Medical Humanities Section Newsletter - December 2009, Vol 6, #1
MUSE - December 2009
From the Chair
Edwin Leap, MD, FACEP
To the section,
Thank you for the opportunity to be chair of the Section of Medical Humanities. I am honored by your trust, and thrilled to be in the company of so many amazing, talented and capable physician artists. I feel that I am in the right place at the right time. This is because believe that I understand you. Years ago I began to define myself as a kind of chimera, living somewhere at the junction of art and science. It's so easy to let medicine alone be the driving motivation for our lives as physicians. Medicine will happily take up all of our time. There are ample opportunities for seeing more patients, teaching more students and residents, volunteering for our favorite causes, or caring for the downtrodden and poor. And the frightening part is that all of those things result in accolades from someone. Our patients are happy to have us available. Administrators are delighted to use our time. Volunteer groups are thrilled with our very presence. It is all too easy to become wrapped in the praise of those groups; to go back and do more, because "it's the right thing to do."
But for us, the "right thing to do" requires that we listen to the sounds inside, respond to the colors, write down the words, preserve the memories. For whatever reason, we simply cannot ignore the artist inside without difficulty and pain. Maybe it is our solace in a difficult life. Maybe it is our calling. Perhaps it is our genetic destiny. As Southerners say, "it don't make no never mind." Whatever the cause, we cannot define ourselves only by the work and science which occupy us in our medical lives.
Oddly, this dual nature of ours is, in itself, a kind of transformative art. Whether our art concerns medicine or not, it cannot help but be informed and shaped by our practices, our patients, our failures and successes.
In being physician-artists, I think that we gather up the raw material of human experience (which is nowhere more laid bare than in the emergency departments we staff). We take that raw material, whether images, words, stories, or some raw clay of pain or hope, and we make it into something. It may be entirely unlike the original stuff. It may be floral or landscape art. It may be photos of happy children to block out the images of injured ones. Our art may be a dedication to the suffering we see, or a shout into the darkness against it. We may sing beautifully, because we stand atop a mountain of misery. We may simply want to be heard, for fear of leaving the world without being noticed. We may be, unlike so many, just overflowing with joy!
Or it may go the other direction. Our art may inform our medicine. Our love of beauty may help us to see the faint, antique laugh lines in the eyes of our demented patients. Our love of words may help us to hear the subtle messages of the sick or the psychotic. The very peace and compassion that grow in us from our art may launch itself onto the patients who need love far more than they need prescriptions.
So I want to encourage you. We have a unique "biological niche." We are graced to stand at the junction of art and science, and to take something from both, to distribute blessings in both directions.
I promise to do my best to help us in the journey, for the time you have given me.
Blessings on you all this season!
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From the Editor
Peter J. Paganussi, MD, FACEP
Falls Church, VA
Boston is actually the capitol of the world. You didn't know that? We breed smart-ass, quippy, funny people. Not that I'm one of them. I just sorta sneaked in under the radar.
Boston is an oasis in the desert, a place where the larger proportion of people are loving, rational and happy.
Julia Ward Howe
Down by the River...
Down by the banks of the River Charles
(Oh, that's what's happenin' baby)
That's where you'll find me
Along with lovers, muggers, and thieves.
(Ahh, but they're cool people)
I love that dirty water
'Oh oh, Boston, you're my home
The 2009 annual ACEP Scientific Assembly was "down by the banks of the River Charles" this year in the historic city of Boston. It was a great venue and another opportunity for members of ACEP’s Section of Medical Humanities to convene. After all, Boston has produced Louisa May Alcott, Ralph Waldo Emerson, Winslow Homer, Robert Lowell, Jack Lemmon, James Taylor, Edgar Allen Poe, Leonard Nimoy, and Aerosmith. It is the kind of artistic talent that we can humbly strive for, perhaps, but providing lofty inspiration for our efforts. Indeed in this issue we have on display painters, poets, photographers, authors, and musicians (mp3 file included) "along with lovers, muggers, and thieves."
Enjoy the words, the sights, and the sounds of our section. They are proudly on display in this December 2009 issue of MUSE. We say goodbye to outgoing chair, Dr. Hans House, who was an excellent leader and remains a great friend. We say hello to a new chair, Dr. Edwin Leap, who greets us with his inspirational words thus setting the tone for this newsletter. Also, hello to our new councillor, Dr. Judith Dattaro, who has already set the tone for heightened awareness at the ACEP organizational level.
