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Medical Humanities Section Newsletter - February 2013

circle_arrowFrom The Editor - Medical Humanities Section Newsletter, February 2013
circle_arrowFrom the Chair - Medical Humanities Section Newsletter, February 2013
circle_arrowPoetry - Green to Gold by Jay Kaplan, MD, FACEP - Medical Humanities Section Newsletter, February 2013
circle_arrowPoetry - The Borg Collective by Frank J. Edwards, MD, FACEP - Medical Humanities Section Newsletter, February 2013
circle_arrowPoetry - Butler Sunset by Livia Santiago-Rosado, MD, FACEP - Medical Humanities Section Newsletter, February 2013
circle_arrowPoetry - Departing and Arriving by Jay Kaplan, MD, FACEP - Medical Humanities Section Newsletter, February 2013
circle_arrow2012 Scientific Assembly Medical Humanities Open Mic Night - Medical Humanities Section Newsletter, February 2013
circle_arrowPhotographs - Medical Humanities Section Newsletter, February 2013
circle_arrowPerspective - Sandy Hook - Medical Humanities Section Newsletter, February 2013
circle_arrowPerspective - The Zero Curse - Medical Humanities Section Newsletter, February 2013
circle_arrowPerspective - ABC's for a Tired (and Slightly Cynical) EM Resident - Medical Humanities Section Newsletter, February 2013
circle_arrow2012 Creative Writing Award Winner - Medical Humanities Section Newsletter, February 2013
circle_arrowLinks/Members in the Media - Medical Humanities Section Newsletter, February 2013
circle_arrow2012 Annual Section Meeting Minutes - Medical Humanities Section Newsletter, February 2013

From The Editor - Medical Humanities Section Newsletter, February 2013

Peter J. Paganussi, MD, FACEP

May this edition of the newsletter MUSE warm your heart and soul this winter 2013. This edition is chock full of the talents in our section. We have some old stalwarts who always bring so much to our collective table. Drs. Iverson, Kaplan, Dhillon and Edwards have long been major contributors to this humble publication. That doesn’t change for this issue.

We also welcome some new voices. Dr. Santiago-Rosado has delivered us some wonderful poetry with distinct imagery and style. Really exquisite stuff! Her poem “Butler Sunset” fits nicely with the two stunning photographs of sunsets by Dr. Kaplan. Dr. Sprince , an emergency medicine resident at University of Iowa, has brought us some lighthearted ED humor that is clever and quite poignant.  I am especially delighted to have “The Wisdom of Solomon,” Dr. Bob Solomon, that is. The Editor of ACEP News is a section member and has a wonderful blog that is a must-read. He has graciously contributed a piece from one of his blogs that is very timely indeed for a big election year like we just experienced. Keep them coming Dr. Solomon!

I have divided this edition into categories. There are photos from Open Mic Night at SA 2012 and the minutes from the annual section meeting there in Denver.

We also are proud to showcase our Medical Humanities Section Creative Writing Award winner for 2012. Dr. Mark Rosenberg’s submission “22 Things” is presented herein for all to enjoy. Great work, Dr. Rosenberg!

As always, we kick things off with the letter from our Chair, Dr. Jeffrey Sankoff. Enjoy this issue of MUSE.

From the Chair - Medical Humanities Section Newsletter, February 2013

Jeffrey Sankoff, MD, FACEP

Greetings, Salutations, and Happy New Year!

As I prepare to bid one last farewell to 2012 and open my arms in greeting to 2013, I find myself, like so many of you I am sure, thinking back on all that was and looking forward to all that I hope will be.

When ACEP was in Denver this past October it was a great opportunity to show off my adopted home city and by all accounts, the Mile High City impressed. Best of all, our section meeting was well attended and productive and Open Mic Night was a huge success yet again. We owe our thanks once again to our sponsor Hagan Benefits and are very excited to welcome them back in Seattle for 2013.

At the section meeting we discussed ways to try and better engage our members and increase new membership. My first step towards doing this was to conduct a survey to get a sense about how we stand in these regards right now. As I suspected, one of the easiest things that we could do is expand the focus of the section microsite as well as make it easier to access.

