Medical Humanities Section Newsletter - December 2007, Vol 4 #1
From the Chair
Hans House, MD, FACEP
University of Iowa, Iowa City, IA
My daughter has discovered Goodnight Moon.
Six months into our initiation into the wonderful world of raising a child, my literary indulgences have settled neatly into Dr. Seuss, Eric Carle, and other giants of the young reader. But far be it from me to have a choice in the subject of our nightly book reading. Young Sophie, with the seeds of language skills only beginning to sprout in her little mind, has clearly articulated a preference: Goodnight Moon. My attempts to delve into her already vast collection of rhymes, picture books, and children’s classics are met with squirming and pouting. Yet the bizarre orange-and-green-adorned room featured in Goodnight Moon invokes instant calm and an attentive gaze.
I have learned one important fact in the past few weeks: if something works when you are trying to get a 6-month-old baby to bed, keep doing it. Therefore, I have read that darned book about 64 times. So you must forgive me when I admit I am clueless about anything new in the world of books without pictures. In fact, my productive time has now narrowed to a brief two hour window between the ending of Goodnight Moon and the moment I pass out with my fingers still on the keyboardddddddddddddddddd.
Greetings, section members! I am your new Section Chair! Frightened yet? Good. Our beloved former leader, Mike Burg, is still waiting in the wings and tossing me hints every moment I forget my lines. I only hope to carry on his great achievement in getting this ship on its voyage while I desperately look for an iceberg to hit. Er . . . I mean . . . look out for any icebergs so I don’t hit them. Fortunately, I have a crew that will keep me honest and keep us moving forward. Pete Paganussi is taking over the newsletter (thank you!), Seth Hawkins is continuing his great work with the Artistic Expressions Gallery, and Liz Mitchell is essential for the wonderful Open Mic Night. Best of all, we continue to be blessed with the best possible ACEP staff liaison, Tracy Napper. Tracy’s day job as Managing Editor for Annals of Emergency Medicine proves her importance in the College: they trust her to run the preeminent journal of our specialty (also one of the most important scientific journals in all of medicine).
My goals for the next year are simple:
- Maintain the quality of the newsletter while seeking new directions and material.
- Return to Scientific Assembly with another successful Open Mic Night.
- Solidify Artistic Expressions as an annual, expected element of Scientific Assembly that is supported financially by the College.
Thank you for listening, but tonight’s performance of Goodnight Moon ended about two hours ago, so I need to end this essay now. To paraphrase Sloane Tanen, artist and author of Bitter with Baggage Seeks Same, “Goodnight Moon, Hello Martini.”
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Section of Medical Humanities - Meeting Minutes
American College of Emergency Physicians
Section of Medical Humanities
October 9, 2007
Participating in all or part of the meeting were: Jay Baruch, MD, FACEP; Marion Bishop, MD, PhD; Frederick C. Blum, MD, FACEP; Michael D. Burg, MD, FACEP, Chair; Arthur R. Derse, MD, JD, FACEP; Marianne Gausche-Hill, MD, FACEP; Kathryn Hall-Boyer, MD, FACEP; Seth C. Hawkins, MD, FACEP; Mary Hermann, MD; Hans R. House, MD; Brian Keaton, MD, FACEP, ACEP Board liaison; Elizabeth Mitchell, MD; Katrin (Kay) Takenaka, MD, FACEP; Jeannette M. Wolfe, MD, FACEP
Others participating: Tracy Napper, ACEP staff liaison.
Call to Order
- “Open mic” discussion
- Select chair for art gallery for 2008
- Web site development/Newsletter expansion
- Medical humanities conference/course(s)
- Medical Humanities curriculum development
- Writing Award for 2008
Election of new chair
Major Points Discussed
The meeting was called to order by Michael D. Burg, MD, FACEP, section chair.
- “Open Mic” – Dr. Mitchell encouraged everyone to attend the Open Mic Night on Tuesday, October 9. She said that there were more readers this year and fewer musicians and that it was difficult to obtain commitments from performers. More advertisement is needed, including targeted e-mails and ads in ACEP News. A section grant or other sponsorship, perhaps combining with EMF’s fundraising event, should be pursued to help defray costs. Dr. Mitchell agreed to organize the event in 2008 in Chicago.
- Art Gallery for 2007 – Dr. Hawkins has agreed to again organize the gallery for 2008. Dr. Blum was thanked for having ACEP pay for the gallery this year. He noted that Dr. Lawrence and Dr. Jouriles will need to be approached for future funding. More publicity is needed as well. He also noted that he is chair of the new ACEP Foundation, which is sponsoring a new consumer-oriented publication by ACEP. This might be a good venue for publishing more artists’ work. Dr. Gausche-Hill suggested giving a prize for the best item in the gallery. Dr. Wolfe suggested another table for displaying prose pieces and books. This year there were impromptu performances by musicians in the gallery. A sign with schedules of performers would be helpful for next year. Ms. Napper noted that Dr. Sklar has a book coming out in September 2008; he would like to have a book signing at the gallery and donate his profits to EMF.