At this point I shall step aside and let this veritable "greatest hits" of the section speak for itself.
As for me, "I just sorta sneaked in under the radar."
'Oh oh, Boston, you're my home!
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The Longest Day
Hans House, MD, FACEP
Iowa City, IA
Saturday, October 10, 2009, 5:05pm: Arrive at the hospital, passing tailgate parties on the way in. Swoon over the forbidden aroma of peppermint schnapps and hot cocoa.
5:10. Collect ER doctor fuel (aka double mocha with whip) at the hospital Java House.
5:30. Walk across the street to Kinnick Stadium, check in for duty at the first aid station. Run inventory of the medications, especially checking on the quantity of ibuprofen available.
Iowa fans have a pathologic dedication to tailgating. I have actually done scientific studies on this and presented data on it at regional meetings. Most Iowa home games start at 11am. For these games, fans start drinking at 7am. Sometimes, the game is later, at 2:30pm. For these games, the fans start drinking at . . . 7am. Once in a couple of years, the Hawkeyes will play a special game at 7pm. For these games, fans will start drinking at . . . you guessed it . . . 7am. In 2006, Iowa hosted Ohio State in a highly anticipated night game. There was so much hype around the game that ESPN’s Game Day crew came to Iowa City, thrilling the locals. I worked the first-aid station that night, also. We stocked up on extra bags of IV fluids and arranged for an army of medical students to be ready to help with placing IVs on all the hundreds of drunks we were expecting. Surprisingly, we didn’t see all that many. But we gave out more tablets of ibuprofen for fans with headaches than any other day in history (in fact, we ran out).
Iowans were so looking forward to the game that they showed up on campus at 7am, starting drinking, then stopped in the afternoon so they could sober up for the game.
We had 70,000+ Hawkeyes with hangovers!
5:55pm. Popped down onto the field to check out the new high-tech turf on the field (not bad). I stood in the end zone, protected by the goalpost netting, under punting practice. Looking up at the little pigskin bombshell hurtling toward me, I marveled at skill and bravery of punt returners.
6:30. My very first patient of the long night arrives, after kicking his leg into the stands and getting a laceration to his shin. I start to sew the leg and show a medical student how to place his first-ever suture. He failed. In a quick pre-game rush, we see another laceration, this time on a finger, and 2 nosebleeds (one from trauma, one spontaneous).
7:10pm. Michigan kickoffs to Iowa with the temperature at 30 degrees and a wind chill 24 degrees, unseasonably cold for October 10th. I start seeing a man who is having frequent falls.
7:25. Finish with the man with falls (not a stroke, not syncope, and not an acute trauma, so nothing to worry about right now). He was the last patient in the aid station; it emptied out right after game started.
7:36. Sit down in a wheelchair to enjoy the game on closed-circuit TV. The Wolverines and Hawkeyes exchange TDs. I am stunned by the Colorado-Texas score (14-3, 2nd quarter).
8:06. Patients start showing up again. I treat a broken toe and a man with SOB (that’s shortness of breath, not son of a bitch). Come to think of it, this patient was kind of a pain. . .
8:36. Uh oh. Here come the hangovers. We treated three headaches at once. Also at this time, we discovered there is a 6-second delay between the live game and our video. It sort of ruins the fun because we know before the play if the Hawks are successful.
8:45pm. Game at halftime, and we expect a rush of patients. I see that the Colorado-Texas score returned to reality. I treat a treat lip laceration from a fall in the stands onto the face, another headache, and a paraplegic with an upset stomach.
9:06pm. Halftime ends and the expected rush never materialized. Treat another upset stomach.
9:14pm. Watch a nice drive by Iowa, and treat a lady with back spasms.
9:36. I stepped out to the stadium tunnel to watch a series on the field. When I get back to the first aid station, we start an IV on a dehydrated drunk.
9:46. Another vomiting drunk comes in. Also, a woman brings her 10-month-old baby in to change his diaper in a warm, comfortable place. She turns out to be Iowa Tight End Tony Moeaki’s sister and the infant is Tony’s nephew.