Twenty-eight people completed the survey and of those, the vast majority considered themselves writers. The next most common talent was photography. Very few of the respondents said that they visit the section site and the reasons for this were several but clearly the most important were the lack of changing content and the difficulty of getting to the site (not an intuitive URL). More than 90% agreed with the idea of unrestricted access for non-section members with section members getting immediate access to certain content and non-members getting delayed access (such as the newsletters, for example). A majority said that they would contribute visual or written content to an open Web site and almost all (>98%) wanted to see new prizes for photography and non-photographic visual art to go along with our annual prize for written word. Two thirds of respondents felt that these prizes should be open to non-section members as this would potentially improve section visibility and increase section membership.

So, given all of this, I am going to work with Tracy Napper and ACEP in 2013 to try and overhaul our Web site to do the following:
• Open access for non-members with delayed access to newsletters (six months)
• Enhance the appearance of the Web site to include more photographic submissions by members
• Allow for ongoing submissions to the Web site of written word and photographic and non-photographic visual art.

We are also going to introduce two new section prizes to be awarded at the ACEP SA in Seattle in October: one for photography and one for non-photographic visual art. Both will be open to non-section members. This year, for the first time, all prizes will be voted on by section members and not selected by a panel.

I hope that you will agree that these represent positive and substantive changes for the section and will improve the way you can collaborate with like-minded colleagues! It is my hope that in doing these things the Section of Medical Humanities will continue to grow and afford all those within it who want the chance to show their hidden talents the opportunity to do so.

Please accept my sincere wishes for safe, healthy and very happy 2013.

Poetry - Green to Gold by Jay Kaplan, MD, FACEP - Medical Humanities Section Newsletter, February 2013

Green to Gold
Jay Kaplan, MD, FACEP

the sun begins to hint its rising
as the tree-line turns from its night black to dawn blue to hopeful orange
and my gaze is met by the friendly maple

the last time we were together
you were in your prime
              a mature vibrant green
and now only hints of that vitality remain
as you now rest in your gorgeous gold

how are you feeling in this season of your life

I find you more beautiful now even as you prepare to fall away
returning to the ground from which you were nourished
each leaf itself at different stages
            uniquely colored
indicating that while all are on the same path
             the journey is different
             and the days of remaining attached will vary

how do you feel as you prepare to let go
do you worry about when
can you enjoy your now
will you feel your spirit alive even as in the distance you can see the finish line
there are still places to go
and wonders to behold
and hands to hold
and gifts to give
             and to be received

we are all trees with all the parts of ourselves different colors and at different stages
at times eagerly bursting forth with excited life
then comfortable in maturity
inevitably followed by the release to the wind

and the more we relax the further we are carried
             and the more we can nourish our next generation of life
green to gold to brown and back to green
to have faith in our seasons and in the parts of ourselves having seasons
brings trust and permission and fullness
and a deep appreciation for the journey we are always on

Poetry - The Borg Collective by Frank J. Edwards, MD, FACEP - Medical Humanities Section Newsletter, February 2013

The Borg Collective
Frank J. Edwards, MD, FACEP

They roared through the cosmos
In huge, green, externally plumbed cubes,
Bionically enhanced
And all neurally linked
Like drones in a hive,
Infused with a merciless agenda:
To assimilate every man, woman or child
Of whatever species it encountered,
Just wire them in and spit out their egos
While muttering in metallic tones:
“Resistance is futile.”

In an episode called Family
Captain Jean Luc Picard has just escaped
A brief but harrowing encounter with the Borg 
During which he was briefly assimilated,
Forced to betray his own kind,
And now takes a well-deserved
R & R to visit home and heal,
Back in rural France with his brother,
The one who had stayed behind
To tend the family vines
While Jean Luc soared off
To Starfleet Academy.

Driven by pride and envy,
The brother, however,
Will not let Jean Luc lick his wounds in peace,
Keeps lobbing innuendos
On the theme of ‘You reap what you sow’
Harsher and harsher
Until Jean Luc’s damaged warp core erupts,
And they grapple in the mud
Rolling through puddles
In the shade of verdant vines
And when the punches and anger are spent
And they are thoroughly bloodied and mud sodden,
The curses melt into laughter.

