed as if it was bubbling up from deep inside me. I felt as if it was oozing from all the pores in my skin. It was like something deep in my DNA was beginning to take over. I could speak, and think, and feel in Italian.

Mia Grande Nonna. Mio Grande Nonno. Sono qui, sono qui. (My Great-Grandmother. My Great-Grandfather. I am here, I am here) These were my thoughts. They seemed to carry up onto the wind and I was answered. It came like a song. It is an old song that I had mostly forgotten, but once I heard the faint melody I knew all the words.

Sappiamo che sei qui. "We know you are here" came the reply.
Ascoltare il vento Pietro… "Listen to the wind Peter."
Parleremo a ti… "We will speak to you…"
They spoke across a century. They whispered across time.
Ei ci sentirai… "…And you will hear us."
Sei dove devi appartiene…"You are where you belong".
Cantare una canzone di vita Pietro… "Sing a song of life Peter."
Rapidamente, prima che andiamo… "Quickly before we go."
Non partimi la grande nonna, non partimi… "Don’t leave me great-grandmother, don’t leave me," I longingly thought as I felt her spirit swirl around me and move through me. I began to sing slowly in my head. An old song, the only one I could think of at the time. It was one my father used to sing when I was little. He had this record of an Italian quartet singing traditional songs. He didn’t understand a word of it, but he loved the music. He especially loved this one particular song.

"Il merlo ha perso la lingua. Come farà cantare?" Loosely translated it is about a blackbird (ie,. il merlo) that somehow has lost its tongue. The singer imploringly asks the blackbird to sing but wonders how will he make his song without his tongue? It’s a strangely sad song, but somehow it made me happy. It was from my childhood and a connection to this country. I could literally feel the ghosts of my ancestors move through me. I was inspired by the extreme beauty that surrounded me and profoundly moved by the raw elemental conditions that I found myself in. I wept like a child who had just lost his balloon and helplessly watches as it rises into the sky. I sobbed and felt strangely unburdened. I felt like my soul had been thoroughly cleansed. I lifted my face into the fleeting raindrops that were now giving way to brilliant sunshine.

The rain mixed with my tears and washed down my face. I cried like I have never cried before. I thought about all the horrors, the suffering, the misery, and death that I have stood and stoically born witness to over the last 25 years as an emergency physician. It all seemed to come tumbling out in that instant; and just as quickly, it was gone on the wind that now lifted my hat and broke my tear-soaked reverie. It was as if my ancestors were showing me the way: the way to finally rid myself of all the "slings and arrows of outrageous fortune." My ancestors spoke to me that day up on that ridge, and I was clever enough to hear them. More importantly I believe that I was even smarter to embrace what they had to say. Because of them I was able to let go. To let go of my fears, my emotional hang-ups, my anxieties, my paranoia, but most importantly to let go of my anger and things that anger me. It was easier, much grander, certainly cheaper, and far more effective than any psychiatric consultation.

As my shoulders stopped shaking, and the last of the giant tears rolled down my cheek I saw the trailing group of hikers coming up from behind me. I took off my cap and mopped my brow. I collected myself and waved to them. I could see them smile below me, and they waved back. I could still hear whispers, but they were getting softer. I smiled a smile that I am sure looked as if I had just discovered the meaning of the universe but was not quite ready to share my findings yet. Rather I would hold the knowledge, just as I would hold the moment, very close to me.

Indeed the next hiker who came up behind me said,
"Pete, with that magnificent smile you look like you just ‘ate the cat’." (I think he meant I looked like the proverbial cat that ate the canary!)

"I believe I did Ken. I believe I just did," came my reply.

I will return to that place in my mind when I need to. I promised myself and I promised my ancestors that day that I would. I am the better for it now. I am sure of it.

Eleanor Roosevelt once said, "Yesterday is gone. Tomorrow is a mystery, but today is a gift. That is why it is called the present." I couldn’t agree more. It took voices from the past to make me embrace the present. It took some ancient whispers to really make me hear and understand that message. I am still a man of science, but now I am also a spiritual being with a little bit of mysticism thrown in. Here’s to mysticism and all things mystical, wherever they may lead you. May the wind whisper to you someday just as it did for me.

Grazie la grande nonna. Ricorderò sempre… Thank you great grandmother. I will always remember.

Ascoltare il vento…Listen to the wind.


Looking east to Lake Maggiore with the snow-capped Alps in 
 the distance.