10:00pm. Uncle Tony scores the go-ahead touchdown, his second of the night.
10:29pm. Game winning interception by Brett Greenwood for Iowa.
10:30pm. My shift is supposed to start in the ER across the street, but I have to stay in the stadium until the fans leave. It can take a while for 70,000 people to file out, especially when they are celebrating their biggest win in a long time.
10:50pm. I arrive in the ER for the shift and take sign-out from the person I am relieving. My first patient is the one patient I sent directly from the stands to the ER without evaluating him in the first-aid station. I love continuity of care! It turns out to be the right decision- he needed to be admitted, no question.
11:35pm. A patient with back pain and a herniated disc. And a nursing home patient with frequent falls.
Sunday, October 11th, midnight: An older man with fever and cough. Probably has the "old man’s friend," pneumonia.
12:30am. I saw a mom and her 6-year-old son with flu. Neither get Tamiflu prescriptions. Welcome to the rationing of health care.
12:50. Our first trauma "alert," a man who fell 40 feet out of a tree stand used to hunt deer. Both I and my resident wonder what he is doing in a tree stand when deer season doesn’t start for at least a month. (The last full moon was the Harvest moon when the fields start getting cut. The next full moon, still a couple weeks away, is the Hunter moon, when the cleared fields and bright moon make it easy to see the deer at night.) Our head nurse, who is much smarter than both of us, remind us that bow-hunting deer season is in effect.
1:23am. I took sign-out from colleague, the last staff physician on duty besides myself. I noticed that I hadn’t seen all that many patients and I have had time to chart and keep notes for this diary. It makes me think that it’s not all that busy. But these are dangerous thoughts for ER docs. We never say the "q" word or the "s" word while working.
1:45am. I supervise the anesthesia for aligning a badly fractured elbow. Around the same time, the paramedics arrive with a drunk who was found passed out in the bathroom of Buffalo Wild Wings with his pants around his ankles. Not pretty.
2:00am. The ER is starting to pile up and I start to lose track of the patients (see entry for 1:23am, above), so I grab my intern and walk around to every room. She tells me about a cab driver who was assaulted by his customer. Rough job.
2:09am. There is a man here who walked into a metal sign, slicing his head open. An artery has been cut; it’s gushing down his face and I confirm the rate of pumping matches his heart rate exactly. I get my medical student to hold direct pressure on the head while I figure out how to stop it.
2:39am. A drunk student is brought in as a Jane Doe. Also, a crushed toe, another 3 drunks, and 2 young children with fevers. I am starting to feel a little anxious.
Approximately 3:00am. The gates of Hades, previously straining under the stress of the contained abyssal chaos, suddenly burst asunder. In other words, all Hell breaks loose.
A minivan with 5 teenagers swerved to miss a deer and goes tumbling into the ditch. Our helicopter and several ground crews have been dispatched to bring in the injured. We start seeing our department fill with injured teenagers on backboards, crying, faces crushed, and we do our best to keep up. One goes in trauma 3, then trauma 1, then room 23, then room 16, then room 11. We don’t even find out until over an hour later that they are all from the same accident.
At the same time, we have a woman who slipped and fell in the bathroom of the Union Bar, cutting her chin. And a patient with severe pancreatitis. And a teenager from a car crash with bleeding inside her brain (not related to the victims above). And, most frightening of all, a 6-month-old baby in shock carried into the ER in her mother’s arms.
The baby is pale and listless. I am now officially scared shitless.
My mind went blank. My initial thought was, I have no idea what to do. But somehow, between the energy drinks consumed tonight and the milligrams of adrenaline coursing through my veins, I slowly calm down and let my training take over. His airway is open and clear. He’s breathing fine with a good oxygen saturation. But that color and heart rate is really, really bad. OK, so the problem is circulation. We can fix that. Does his heart need to be shocked? No, he’s not in an arrhythmia, his heart is just running really, really fast. Normal, but fast. I think. No, I know. I’ve got to know. I’ve got to be right about this. He needs fluids. Lots of fluids. As calmly as possible (concentrating with every word), I ask my nurse to start an IV and give a bolus of fluid. If she can’t get the IV with a minute or two of trying, I tell her, I am going to put an intraosseous line into him (an intraosseous line is a hard needle driven into the tibia to deliver fluid or medications. It’s extremely easy, fast, and effective, but we don’t like punching through bone if we don’t have to.) She gets the IV (her adrenaline level was pretty high, too) and we start treating the child. He starts to improve for now.