Fade now to a cask-filled cellar
In the old chateau,
Dust shimmering in a shaft of light,
The brothers Picard pass an ancient bottle back and forth
And sing.
And later that night at dinner
Jean Luc, his brother and his brother’s
Earth mother wife
Glow in reconnection,
While, as the music dims,
The camera fades back through the window
Out into the night
Where all is silent but for the kissing of crickets,
And bright, wild, magnetic light from a universe
Of Borg roving stars
Glints on the roof slates,
And the camera eases into a close up
Of Jean Luc’s nephew
Sitting alone at the bole of a tree,
Hands folded in his lap,
Staring up.

Poetry - Butler Sunset by Livia Santiago-Rosado, MD, FACEP - Medical Humanities Section Newsletter, February 2013

Butler Sunset
Livia Santiago-Rosado, MD, FACEP

If not a blackbird up above
if not the juvenile chanting
if not the lustful inconsequential chitchatting
if not the sighing and the clearing of throats
             and the turning of pages
             and the pencil-scratched notes
if not the rustlings of the afternoon
then you.

If not the creaking of a chair
if not the squeaking of a sole
if not the stares off into space
if not the breathing and the words
             bleak and senseless, silent whispers
             stifled voices muffled low
if not the stark impending gloom
then you.

You are the blackbird
and the chair.
And the pages
the voices
the sole.
You are the sighing
and the breathing.
You are the whispers
the afternoon.
Then nothing
if not you.

Poetry - Departing and Arriving by Jay Kaplan, MD, FACEP - Medical Humanities Section Newsletter, February 2013

Departing and Arriving
Jay Kaplan, MD, FACEP

being flown from departing to arriving
the background hum of air passing throughout
broken harshly by the admonitions of the responsible voices
giving permission to turn on this and later to turn off that
as if we need others to tell us
when we should stretch open ourselves to the possibilities of more than just sitting

we passively allow others to move us
and then we land on terra firma for the briefest moment
is it an illusion

before we are off again as the engines rev
and our lives accelerate

the time zone changes
is it an illusion
is it true we become hours older or younger
depending upon our direction and destination

we are the ones with choice

can we give ourselves permission
to turn on this and turn off that
growing younger even as we age
every day full of departures and arrivals
sometimes simultaneous
requiring only our courage to recognize and welcome
as we then continue to move and be moved
propelled within and without

there is a moment’s peace upon arrival and a moment’s hope upon departure
as we land yet again not having reached our destination.

2012 Scientific Assembly Medical Humanities Open Mic Night - Medical Humanities Section Newsletter, February 2013

Peter Viccellio

Jay Kaplan  

Uri Freeman, Mark Hermann, Kalev Freeman

The Fab 4


Photographs - Medical Humanities Section Newsletter, February 2013



Here are two pictures from the Tsukiji Tokyo market at the end of the year 2012 and a new pair of Gel Kayano 19's from
Tokyo (where asics is from) to remind people about their New Year’s resolutions to run. 
Paul Dhillon, MD

Sunset Venice, Italy
Jay Kaplan, MD, FACEP

Sunset North Dakota, USA.
Jay Kaplan, MD, FACEP

Perspective - Sandy Hook - Medical Humanities Section Newsletter, February 2013

Ron Iverson, MD, FACEP

December 16, 2012   
Sandy Hook

Twenty children obliterated, rendered blood and body parts scattered upon tile floor, within minutes, of unspeakable violence and uncontrollable rage.  The media frenzy. The call to action, but what action?  For what purpose?  What is the problem anyway?

Mental illness a silent epidemic.  I see the problem every day in the sad, angry, tormented faces of my patients. Human beings with pain too deep to contain within their bodies who end up in a hurried, uncaring, loud, abusive environment called the Emergency Department for one reason and one reason only: there is no other place for them. 

We have made no place for the mentally ill in this country.  Nowhere can they find solace from their demons.  We pretend mental illness doesn’t exist until people die, particularly if they are children and it catches the attention, for a brief amnestic moment, of the public. 