Back to Top

Updated Operational Guidelines Review

And finally, a word from our sponsor. Please review the operational guidelines below. Our liaison,Tracy Napper, used the new template provided by the ACEP Board of Directors, and indicates with Track Changes where she edited the template with our section-specific information. We will discuss the guidelines at our section meeting at Scientific Assembly. If approved, they will go before the ACEP Board in January 2009 for final review.

Section of Medical Humanities
Draft Operational Guidelines

The Section of Medical Humanities is chartered by the Board of Directors ("the Board") of the American College of Emergency Physicians (College) to provide a forum in which members of the College with special interests in the fine arts, literature, humanities research, and the humanistic social sciences can develop a knowledge base, share information, receive and give counsel, and serve as a resource to others interested in the application of these areas to emergency medicine.

Because sections are considered a subcategory of College membership, sections will not have separate bylaws or formal incorporation documents, and their existence and operations shall be subject to the terms and conditions stated in the Policy on Sections of Membership, as adopted and/or amended by the Board.

These operational guidelines have been drawn up to facilitate operation of the section. They shall conform to the Bylaws of the College, and the activities of the section to the decisions of the Board. Projects in the areas of education, internal governmentgovernance, legislation, or public relations shall be undertaken only with the advice and consent of the Board. The activities of the section shall be intimately coordinated with those of the College.





The name of this section shall be the Section of Medical Humanities.