Remember that patient with the nasty head wound? Well, he’s still bleeding. Only now, he’s starting to go into shock. He’s getting confused, an elevated heart rate, and he’s starting to look a little pale. Unable to tie off the bleeder with sutures, I grab a staple gun and start shooting away into his head. I’m desperate, but amazingly, it works. I manage to get the bleeding stopped and we get an IV going so he can recover some of the plasma now decorating our floor.
The teenagers with the minivan crash? They’re mostly fine. Just scared and a few cuts on their cheeks, chins, and eyelids. But one of them is having trouble speaking. Then he spits up blood. Then he starts coughing and choking on the blood from a broken maxilla (the bone for the upper teeth). We immediately put a tube in his throat to keep him from suffocating and the trauma surgeons, bless their souls, took it from there.
Our team was stunned by the onslaught of patients. Our resources were totally overwhelmed. But somehow we started to get a handle on the situation. The infant in shock had a line and labs and a bed in the pediatric ICU. The head bleeding was controlled. The airway was protected from the broken face. The other boys and girls were bumped and bruised but somehow were safe. The two other children with fevers did not have dangerous infections. And I even found a moment to close the chin laceration from the Union Bar.
6:20am. I helped my intern perform a spinal tap on a patient who had been waiting all night for a diagnosis. The test was normal, thankfully. Meantime, my resident had a chance to revise my messy head staples so that it looked pretty good. And the patient was feeling much better.
6:30am. My relief starts her shift.
6:40. Closed another chin laceration on a teenager from the minivan.
7:05. The nurse of the really sick baby asked me to escort them up to the pediatric ICU, "just in case anything happened." The tests, so far, were normal. I started breathing easier when the baby was in the caring hands of the ICU nurses. I still can’t figure out what caused his problem. As of this writing, the case is still unclear, but a bacterial infection of the colon is the leading theory. If Gregory House were a pediatrician, this might be a good case for the show.
7:48am. I buy croissants from the Java House for my wife and daughter.
7:53am. Leave hospital 14 hours and 48 minutes after I entered it. It was the best croissant I’ve ever tasted.
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Frank Edwards, MD, FACEP
Friday, November the 6th, 2009
Last day of vacation, Ocracoke Island, NC
Light wind out of the west
Air temperature cool
Water temperature, even less
Time of day: pretty damn early
Sounds at this moment:
Wife rising upstairs
Tooting ferry on Pamlico Sound
Fan hums somewhere below.
State of the nation:
Saddened, bewildered by act of
Army psychiatrist murdering 13 people.
Democrats sensing victory
Anxious to ram health care bill
Down crusty throats of deer-in-headlight conservatives,
Think: Grant riding up to courthouse in Appomattox.
State of the world:
Usual hodgepodge of peace, hope, love, violence and hatred.
Likelihood of violent death = population in pain, squared.
State of the universe:
God on the sidelines hoarding knowledge of
Being, nothingness, time and infinity
Further input unavailable.
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Frank Edwards, MD, FACEP
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Gary Moreau, MD, FACEP
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Dr. David Newman, "Hippocrates’ Shadow: Secrets from the House of Medicine"
Paul Austin, MD, FACEP
Dr. David Newman is the Director of Clinical Research and Assistant Professor in the Department of Emergency Medicine at St. Luke’s-Roosevelt Hospital Center/Columbia University in New York City. In 2005, as a major in the US Army Reserve, he was deployed to Iraq, where he received an Army Commendation Medal. Dr. Newman recently published the book Hippocrates’ Shadow: Secrets from the House of Medicine. He is also a member of the Section of Medical Humanities and is interviewed by member and fellow author Dr. Paul Austin.
Paul: David, thanks for doing this interview for the medical humanities section newsletter. I loved your book, Hippocrates' Shadow, and am glad to get the chance to talk with you.
Paul: First off: great title. How did you come up with it?