The problem is large and encompasses not just our culture and our genetic design but a fact of the human condition.  Mental illness is a timeless problem for which no culture has found an answer. We feel compelled to do something, but what?  It is not more security.  It is not gun control.  It is not more politicians or ill-informed media exposés. Whatever the answer is, it must be in an effort to heal the pain of those with mental illness and find ways for them to keep their demons in control. 

Peer into the mind of the disturbed.  Perhaps John Knowles did so when he wrote in his classic novel, A Separate Peace,

“I felt that I was not, never had been and never would be a living part of this overpoweringly solid and deeply meaningful world around me…the stadium did speak powerfully and at all times, including this moment.  But I could not hear, and that was because I did not exist.”

We must find a way for the mentally ill to feel that they do, indeed, truly exist.

I walked in the silence of fog, thinking about the tragedy at Sandy Hook School.  There was no sound but that of my boots leaving quiet footprints on the snow-covered ground.  Fog comforts and insulates me from the terrors of the world.  Here I am among my friends, the Lodgepole Pine and Ponderosa, who rise gently above me, into the wispy fog.  Peace.

Perspective - The Zero Curse - Medical Humanities Section Newsletter, February 2013

The Zero Curse
Robert Solomon, MD, FACEP

In the final weeks, and then days, preceding the presidential election, the pundits were talking about how close the race seemed to be. They were intently focused on the "battleground states." They worried (or were they really rubbing their hands together in eager anticipation?) that some of the state vote tallies might be so close as to trigger automatic recounts. And that could lead to legal challenges. There were echoes of Florida in 2000.  It didn't turn out that way, probably to the disappointment of some journalists (and maybe lawyers) and the relief of everyone else.

But it brought to mind conversations I'd had during the six weeks or so of the contested election of 2000, that period between Election Day and the U.S. Supreme Court's ruling.  Perhaps, I said to the medical students and residents I was supervising in the emergency department, neither Bush nor Gore should want to be the winner, because of the tragic history of presidents elected in years ending in zero.

I noted that the last president elected in a year ending in zero, Ronald Reagan (1980), had been shot soon after taking office and came perilously close to death. Who, I asked them, was the last president before Reagan to be elected in a year ending in zero and not die in office?

I didn't expect anyone to know the answer straight away.  I wanted to see how they would approach the question, what they knew of presidential history, which I would be able to tell if they tried to work their way back through the years that were multiples of 20 - the presidential election years ending in zero.

Nearly all (I was aghast that it was not all) knew that John F. Kennedy was elected in 1960 and assassinated.  But things went downhill quickly from there. Most did not know that Franklin Roosevelt was elected in 1940 (and, of course, also 1932, 1936, and 1944) and died in office (in the spring of 1945, from a cerebral hemorrhage), to be succeeded by Harry Truman.

As I recall, exactly no one knew that Warren Harding was elected in 1920, died in office, and was succeeded by Vice President Calvin Coolidge.  I believe one person knew William McKinley was elected in 1900, assassinated by an anarchist, and succeeded by Teddy Roosevelt.

1880. James Garfield was shot in 1881 by a psychotic man who believed Garfield should have recognized the work he'd done on behalf of the presidential campaign (which was trivial) and appointed him to an important job. The bullet wound was actually not that bad - nowhere near as serious as the one that almost took the life of Ronald Reagan. Garfield was more a victim of the terrible medical care he received. No one knew that. I can't say I was surprised, but I was disappointed just the same, if only because the medical part of the story was so important.

Truly appalling, however, was that not everyone knew 1860 was the year of Lincoln's first election, although of course everyone knew he'd been assassinated.

1840 offers yet another especially interesting piece of presidential history. William Henry Harrison was elected.  In those days inauguration was on March 4th.  (It didn't move into January until FDR was president.  The nation decided that the wait until nearly spring for Roosevelt's inauguration had been too long, given the urgency of addressing the economic woes of the Great Depression. So 1933 was the last year it was March 4th, and it was then moved to January 20th.) Harrison gave his inaugural address outdoors. The weather in early March in Washington, D.C. is usually mild, but in 1841 it was not. Harrison did not wear an overcoat. A month later he died of pneumonia. Causality, of course, is open to question, but the result was that Harrison became the first U.S. president to die in office.