- Membership – Dr. Burg is concerned about membership numbers. He reminded section members to sign up their residents, as residents are allowed 1 free section membership. He also suggested that ACEP automatically sign up residents with a random section, if they don’t choose one themselves. This could garner more humanities section members. Dr. Gausche-Hill agreed to assist Dr. Burg in increasing section membership and visibility.
- Web site development/Newsletter expansion –Dr. Burg suggested adding more links to our Web site, including photos of the art from the gallery. Dr. House suggested including links from the newsletters under “helpful links.” Dr. Burg will e-mail the section list to ask if anyone is interested in spearheading the Web site development. Dr. Mitchell said she may have a resident who would be interested. Dr. Blum offered his assistance.
- Medical humanities conference/course(s) – The deadline has already passed for a course proposal to be put together for Scientific Assembly 2008. Dr. Burg believes that Catherine Marco, MD, already submitted a proposal but he will follow up.
- Medical Humanities curriculum development - Dr. Burg continues to be interested in collecting course materials to share with medical schools and residency programs. Dr. Blum agreed to assist Dr. Burg in this endeavor.
- Dr. Burg thanked Dr. House for his excellent work on the newsletters; Dr. Hawkins for his work on the gallery; Dr. Mitchell for her work on the open mic night; and Ms. Napper for her help as section liaison.
- Dr. Hawkins said that this year’s recipient of the first Writing Award is Jennifer Blair, MD, for her piece “San Sebastian.” Dr. Blair was not in attendance. The rules for the content need to be formalized for 2008; Dr. Hawkins will work on this objective.
Dr. House was elected as the new section chair. He thanked Dr. Burg for all his hard work in creating the section and Ms. Napper for her assistance. Peter Paganussi, MD, FACEP, was elected newsletter editor.
The meeting was adjourned.
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Open Mic Night 2007
Elizabeth Mitchell, MD
Boston Medical Center, Boston, MA
The second annual Open Mic event at ACEP’s Scientific Assembly in Seattle was a resounding success. Sponsored by the Section of Medical Humanities, the event drew a broad range of performers to the intimate stage at the Marriott Hotel. Beginning with the sweet strains of Peter Viccellio’s masterful jazz piano, and ending with a bluegrass jam, there was something for everyone.
Performance artists included stand-up comic Rauven Averick; the always amazing and delightful magician, Joe Finkler; and numerous musicians including Irish fiddle tunes performed by masterful guitarist Rick Nelson and fiddler Kalev Freeman (who also performed with 2 other groups), and singer-songwriters Bill Kopelman (who now has a devoted fan club) and Liz Mitchell. Walter Limehouse spun some piano improvisation, which he called “Two Days of ACEP,” and finally Mary Hermann and gang treated everyone to a bluegrass set.
Jay Baruch was one of several authors who read original work. He opened the literary talent by reading from his book “Fourteen Stories.” The crowd enjoyed Jeff Sankoff’s humorous musings about life as a cruise ship doctor, and Jeannette Wolfe and Marion Bishop each read thoughtful personal essays.
It was a tremendous night and everyone had a wonderful time. Plans for future shows include food and beverages for a café atmosphere. Anyone who may have thoughts on sponsorship and funding should contact Tracy Napper at firstname.lastname@example.org. For those of you who might be interested in performing next year, it’s never too early to sign up. Please contact Liz Mitchell via email@example.com for further information.
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ACEP Artistic Expressions 2007
Seth Hawkins, MD, FACEP
Mountain Emergency Physicians, Morganton, NC
The gallery was truly a multimedia event this year, with craftworks, artwork, photography, headsets to hear selections from last year’s Open Mic Night, and even some live music sets!
A real addition to the gallery this year was our partnership with the Section of Wilderness Medicine, which ran a wilderness photo contest hosted by the gallery. Their pictures were randomly rotated across a digital frame set up in the gallery. This format in particular was very popular with attendees.
Placement on the bridge between two wings of the Exhibition Hall ensured a good deal of exposure and foot traffic. Attendees were again very positive about this contribution from our section to the Scientific Assembly, and we look forward to improving it even more for 2008. Start thinking now about what you want to contribute!