David: I was looking for something that conveyed two ideas. The first is that we have yet to live up to the father of medicine, which is to say that we’re still living and working very much in his shadow. The second is that we’re in a bit of a shadowy period in medicine, when we’ve chosen to be somewhat secretive about the real nature of medicine and the potential benefits of the medical sciences.
Paul: How was writing this book different from the other writing you've done?
David: The great majority of my previous writing has lacked any narrative. This book is driven, both structurally and thematically, by patient care and doctor experience anecdotes. That was new for me, and exciting.
Paul: In Hippocrates' Shadow, you make very effective use of short anecdotes to introduce or illustrate a point you want to make. Yet, in academic circles, "anecdotal" seems to be the quickest way to dismiss an observation. What is the proper role of anecdote in clinical discussion/writing?
David: There’s great confusion about the place and the role of anecdote in medical writing. Anecdotes are powerful communication devices, and the growing movement in "narrative medicine" illustrates this, but the power can swing both ways. As a method for finding scientific truth anecdotes are often powerfully misleading (Hippocrates called experience "delusive"), since they’re essentially a form of uncontrolled observation. This is the opposite of deductive, or scientific, method. Anecdotes can, however, be powerfully illuminating when used as a means to link a scientific truth with human consequence or impact. We all understand scientific concepts a little more quickly and completely when there’s a real world example to illustrate their meaning, and it’s critical to understand that science exists to serve humans — not the other way around. Anecdote is a means of exploring and understanding established truth, not a means of finding it.
Paul: You write with such clarity and candor about the lack of scientific basis for much of what we do. How have your fellow EM docs responded? What about docs from other specialties?
David: I’ve had very positive responses from physicians. As a researcher, of course, I have to note that the group that approaches me is quite a biased sample, so this isn’t a very valid way of measuring what physicians have felt overall. But the comments so far have reflected a sense of relief. Doctors tend to tell me that they feel unburdened.
Paul: What has been the biggest surprise you've had about being published by a major publisher like Scribner?
David: First of all, Scribner has been delightful. I’ve been incredibly impressed with the sophistication, patience, and insight of the editors I’ve worked with. On the other hand I’m an amateur to this whole scene, so like many before me I presumed that a large publisher would bring some of their weight to publicity and distribution efforts. But the truth is that the publishing world has virtually always left it to authors to do most of this work and that’s probably always how things will always be. For those with full time work (and authors who aren’t naturally comfortable with promotional activities) that means "PR" is hard to come by.
Paul: I am not a "numbers guy." During my short stint in academic emergency medicine, I published several studies, and I always "subbed out" the numbers, as if I were a general contractor, subbing out the plumbing, or the wiring. I knew what I was trying to get at, but didn't understand the math. So, I found a colleague I trusted, and got her to help me design the study, and choose the statistical models we'd use. I guess my question is: how often do the researchers themselves really understand the math they're using? (The recent financial disaster seems another example of people using math that was so advanced, so esoteric, that no one really understood it.)
David: Very perceptive point. I’ve thought about the recent financial debacle and its relation to medicine. In many ways I think my book is about this exact problem, the problem that we have with respecting science. For years we’ve stood on the shoulders of presumed giants. We have accepted what we’ve been told in medical school and accepted conventions like the recommendations and statements of professional societies and groups. This, in many ways, is one of our dirtiest secrets: physicians don’t have the time, nor are we given the tools, to closely examine most of the foundational scientific evidence that has established our common practices. Because of this we simply have to accept what we’re told. By accepting and believing in the methods that have been used to teach our science to us, we have unintentionally disrespected the science. This explains how it is and why it is that so many of our common practices, when closely examined, not only lack an evidentiary basis but also often clearly contradict the best available evidence. And there is little other option at the ground level for most physicians. My sense is that except for a few individuals the financiers who played a role in the recent collapse had been doing the same thing for years.
Bit of a digression there, but to bring it back: it’s very easy to get confused about what statistics are for and how to use them. They should be used for finding truth, but the underlying assumptions in most statistical methods (the existence of a yes/no answer and no grey zone, that human factors behave like coins being flipped, that large numbers of humans can be averaged to find truth for one human, etc) are very problematic when we try to apply them to people. So yes, there’s still some real misunderstanding, even among researchers, about the certainty and precision that statistics can offer us.
Paul: Where, and when, do you write?
David: Wherever I am, and whenever the feeling strikes.