No. That's the answer to your question. Not a single one of the young medical trainees knew anything about Harrison or his vice president, John Tyler. What a shame. Because it's a fascinating story.

Harrison, you see, was not a politician, but a war hero, best remembered for the Battle of Tippecanoe.  (Remember the campaign slogan, "Tippecanoe and Tyler, too?") He was recruited by the Whig Party, which was desperate to win the White House. The Whig party was opposed to just about everything Andrew Jackson (Democratic president elected in 1828 and 1832) stood for, but they had learned from dealing with the hero of the Battle of New Orleans (1815) just how popular war heroes can be. Harrison was perfectly willing to run on the Whig party platform, which was very short on detail, as he had no fixed political principles of his own. The Whigs then needed a candidate for the #2 spot on the ticket. Harrison was from Ohio, so they looked south of the Mason-Dixon line for geographic balance and asked John Tyler of Virginia. Tyler was a Democrat, but apparently not a loyal Democrat, as he agreed to run for VP as a Whig.

Then Harrison died, and Tyler assumed the office. This had never happened before, and the Constitution was not entirely clear on how it should work. The Constitution said that in the event of the death of the president, the "powers and duties" of the office "shall devolve on the Vice President." What wasn't clear, however, was whether the VP actually became president, with all of the accoutrements of the office, or whether he was just the acting president.

It probably wouldn't have been a big deal if Tyler had been a loyal Whig. But not only was he really, after all, a Virginia Democrat who differed with the Whig party's principles in important ways, but he started doing something earlier presidents had generally not done: vetoing bills passed by Congress because he didn't like them.

[Before Tyler, presidents typically vetoed a bill only if they could plausibly contend it was unconstitutional. Nowadays we think of it as the Supreme Court's job to address such questions (which it does only if a challenge is brought before it), established very early in the 1800s by Chief Justice John Marshall as the doctrine of judicial review, and presidents routinely veto bills with which they disagree.  But the president is sworn to uphold the constitution and certainly shouldn't sign into law a bill he thinks is unconstitutional.]

Congressional Whigs were livid, and came very close to mustering the votes to impeach Tyler. They refused to call him the president, referring to him as the acting president - or "His Accidency."

No one I asked knew any of this. Nor did they know that our fifth president, James Monroe, had been elected in 1816 and 1820 and served his two terms in full, the last president before Reagan to be elected in a year ending in zero and survive to the end of his elected tenure.

So I did not expect anyone to respond to my initial question by saying, "James Monroe!" I just wanted to see what they knew of presidential history. Damned little, as it turned out.

Far too few of us show much interest in history in grade school or college, and I'm sure it's at least partly because there are too few history teachers who make the subject interesting, as some of mine did. This is a terrible shame. American history is fascinating, and studying presidential history is a wonderful way to approach it. Thomas Carlyle said, "The history of the world is but the biography of great men." We've had forty-three presidents (Grover Cleveland, who served two non-continuous terms, is counted twice to get to #44 for Barack Obama). The history of our nation is most certainly the history of these men, especially if you read the sort of expansive biography - the man and his times - that is the kind really worth reading.

I tell residents who train at our institution that there is more to learn in the emergency department than medicine. A sense of history is something I hope to give each of them, at least a little bit, by the time they've completed the three years I have to influence their lives.

Perspective - ABC's for a Tired (and Slightly Cynical) EM Resident - Medical Humanities Section Newsletter, February 2013

ABC's for a Tired (and Slightly Cynical) EM Resident
Meredith Sprince, MD

A is for adipose. inches and inches of fat. Good luck directing a spinal needle through that!

B is for bypass, the gastric kind- you found a healthy diet just too hard to mind?

C is for CHF exacerbation- why didn’t you bring your Lasix with you on vacation?

D is for doorway, you’ll almost be through, before the patient asks “did I mention that I have crushing chest pain, too?”

E is for EKG changes- they were so subtle! But Cardiology won’t accept that as a rebuttal.

F is for fever, so scary at 99.3! "But I always run low, so that’s high, don’t you see?"