2 Purpose
This section provides a forum for members of the College to share their special interests in the fine arts, literature, humanities research, and the humanistic social sciences.
23 Objectives
  In addition to the general objectives of the College as set forth in the Bylaws, the objectives of this section shall be:
  23.1 To provide a forum for ACEP members interested in fine arts, literature, humanities research, and the humanistic social sciences.To promote the development of the specialty of emergency medicine across the world and in medical humanities.
  23.2 To promote the utilization of literature, arts, and the humanities in the instruction of emergency physicians. To promote collegiality and cooperation among the physicians who practice emergency medicine.
  23.3 To promote the medical humanities as a source and means of lifelong learning for emergency physicians.To provide an opportunity for physicians interested in emergency medicine to meet, interact, and network.
  23.4 To promote the application of humanities theories and methods, derived from philosophy, English, literary theory, the social sciences, the arts, rhetoric and ethics to investigate the social and cultural dynamics of emergency medicine. To develop and present educational programs on the many facets of emergency medicine.
  23.5 To enhance opportunities for ACEP members to increase their literary or artistic output.To prepare and distribute an interesting, educational, and informative newsletter for members of the section.
  23.6 To create collegial alliances and research opportunities for humanities and social science scholars in emergency medicine, and to promote the publication of medical humanities research.To serve as a resource to the College president, Board of Directors, College committees, and ACEP members on issues relating to emergency medicine.
  23.7 To create avenues for showcasing the artistic and literary achievements of emergency physicians.To coordinate activities with other organizations involved in emergency medicine at the invitation of the President and/or Board of Directors.
  23.8 To serve as a resource for ACEP members and the ACEP Board of Directors for the application of literature, arts, and the humanities to emergency medicine. To advance and publicize legislative issues related to emergency medicine.
  3.9 To provide a pathway for professional leadership development within the organization.
  3.10 To promote the utilization of literature, arts, and the humanities in the instruction of emergency physicians.
  3.11 To promote the medical humanities as a source and means of lifelong learning for emergency physicians.
  3.12 To promote the application of humanities theories and methods, derived from philosophy, English, literary theory, the social sciences, the arts, rhetoric and ethics to investigate the social and cultural dynamics of emergency medicine.
  3.13 To enhance opportunities for ACEP members to increase their literary or artistic output.
  3.14 To create collegial alliances and research opportunities for humanities and social science scholars in emergency medicine, and to promote the publication of medical humanities research.
  3.15 To create avenues for showcasing the artistic and literary achievements of emergency physicians.
3 4 Membership
  3 4.1 The membership of the Section of Medical Humanities shall consist of physicians who have a special interest or expertise in medical humanities, who are interested in contributing toward the objectives of the section, and who fulfill membership requirements as defined in the ACEP Bylaws. Section members may vote on section matters and be officers of the section.
5 Nominating Committee
  5.1 The make-up of the Nominating Committee will be determined by the section leadership. See Section 9.1, Standing and Special Committees.
46 Section Executive Committee
  46.1 The governing body of the section shall be composed of not less than four officers of the section: chair, chair-elect, immediate past chair, and secretary. The officers of the Section of Medical Humanities are the chair, chair-elect, immediate past chair, and secretary/newsletter editor.
  46.2 Nominees for officers shall be members of the section presented by the section's Nominating Committee to the section membership through its newsletter or through the section e-list at least 30 days prior to the section's annual meeting, which will be held in conjunction with the College's annual Scientific Assembly. If elections are held during the annual meeting,nNominations from the floor will also be accepted at the time of the section annual meeting. If elections are held via e-mail or U.S. mail, write-in candidates will be accepted.
  46.3 The election cycle of the section's officers will be every two years, and will coincide with the dates of the Scientific Assembly.
  46.4 Unless otherwise scheduled via e-mail or U.S. mail ballot, tThe election of officers shall be by a majority vote of the section members present and voting at the annual meeting. The section will elect a chair-elect and a secretary. If the current chair-elect cannot serve as chair, the section will also elect a chair.
5 7 Officers
  The officers of the section shall be at a minimum the chair, the chair-elect, the immediate past chair, secretary, councillor, and alternate councillor. The officers shall be members of the section and serve for a term of two years. Following the chair's term of two years, there will be an additional two-year term designated as immediate past chair. Officers may not serve more than two consecutive terms.
  57.1 Duties of the chair of the section:
    57.1.1 May be appointed by the College president to serve as a voting member of a related College committee, if one exists.
    57.1.2 May attend ACEPBoard of Directors meetings at his/her own expense. Will receive minutes of meetings of the College Board, Council, Steering Committee, etc.
    57.1.3 Shall keep the Board of Directors and executive director informed of section activities via copies of correspondence, agendas, minutes of meetings, etc.
    57.1.4 Shall submit an annual report to the College president and executive director, which consists of a list of achievements and activities of the past year and goals and objectives for the coming year.
    57.1.5 Shall submit to the Board of Directors for approval all section plans, goals, objectives, budgets, and meetings before they are implemented by the section.
    57.1.6 Shall preside at the annual meeting of the section and at any other meetings of the section. If absent, the chair shall assign this function to the chair-electelect will assume the functions of the chair.
    57.1.7 Shall appoint chairperson and members to any standing and special committees of the section to carry out section activities.
    57.1.8 Shall have the privilege of recommending to the President the appointment of section members to committees of the College or section members representing the interests of the College with external organizations.
    57.1.9 Shall be an ex officio member of all standing and special committees of the section.
    7.1.10 From time to time, section leaders may be asked by the President to attend the Board meetings of other entities. In this case, their expenses will be paid by the College.
    7.1.11 Shall review all section grant proposals developed by their section members. Those developed section grant proposals that are determined to be appropriate for sumbisison are then signed and submitted to the appropriate committee or task force assigned to manage the Section Grant Program.
  57.2 Duties of the chair-elect:
    57.2.1 Shall serve as an officer of the section.
    57.2.2 Shall assist the chair in section duties as designated by the chair.
    57.2.3 Shall serve as chair in the absence, resignation, or death of the chair.
  57.3 Duties of the immediate past chair:
    57.3.1 Shall serve as an officer of the section.
    57.3.2 Shall serve as chair of the Section Nominating Committee.
    57.3.3 Shall assist the chair in the duties for the section as designated by the chair.
  57.4 Duties of the secretary:
    57.4.1 Shall take the minutes of the annual meeting of the section and submit to the appropriate section communication vehicle.
    57.4.2 Shall provide the Board of Directors the names of the elected section officers.
    57.4.3 Shall assist the section chair in the preparation of an annual meeting and the chair of other committees of the section, as requested.
    57.4.4 Shall distribute to the membership via the section newsletter or other communication vehicle: The minutes of the annual meeting of the section. Such information as shall from time to time be of interest to members of the section.
    57.4.5 Shall notify members regarding their appointment to any committees of the section and shall send copies of such notification to the executive director of the College.
    57.4.6 Shall give due notice of all meetings of the section and the Section Executive Committee to the membership of the section and the Board of Directors of the College.
    57.4.7 Shall serve as editor of the section newsletter.
    57.4.8 Shall carry out such other duties as are assigned by the chair of the section and the Board of Directors of the College.
6 8 Councillor
  68.1 The section shall elect a councillor and an alternate councillor to represent the section to the Council of the College (Council). Term of office is two years, with the alternate councillor becoming the councillor at the end of his/her two-year term. If he/she cannot serve as councillor, the section shall elect a member to fill both positions and resume normal progression from alternate councillor to councillor.
  68.2 Duties of the councillor and alternate councillor:
    68.2.1 Shall represent the section at the Council meeting.
    68.2.2 Shall have duties, obligations, and privileges as designated by the Bylaws and procedures adopted by the Council.
    68.2.3 Shall keep the section informed of all Council activities before, during, and between sessions and report to the section, in its newsletter, and/or other communication vehicles, all important matters considered.
    68.2.4 Shall bring any resolutions that are developed to the Council from the section.
79 Standing and Special Committees
  79.1 The chair shall appoint a Nominating Committee as a standing committee and designate the immediate past chair to serve as chair. In addition to the immediate past chair, the Nominating Committee shall consist of three members appointed for a term of two years.
  79.2 The section chair shall appoint special committees when indicated.
810 Meetings
  The annual meeting of the section will be held during the annual Scientific Assembly of the College and will consist of two portions:
  810.1 A professional program open to all members of the College, professionals, paraprofessionals, and guests invited by the section.
  810.2 A business meeting open to all members of the College with voting limited to section members.
  10.3 At their own expense, sections may hold special meetings at other ACEP functions.
  10.4 Sections may seek outside funding support for their meeting as long as it is not in conflict with the College’s fund raising activities associated with Scientific Assembly.