Paul: What (or who) inspired you to write Hippocrates’ Shadow?
David: I had the same experience most doctors have: the transition from being an outsider to being an insider in medicine was confusing, and it almost seemed like there was a real effort to stifle both humanity and skeptical thinking. My sense is that both are absolutely necessary for science to be applicable and useful to humans. The deeper my own research went, the more it became clear to me that both doctors and patients would be flabbergasted if they could see what I was seeing. For doctors much of our foundation is profoundly flawed and I believe we know this deep inside. Our disaffection and our increasing dissatisfaction are the manifestations of this intuition. For lay people much of what they have come to accept as scientific truth is anything but, and they have been instinctively skeptical and frustrated as well. I wrote the book to unite patients and doctors, to unite science and society, by showing them what has divided them for so long.
Paul: How would this book change the clinical practice for most ER docs?
David: The book offers a new way of thinking about our science. For me, this has changed everything about the way I approach and treat patients.
Paul: How would this book change job satisfaction for most ER docs?
David: Dissatisfaction comes from a disconnect between our original goals in medicine and the reality of our practice. The book shows us where the disconnect occurs, and then shows us how to reconnect. I very much hope that this book will allow doctors to get back to their roots and believe again in their science.
Paul: What advice would you give other physicians who want to write a book?
David: Go for it.
Paul: Who is your favorite author, and why?
David: Sherwin Nuland is my favorite medical writer. He’s found a way to write beautifully to the level of physicians and the level of lay people — in the same sentence — while uniquely respecting both. That’s a gift.
Paul: What do you read for fun?
David: I love a good detective novel.
Paul: What book are you reading right now?
David: The Life You Can Save, by Peter Singer
David Newman is the author of Hippocrates’ Shadow: Secrets From the House of Medicine, available in all major bookstores, and as a hardback, paperback and Kindle at Amazon.com.
Paul Austin is the author of Something For the Pain: Compassion and Burnout in the ER, available in all major bookstores, and as a hardback or paperback at Amazon.com.
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Kathryn Hall-Boyer, MD, FACEP
One plus one was only two
Doing good things
Then came cooperation and
One plus one equaled three
Getting a step up
A gentle shove
A fireman’s carry
Together they were more than
The sum of their deeds
Then came imagination
Complementary works and
One plus one equaled more
Oh, so much more
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The Young Taliban Fighter
Jon R. Hager, DO
The young Taliban fighter is jovial and animated. With his
good hand he gives me a high five as I pass by his
hospital bed. He is receiving definitive care for the
gunshot wound to his other hand and wrist, which
occurred in a firefight with coalition forces some 6 weeks
ago. Now he's getting the best treatment that western
medicine can offer in the austere environment of
Afghanistan. Indeed, the U.S. Army combat support
hospital in Bagram is like Johns Hopkins to Afghanis
like him. When none of our Pashtu interpreters is
available, he jokes with me in broken English. An armed
guard stands nearby. How this kid got mixed up with the
bad guys is a mystery to me, but there are many more
like him. I am sorry that we must now deprive him of his
freedom, but if not detained he would only drift back
to the lawless tribal area from which he came. There, he
would surely be re-indoctrinated and re-deployed by
those who would violently impose their harsh will on their
fellow countrymen. He laughs and shakes my hand in
sincere gratitude, and for the moment we are just like a
couple of buddies. I wish it could always be like this.
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Reality Revealed: Painting
Gary Moreau, MD, FACEP
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Elizabeth Mitchell, MD
Listen to MP3
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Dr. Paul Austin book signing: "Something for the Pain," October 2009, Boston, MA
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Performing at the EMF Event, October 2009, Boston, MA: Kalev Freeman & Walter Limehouse
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You Are Here
Peter J. Paganussi, MD, FACEP
Falls Church, VA
If you pay a visit to any decent size shopping mall, museum, public/municipal building, a state/national park, or a historic site, you will undoubtedly encounter the ubiquitous locator maps at the entrances of said places. If you consult the map they always have that bright red pointy arrow and the words "You Are Here" in an equally eye-catching color, usually fire engine red. Thus designating the point at which you are located. It’s basically where you are currently positioned. Quite literally it is where you stand.
You are here.