G is for Grey’s setting high expectations, for call room shenanigans and sexy gyrations.

H is for headache- tension, or something much worse? Better choose right, or they'll leave in a hearse.

I is for iatrogenic opiate OD. Quick, hang the Narcan, maybe no one will see!

J is journals quoted by my faculty- now I realize how much my knowledge is lacking.

K is for kidney injuries of all types, when internal medicine is mad I didn't order urine lytes.

L is for loved ones- goodbye, my dears! Hope you're still around when I graduate in 3 years!

M is for meth addicts, burned head to toe. Making drugs isn't as easy as that one TV show.

N is for notes piling up when I stall; two days later, I don't remember these patients at all!

O is for overnights with an off-service intern. 14 patients at once - more chances to learn?

P is for patients who search WebMD, making a mockery out of my hard-earned degree.

Q is for "quiet," don't you dare say it out loud! ER docs are a very superstitious crowd!

R is for rectal, testicle, prostate exam. Seems that the old men are enjoying them much more than I am.

S is for surveys, Press-Ganey for one. Less than 5 out of 5 and your hospital's done.

T is for Tylenol- let me guess, you’re allergic? You’ve got 12 out of 10 pain, only Dilaudid will cure it?

U is for ultrasounds and other tech we can't buy, because they spent all the money on the Disney service guy.

V is for vaccines- get them, I implore! No one knows how to treat mumps anymore!

W is for work note- fine, here you go. I’m sure that was quite the debilitating stubbed toe.

X is for x-rays, not quite sure what I see. It's no help when the report comes back "correlate clinically."

Y is for yellow skin, alcohol oozing from each pore. "But Doc, I haven't had a drink since 2004!"

Z is for zebras- think you've found one in the herd. After six hours of testing, turns out it was just GERD.

2012 Creative Writing Award Winner - Medical Humanities Section Newsletter, February 2013

[22 Things]
Mark S. Rosenberg, DO, MBA, FACEP

In all my career, I never met a patient who taught me as much as Staci. Staci was a 25-year-old business owner who presented with a headache. A very routine case—she had had similar headaches before and a strong family history of migraines. Her headaches usually got better with Excedrin, but every once in a while she came to the ED for Compazine or Reglan with Benadryl. This time was no different. Normal exam, photophobia, no neck stiffness. She was treated in the usual fashion and felt much improved. She went home and smiled as she said thanks and good night. 

The next day Staci had more pain, worse than before. She was sent to imaging, and the radiologist saw something suspicious. MRI showed a tumor. It had the classic appearance of the last thing a doctor wants to tell and a patient wants to hear. After a workup, biopsy, and surgery, Staci awoke on Oct 14, 2009, in the recovery room very cheerful and told everyone how much she appreciated the care she received. In the days that followed, she was made aware of her diagnosis of brain cancer. The neurosurgeons got all of it, but wanted her to have chemotherapy, just to be sure. 

This case fueled my passion for improving end of life (EOL) care and perhaps starting a Palliative Care program at our hospital. Of course, there were some concerns about the long lengths of stay and tremendous costs associated with EOL care.  After all, a Dartmouth study cited New Jersey as the state with the highest cost for end of life care. However, I continued pursuing my interest, served on EOL committees, and became involved with the local hospice. I also planned to take the Palliative Medicine boards in November 2010. 

A month later, Staci came back to the ED. She again had headaches even while on the chemotherapy. When I greeted her, the first thing she said was, “Thanks for caring about me.” Her neurosurgeon had asked her to come back to the hospital to see what was going on. A CT showed post-op changes and mass effect. I felt comfortable telling her the tumor was back. I explained that the pathology report showed a highly aggressive tumor. I explained that some people don't survive this. I asked her if she had been told this before. She said never. I was horrified. What had I done? She made me feel better when she then said that no one had told her, but she learned from reading her medical record that she had a glioblastoma. She knew she would “take a trip” soon, she just didn't know exactly when. You see, Staci would never say she was dying—she insisted she was taking a trip to Milan.  She was just waiting for her doctors to confirm it. They told her it doesn't matter what the diagnosis is…focus on the treatment.