The section may recommend to the Board of Directors of the College a dues increase if members feel it necessary to support their activity. A dues increase recommendation must be approved by a majority of section members present during their annual meeting.The dues for the Section are established by the Board of Directors of the College.

12 Additional Funding for Activities
  12.1 To increase its funds, the Section may apply for: 1) An allocation of 15% of its total dues collected during the previous year; or 2) A one-time per project voluntary special assessment.
  12.2 The Section may raise funds from outside entities such as corporations. All such fundraising must be approved in advance by the College and meet the criteria established by the College.
  12.3 The Section may apply for a Section Grant. Projects can be funded which benefit individual sections as well as advance emergency medicine and educate the public.

Parliamentary Authority

The parliamentary authority for all proceedings of the section shall be the parliamentary authority approved for use for proceedings of the College. However, should conflicts or inconsistencies arise between the parliamentary authority and this instrument, this instrument shall govern.

1114 Amendments Voting
  14.1 Voting on any issue, except amendments to these Operational Guidelines, may be accomplished either during the annual meeting, or via a mail ballot. Mail ballots can be electronic and/or U. S. mail. The Chair shall determine which method is appropriate for each item coming before the Section.

For e-mail and U.S. mail ballots, the voting membership will be defined as the section membership on the date the ballot is sent. The majority of dues paying section members (based on the number of dues paying members on the day the ballot is sent) must approve any item in order for the item to be approved.

For e-mail and U.S. mail ballots, write-in candidates will be accepted.


Voting by E-mail

Snap Survey software will be used to e-mail the ballots and to tally the results.

Two e-mail notices will be sent, seven days apart, to all section members regarding the upcoming ballot.

Seven days after the second notification email, the ballot will be e-mailed once to all section members with a due date for return by e-mail in 10 days.


Voting by U.S. Mail

Mail ballots shall be distributed to members through the section newsletter or the section e-list a minimum of thirty (30) days prior to the voting deadline. The ballot will also be sent once via U.S. mail to all section members with a due date for return in 10 days. Executed mail ballots will be forwarded to by e-mail or U.S. mail to the section staff liaison.



Any member of the section membership may originate a proposed change in these section operational guidelines. Proposed amendments to the operational guidelines must be submitted in writing (by the approved communication vehicle) to the chair in care of the section’s staff liaison at the College at least ninety (90) days prior to the scheduled annual meeting.

Proposed amendments will be published in the section newsletter or e-mailed via the section e-list immediately preceding the annual meeting of the section, and will be placed on the agenda of the section annual meeting. Any proposed amendment must be approved by two-thirds of the members present and voting during the annual meeting or the section will follow the procedures for electronic voting.

The Section Executive Committee and the Board of Directors of the College will review adopted amendments. Amendments approved by the Board of Directors of the College will be published in the section newsletter preceding the next annual meeting of the section.

Approved by the section, October 2004.
Approved by the ACEP Board of Directors, November 2004.




Back to Top

This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.

Click here to
send us feedback