It is usually comforting to know where you are. There are also occasions to the contrary, however. Sometimes it can actually be frightening knowing where you are. You might find yourself in a very disadvantageous position or a dangerous place. In these instances it would seem that it is better to know where you are going than where you are. Having a clear-cut source of direction and a plan for getting there become the issue, rather than where you are. It is good to have a destination.
So I ask the question, where am I? Where exactly is "here"? If I were staring at a locator map right now, where would that fat, red arrow be pointing? I need to get a bearing, a sense of location, before I can even contemplate where I am headed. According to the laws of classical physics I need to know my position in time and space. I assume a velocity of zero for this problem. Let’s keep it simple. We assume a position of relative stasis for this exercise. Let us also assume that since you are reading this the likelihood is about 95% that you are an emergency physician. I practice in the state of Virginia, so by point of reference I use the Virginia Commonwealth as one of my fixed points. Thus, you are essentially looking over my shoulder on this one. You are standing next to me. We share the same position with only a few degrees of separation. Accordingly, we both look at the same map in helping determine the spot that corresponds to "You Are Here."
Let’s pull back to get our bearings. First we find ourselves on a very unique blue planet that we call Earth. Earth is located in a singular solar system that resides in a barred, spiral galaxy known as the Milky Way. Ours is the largest and densest of the inner planets, the only one known to have current geological activity. It is the only inner planet with a large, solitary satellite we call the Moon, and it is the only place in the universe where life is known to exist. Our liquid hydrosphere is unique among the terrestrial planets, and we inhabit the only planet where plate tectonics have been observed. We live in its delicate, self-contained atmosphere that is altered by the presence of life to contain 21% free oxygen.
As we dive towards our current position the atmosphere thickens. The blue and white swirls of Earth as seen from space give way to the greens and browns of land. The terrestrial platform for life begins to take shape. Distinctive landforms we call continents come into view. What we refer to as the North American continent begins to come into focus. We drop down onto the Atlantic side of the continent. We roll eastward towards the Atlantic Ocean and the distinctive outlines of the Chesapeake Bay can be seen. To the west lie an ancient spine of mountains laced in clouds; the Blue Ridge rises proudly. We come to rest in the Commonwealth of Virginia. We now have one of our desired coordinates. We know our position in space. We still need to know our position in time to get the most accurate fix on where we are.
We are ground-based, upright and sentient creatures. We are the one species to have shaped and sculpted this planet on a global scale to fit our needs and in doing so we have created wonders to be marveled for the ages. We have also wreaked havoc and in some cases done irreparable damage to our delicate and nurturing biosphere. We are a species capable of incredible wonder and conversely we are equally capable of unspeakable atrocities. Yet unlike just about any other life form on this planet we have the capacity to care for and nurture our sick, and we usually tend to our dead in some fashion.
I will not debate whether these ideas solely make us "civilized," because so very much more goes into this concept. The fact is we, as a species, have a keen cognitive ability tempered with emotion that seems to compel many of us to engage in activities whose singular purpose is the physiological well being of another one of our species. This is unique amongst biologics and is really quite extraordinary. Our ancestors shook bones in the sand, looked for patterns in the stars, performed gruesome sacrifices, prayed to gods, erected monuments, all in an effort to help heal the sick and cure disease. Slowly, through the ages, we have learned to use science to unlock the pathologic mysteries that plague our species. To paraphrase Carl Sagan, science has truly been a "candle in the darkness" illuminating the path to ultimate causality. Science has provided us with the knowledge and wherewithal to create cures and palliatives for much of what ails our species. As physicians we are keenly aware that we have come a long way from bones-in-the-sand and star charts, but through the prism of science there is still so much yet to learn and improve upon.
Currently there are approximately 300 million of our species inhabiting the boundaries known as the United States. There are another 7.7 million within the boundaries that distinguish Virginia. Debate now rages within both borders over the essence of that care and how it is to be administered. As a physician, I feel as if we as a group have been largely pushed aside in this debate. It takes place at a different plane amongst our agreed upon societal leaders. Really they argue over the "expense" created by the care that is needed to tend to our sickness and pathology. They debate just how to pay for it all. This is the time we find ourselves in as physicians. This is our second coordinate for this exercise. Our temporal position is not enviable. It is one of those disadvantageous positions I referred to earlier. So what we need is a plan, a clear-cut source of direction. We need to know where exactly we are going.