Staci was scheduled for surgery just after Thanksgiving. She had been in the ED twice for pain. Every time we spoke, she said thanks. She said her goal was to spend Christmas with her family. She knew she could make it. 

Staci's surgery went well from a medical standpoint, but the tumor had grown much faster than expected. She would not leave the hospital. She was going to be admitted to inpatient hospice. At least that's what the surgeons and oncologist said. 

On December 11, Staci painted her nails stiletto red and signed herself out of the hospital AMA. 

Over the next 14 days, she put her life in order. She sold her business, took care of all financial issues, made arrangements for her pets, and made plans for her clothes and furnishings to be donated to a women's shelter. She put her house on the market and decorated it for Christmas. She even bought Christmas presents, wrote notes to her nieces, and watched her favorite basketball team with her dad. Her health continued to decline, but her pain and non-pain-related symptoms were well controlled. She told me she was going to make it to Christmas but not to New Year’s. On December 23, she wrote “The 22 things you must do before you die.”

Staci slept most of December 24 and was too weak to have Christmas Eve dinner with her family. She wasn't upset by this—she couldn't eat anyway. Staci was saving her energy for the next day. Her nieces woke her at 5:00 Christmas morning. Late that evening, she told me it was the best Christmas ever. Her mom and dad were there, her nieces and all those she cared about. She told me she was ready to take her trip. I asked her when she was leaving. She responded confidently, “in a couple of days.” I last heard from her on the morning of December 28. She said goodbye and thank you. She asked me to share her list of the 22 things. Staci finally took her “trip to Milan” in her sleep that night. 

On January 7, 2010, St. Joseph’s Healthcare System started an ED-based Palliative Medicine program and Palliative Care Emergency Center. We treated and cared for more than 300 end of life patients in the first 18 months. 

Thank you, Staci.

22 Things to Do Before You Die

1. Tell the people you love that you love them.
2. Plan your flight (will, burial, monies, belongings…..) Dot the “i’s” and cross the “T’s.”
3. Keep pushing…what's the worst that can happen?
4. Don’t worry about things you never had a chance to do… cherish the things you did.
5. Find a way to laugh.
6. Give hope to those still in the fight.
7. Run up your credit cards—banks are the last to know.
8. Acknowledge that the people who are close to you will be sad and think it’s not fair. Comforting them for some reason will comfort you.
9. Make peace with friend and foe.
10. Cover you mirrors…don’t dwell on how you look now. What you see in the mirror is cancer…that’s not you.
11. It’s OK to cry even if you tell others not to.
12. Take care of your pets. They love you unconditionally. Leave plenty of food and water out for them because friends and family will forget to feed them.
13. If there are children or loved ones, write a letter in words they can understand.
14. Record an audio message…videos show death, but your voice doesn’t have to reflect that.
15. Keep in mind that no parent or spouse wants to watch you die. Comfort them. Let them know it’s not their fault. They will never forget that conversation.
16. Live your life and live your death like a Dr Seuss book, “I will never say, I wish I would have could have!”
17. Keep pushing. Drink Red Bull. You’ll have plenty of time to sleep when you’re dead.
18. Support groups are fine – BUT – having one true friend who listens to you is like a MasterCard Commercial: Priceless.
19. Die at home if possible. Sign out of the hospital. Don’t turn your home into a morgue. Have as little medical equipment as possible.
20. Believe in things that are out of sight—Santa Claus, flying reindeer, virgins having babies, and me! 
21. Don’t let a scared family member call 911.
22. Know when to give up your car keys.

Links/Members in the Media - Medical Humanities Section Newsletter, February 2013

Below is a link to the Program in Clinical Arts and Humanities, Alpert Medical School at Brown University from section member Dr. Jay Baruch. Jay is Assistant Professor of Emergency Medicine. He serves as the Director for the Program in Clinical Arts and Humanities. Dr Baruch is the Director of the Ethics Curriculum and Co-director, Medical Humanities and Bioethics Scholarly Concentration The Warren Alpert Medical School of Brown University. We are fortunate to have him as a member of our section.