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Skyscrapers and Planes
Jay Kaplan, MD, FACEP
California Emergency Physicians Medical Group, Emeryville, CA
|skyscrapers standing tall
||rising to meet the sky
|airplanes flying off to distant destinations
|the two oblivious to each other’s existence
|I try to say to fear
||there’s no room for you here at the inn
|and I know that’s not true
||it’s a lie
|if fear comes to live in my house
|and it already has
|is it by
|that I allow it to alter
||the architecture of my life
|the new houseguest is now present in my home
||but does not
||and will not
|have the run of the house
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Jeremy Orvik, MD
Los Angeles, CA
Shot in Sequoia National Park during one of the massive snowstorms of 2004. D60, 17-40mm wide angle L lens.
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From the Editor
Peter J. Paganussi, MD, FACEP
Fairfax Hospital, Falls Church, VA
Yogi Berra on Good Medicine
As I write these words it is October, and thus baseball is on my mind. It is time for the World Series and the bittersweet joys of the season finale. The wondrous, memorable, climactic moments that the “Fall Classic” always seems to produce inevitably concludes with the knowledge that the boys of summer will not return for four long, dark, dreary months. Interestingly enough the player with the most World Series championships, a staggering 10 titles, to his name is one Laurence Peter Berra, a.k.a. Yogi. When you say the name Yogi Berra, even those who know little about baseball smile. Many are familiar with his malapropisms; some of which are quite legendary. People chuckle and even laugh out loud when they hear some of the things Yogi has said, or has been purported to say. There is no doubting that Yogi Berra has a truly unique way with words. His iconic utterance “It ain’t over ‘til it’s over” has become part of the American vernacular. However, somewhere through the misty haze of his oxymoronic redundancies and cliché-altering mixed metaphors lies the sage wisdom of a genius. Somehow we all secretly know just exactly what he means despite the linguistic distortion.
It turns out what many don’t know or choose to overlook about Yogi are the things that really should define him…his playing career, which really is the stuff of legend, and his professional career. He was one of only four players to be named the Most Valuable Player of the American League three times (1951, 1954, 1955), he played on the American League All Star Team from 1949 through 1962, and is one of only six managers to lead both American and National League teams to the World Series. He led the Yankees in runs batted in (ie, RBI) for seven consecutive years from 1949 through 1956, over a span in which he was teammates with the likes of Joe DiMaggio and Mickey Mantle. He is one of only four catchers in major league history to go an entire season without an error (ie, fielding percentage of 1.000). He was elected to the Hall of Fame in 1972.
Yogi is also a successful businessman and philanthropist. In 1998, the Yogi Berra Museum & Learning Center, as well as Yogi Berra Stadium, opened on the campus of Montclair State University in Upper Montclair, New Jersey. Berra is very involved with the project, and frequents the museum for signings, discussions, and other events. Mr. Berra has been the recipient of the Boy Scouts of America's highest adult award, the Silver Buffalo Award. Yogi has also frequently appeared in advertisements for Yoo-Hoo, AFLAC, Entenmann's, and Stovetop stuffing, among others, usually employing one of his famous "yogiisms." He is one of the longest running commercial pitchmen in the U.S.; his television commercials span from the early 1950s to the present day. Based on his style of speaking, Yogi was named Wisest Fool of the Past 50 Years by the Economist magazine in January 2005.
Surely anyone this successful must know what he is talking about…right? I recently had occasion to revisit some “yogiisms.” After careful review I have decided there is no doubt pure genius in his words. They say there is a Seinfeld episode to cover everything in life; well, along those same philosophical lines I feel there is a yogiism for everything we do in medicine. He seems to know a lot about the practice of medicine, especially emergency medicine. Therein lies the genius of Yogi; he would have made one hell of an emergency physician because he seems to grasp our world so well. It can be found in everything he says. We would all be wise to listen, learn and apply these witticisms to our everyday practice. Thus, I give you Yogi Berra on good medicine, more specifically good emergency medicine.
“If you don't know where you're going, chances are you will end up somewhere else.”
How many times have you “chased” a diagnosis only to either create new symptoms because of your treatment, or make a misleading diagnosis in the process? There’s that guy with chest pain and tachycardia you’re sure has a PE. So you chase it, only to find that he has a “nodule” in his chest. It’s probably been there since Lyndon Johnson was President but now that needs to be addressed and the whole case is a mess. It turns out he has cholecystitis with referred pain; he did tell you that the pain was worse after a big meal, but you focused on the idea of a PE instead. It turns out that the tachycardia was caused by pain from the biliary colic, and the caffeine that was in the Excedrin Migraine tablets he took, but forgot to tell you about. Yogi knows the importance of taking a careful history and actually listening to the patient. Then no one gets lost and ends up somewhere else.
“I knew exactly where it was, I just couldn't find it.”