I would maintain at this point that our so-called societal leaders are the ones who should consult a map. They need a guide. They need to perform the exercise that you and I have just completed and figure out just exactly where we are. More importantly they need to figure out where we need to go. They need to get grounded. They think they have this figured out, but I respectfully submit they really haven’t thought this through. They have not used science to light the way. They may as well use bones and star charts given how they have proceeded thus far.
As physicians we need to use Sagan’s candle to light a torch to illuminate, for all those involved, that there are better ways to approach what has been referred to as "The Health Care Crisis." The crisis in actuality resides in the realm of the distribution of the care, not so much the science, technique and application of said care. American males have now reached the average age of 78 years. Historically, this is unprecedented longevity. Yet we act as if we should somehow be ashamed of how we administer our health care system. There exists a bizarre dichotomy here. As physicians, we have to take the lead and get control of this before all the good work that we do gets cast aside in this "debate." We need to do it for the advancement of our society and to continue the tradition our species has of tending to our sick. So, to overstate the obvious, this is our time and this is our place.
You Are Here.
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Gary Moreau, MD, FACEP
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Annual Meeting Minutes
American College of Emergency Physicians
Section of Medical Humanities
October 6, 2009
Participating in all or part of the meeting were: Paul E. Austin, MD, FACEP; Judith Dattaro, MD, FACEP; Hans R. House, MD, DTMH, FACEP, Chair; Paul E. Austin, MD, FACEP; Arthur R. Derse, MD, JD, FACEP; Kathryn L. Hall-Boyer, MD, FACEP; Tae W. Kim, MD; Elizabeth Mitchell, MD; Shannon Moffett, MD; Peter J. Paganussi, MD, FACEP; Jeffrey Sankoff, MD, FACEP; Robert C. Solomon, 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 2010
- Web site development/newsletter expansion
- Copyright Agreements for Web Site Material
- Writing Award for 2009
- Officer Elections
Major Points Discussed
The meeting was called to order by Hans R. House, MD, DTMH, FACEP, section chair.
- On behalf of EMF, Dr. Solomon thanked the section for its work with the art gallery and the EMF Event.
- "Open Mic" – Dr. Mitchell encouraged everyone to attend the Open Mic Night on Tuesday, October 6. She is concerned that interest in the event may be dwindling and feared it would not do well in Las Vegas. Ideas were discussed about different times, venues, and ways to attract attention and funding.
- Art Gallery for 2010 – Dr. Sankoff has agreed to organize the gallery for 2010. This year the gallery was distributed throughout the ACEP Resource Center, using tabletop easels that were purchased with the section dues allotment. Feedback seems to be positive so we will pursue this again next year. Donated art was again auctioned for EMF. The section will investigate possible sponsorships for the gallery and/or a prize for the residency group with the best art.
- Membership – Dr. House said that the section membership numbers seem to be holding steady. He reminded section members to sign up their residents, as residents are allowed 1 free section membership.
- Web Site Development/Newsletter Expansion –Dr. Paganussi asked members to submit items for the Web site and newsletter. He suggested book and media reviews as well as blogs, in addition to literary and art pieces. He will put together a collection of the writing award submissions.
- Copyright Agreements for Web Site Material – Ms. Napper said that ACEP is developing an online site for copyright agreements for newsletter submissions. More details will be forthcoming.
- Writing Award for 2009 - Dr. House said that this year’s recipient of the Creative Writing Award is Paul Austin for "Tucker Put His Gun to His Head." Articles will be solicited for the fourth annual award in June 2010. More advertisement of the award needs to be done next year.
- Medical Humanities Course Proposal – Dr. Wolfe will prepare a course proposal for the 2011 Scientific Assembly; the deadline is September 1, 2010.
- Ms. Napper presented the outgoing section chair certificate to Dr. House and thanked him for his hard work over the last 2 years.
- New Section Officers – Dr. House reminded everyone that the officers for the next 2 years are: Edwin Leap, MD, FACEP, chair; Peter Paganussi, MD, FACEP, newsletter editor; and Judith Dattaro, MD, FACEP, councillor.
The meeting was adjourned.
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