Frank Edwards, MD, was interviewed about a new book about his medical school, the University of Rochester.  Link to the article is:

Seth Hawkins, MD, has 2 new projects in the works: Update of my Emergency Medicine Narratives study:  Hawkins SC.  Emergency medicine narratives: a systematic discussion of definition and utility.  Academic Emergency Medicine 2004; 11(7): 761-76. Also, I've gotten a contract with Emergency Medicine News to write a short quarterly article on the use of language in emergency medicine, tentatively entitled "Words Matter.". It will start in 2013.  In the byline (which can only be a few words), I want to reference the section to try to promote it.  I'm thinking that section members might be interested in proposing topics for the column as it grows.  This could be a way to point out how the work we do in the Humanities is clinically relevant (a perspective we sometimes have trouble conveying). 

Paul Dhillon, MD, section member’s Web site and link to article about winning essay contest. Twitter: drpdhillon Facebook: /drpauldhillon

Peter Paganussi, MD, section member. Article Washingtonian Magazine OnLine; Where I Don’t Have to Spell My Name.

2012 Annual Section Meeting Minutes - Medical Humanities Section Newsletter, February 2013

American College of Emergency Physicians
Section of Medical Humanities

October 9, 2012
Denver, CO


Participating in all or part of the meeting were: Cindy C. Bitter, MD, FACEP; Judith Dattaro, MD, FACEP; Arthur Derse, MD, JD, FACEP: Paul Dhillon, MD; Dinali Fernando, MD; Kathryn Hall-Boyer, MD, FACEP; Shane Hardin, MD, PhD; Hans R. House, MD, DTMH, FACEP; Merril Pauls, MD; Mark Rosenberg, DO, MBA, FACEP; Jeffrey Sankoff, MD, FACEP: Sydney Schneidman, MD, FACEP.

Others participating: Tracy Napper, ACEP staff liaison.

1. Call to Order

2. New Business
    A. “Open mic” discussion  
    B. Web site development/newsletter expansion
    C. Membership expansion/ideas for new projects 
    D. Writing Award for 2012
3. ACEP Educational Needs Assessment

4. Adjourn

Major Points Discussed

1. The meeting was called to order by Jeffrey Sankoff, MD, section chair.

2. New Business

A. “Open Mic” – Ms. Napper is organizing the performers this year. We have again secured a sponsor, Hagan Benefits, for this year. The $3500 sponsorship pays for the piano, a/v technology, food, and cash bar. Members were reminded to come to the event and to bring guests.

B. Dr. Sankoff discussed new ways to expand the membership and the section Web site. Currently the section site is only accessible to section members. However, in order to attract new members, we want to demonstrate what the site and the section offers. We will investigate if we can open up the site to non-members, perhaps requiring a log-in for the newsletters for the first 6 months they are published, then making them free access, so as to preserve value for section members. Ms. Napper will investigate this possibility. Dr. Sankoff will survey the section members for their thoughts. Section members would like to add photos, music clips, videos, and other media to the site.

C. Other new projects include a Visual Arts Award, where anyone could submit a piece of visual art and section members would vote for the winner. Dr. Sankoff would also like to work with EMRA on a writing contest for residents, perhaps with a prize of a free registration to next year’s Scientific Assembly. Dr. Dhillon volunteered to take over the section Facebook page.

D. The Writing Award for 2012 was given to Dr. Mark Rosenberg for his piece, “22 Things.” Articles will be solicited for the seventh annual award in June 2013.

E. The section has long wanted to promote a humanities curriculum. Dr. Bitter has volunteered to work on describing the components of a humanities curriculum and the benefits to residents of such a curriculum. She will investigate the section grant process as a way to fund and disseminate this curriculum.

F. Ms. Napper queried the group on 2 items regarding ACEP’s educational needs assessment. For the first question, “What do you think emergency physicians need more CME or training in?”, respondents said humanities; practice ethics; health informatics; geriatric/end-of-life issues; human rights; communication skills (with patients and with other physicians); non-malpractice medico-legal concerns. For the second question, “What can ACEP offer that will make an impact on patient care or operations, and why?”, respondents said communication skills and transitions of care are two important topics.

The meeting was adjourned.

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