This is the corollary of the above. Example: you can feel the foreign body, you can see the foreign body (ie, on x-ray), you just can’t find the foreign body in that thigh laceration. Or when the friendly orthopedist comes down to admit the little old lady with the hip fracture and asks you what room she’s in. You smile and say, “Let me show you,” and you lead him into the middle of a pelvic exam being done on an entirely different patient. The nurses have since moved Little Mrs. Misses into a side hallway and you can’t find her. All the while a fuming, lumbering Orthopod is in tow and getting testy.
“It was hard to have a conversation with anyone - there were too many people talking.”
It has long been my firm belief that the number one occupational hazard in emergency medicine is noise pollution. Every now and then the din gets so great our unit clerks have to harshly shush people so they can conduct business sanely. Every ED I have ever worked in is like this at some point. It gets so loud and so chaotic you can’t hear yourself think. How about when a nurse, a tech and the unit clerk are all talking to you at once and each expects a response? The cacophony can be quite overwhelming in a busy ED. I sometimes just crave “quiet” when I come home after a shift.
“It's not too far, it just seems like it is.”
The first ten minutes at the start of a clinical shift feel just like this. In fact, the last 10 minutes of a shift feel like this too. It sounds like Yogi has worked “the overnight” a few times. This is also an accurate description of getting to the hospital cafeteria from the emergency department.
“If you ask me a question I don't know, I'm not going to answer.”
This art is learned during residency, but comes to full fruition as an attending physician. Doctors never, ever like to admit they don’t know something, so they simply move past the question. This can be accomplished in any one of a whole host of ways. You can do the “NYC Jewish/Italian Aunt thing” and answer the question with a question of your own. (ie, Q: “How do you feel?” A: “I’m sick, how should I feel?”) You can arch your eyebrow knowingly, take a step back and give a complex, convoluted response meant to throw off anyone listening (ie, commonly called “throwing the bulls#!*”). Or you can simply pretend you never even heard the question. Once again, Yogi seems to have a firm grasp of this vital concept in medical practice.
“I really didn't say some of the things I said.”
You are working a busy weekend shift with two new nursing graduates. They have a combined three weeks of nursing experience between them. They come to you almost simultaneously and each one asks you a question regarding medications you ordered for her patient. You tell them “Give Mr. Johnson a gram of Rocephin for his pneumonia; and give Mr. Smith 100 'mics' of fentanyl and I will be right in to reduce his shoulder dislocation.” They both giggle and scurry off. Do I need to spell out where this one is headed? Later, when the Safety Officer, Compliance Officer, and Hospital Attorney ask you what you where thinking when you ordered the ridiculous dose of fentanyl? You simply shrug, smile and use the preceding yogiism. This is why the man was the MVP three times and an All Star 13 times!
“I always thought that record would stand until it was broken.”
The alcohol level of 0.79, the hemoglobin of 2.2, the amylase of 3,999, the dilantin level of 196, and the sodium of 93…all in the same patient! Yogi saw this patient coming before he even hit he door. Yogi would quickly pat him down looking for his V.A. card.
“I don't remember leaving, so I guess we didn't go.”
Yogi knows that this is what it’s like trying get some lunch or going to the bathroom on a busy shift.
“I'd say he's done more than that.” (When asked if first baseman Don Mattingly had exceeded expectations for the current season.)
Yogi has a deep appreciation of how your department chairman feels when asked about your recent patient satisfaction survey scores.
“If people don't want to come to the ball park, how are you going to stop them?” (Or its corollary “Nobody goes there anymore. It's too crowded.”)
Substitute emergency department for ballpark and you have a great explanation for the hospital administrator why volumes are down.
“I wish I had an answer to that, because I'm tired of answering that question.”
How many times have you answered questions like: “Will you write me a prescription?” or “Will this make me drowsy?” or “Can I have a drink of water now?” or “How do I get to the cafeteria?” or “Can I have a note for work?” Even Yogi gets cranky.
“We were overwhelming underdogs.”
This pretty much summarizes just what it means to be an emergency physician working a Monday holiday or Thanksgiving weekend.
As Yogi said, “It ain’t over, ‘til it’s over” and mercifully this piece is finally over…but it ain’t over until I leave you with this final parting shot from Yogi: “If you don't set goals, you can't regret not reaching them.” Again, this is a good response to the hospital administrator about pretty much any “metric” measured in the ED that can be incorporated into PowerPoint presentations meant to make helpless emergency physicians squirm in dark conference rooms.
Thanks Yogi, we could’ve done it without you, but doing it with you is like doing it alone, but with other people. I guess there’s a little bit of Yogi in all of us!
(Oh, by the way, Opening Day is 161 days from today 10/29/2007 and as this day dawns, the Boston Red Sox are World Champions. Sorry Yogi.)
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(Editor’s Holiday Suggestion: A roaring fire to keep you warm, a glass of something you like to make you glow, and a copy of Charles Dickens “A Christmas Carol” for your soul. “God bless us all…each and every one.”)
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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.