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Medical Humanities Section Newsletter - July 2011

circle_arrowFrom the Chair - Medical Humanities Section Newsletter, July 2011
circle_arrowA Summer Potpourri - Medical Humanities Section Newsletter, July 2011
circle_arrowSpring in Florence, Italy as seen from the Piazza Michelangelo - Medical Humanities Section Newsletter, July 2011
circle_arrowA Tuscan Spring in San Gimignano - Medical Humanities Section Newsletter, July 2011
circle_arrowFlying Solo - Medical Humanities Section Newsletter, July 2011
circle_arrowHaiti Pediatric Intubation Photos - Medical Humanities Section Newsletter, July 2011
circle_arrowBaby Not Breathing in Four Acts - Medical Humanities Section Newsletter, July 2011
circle_arrowAngel Halo - Medical Humanities Section Newsletter, July 2011
circle_arrowSpirit in Residence at Beaver Creek - Medical Humanities Section Newsletter, July 2011
circle_arrowCan We Please Stop Referring to the Hippocratic Oath? - Medical Humanities Section Newsletter, July 2011
circle_arrowNiagara on the Lake - Medical Humanities Section Newsletter, July 2011
circle_arrowMedical Art – The first draft - Medical Humanities Section Newsletter, July 2011
circle_arrowMedical Art – The detail begins - Medical Humanities Section Newsletter, July 2011
circle_arrowMedical Art – The finished product - Medical Humanities Section Newsletter, July 2011
circle_arrowBook Review: The Unbearable Lightness of Being by Milan Kundera - Medical Humanities Section Newsletter, July 2011
circle_arrowSpring in Chianti – La Conca D’Oro (ie, “The Golden Bowl”) - Medical Humanities Section Newsletter, July 2011

From the Chair - Medical Humanities Section Newsletter, July 2011

Hans House, MD, FACEP 

“You know what it is? San Francisco is a golden handcuff with the key thrown away." 

-John Steinbeck 

 “San Francisco . . . I was born there.”

-Hiraku Sulu, Helmsman, Star Trek IV, The Voyage Home 

San Francisco is a unique city.  Perched upon the edge of the Pacific Rim, it welcomes travelers from across the world, blending cultures into a vibrant, eclectic community unlike anywhere else.  This city, one that has produced artists from Jack London to Ansel Adams, is a welcome destination for humanities-minded emergency physicians.  I love walking its steep streets, buffeted by a chilled breeze off the bay.  I never tire of its diverse offering of foods, music, and art.  People-watching in San Francisco is more than a pastime; it is an experience.   

I encourage you to explore some of the local watering holes.  If you are looking for suggestions, check out these two older pieces I have written in my blog:
 http://underdogcontest.blogspot.com/2008/07/coldest-winter.html 
http://underdogcontest.blogspot.com/2010/11/football-in-exile.html  

I am thrilled to return to one of my favorite destinations and to enjoy it with the section.  We will be holding our annual section meeting, location and time TBA.  Please come to share your thoughts on the current activities and direction of the section; your opinion is critical for the future of the section.  We are looking for a new section Chair; any interested persons should contact me or Tracy Napper.  Also at Scientific Assembly we will continue the growing tradition of the Open Mic Night.  This year, the event will be on Sunday, October 16th 7 to 10 pm, location TBA.  Please come and support your colleagues with their performances! 

Live long and prosper, section members.  


A Summer Potpourri - Medical Humanities Section Newsletter, July 2011

From the Editor
Peter J. Paganussi, MD, FACEP
 

Potpourri -is a mixture of dried, naturally fragrant plant material, used to provide a gentle natural scent in houses. It is usually placed in a decorative wooden bowl, or tied in small sachets made from sheer fabric.
- Wikipedia 

In 17th century France fresh flowers and herbs were gathered beginning in early spring and continuing throughout the summer. They were then left for a few days to become limp. They would be placed in a small pot, usually made of wood, clay or porcelain, and layered with sea salt. This mixture was allowed to age as salt and more herbs were added over the course of the summer. The mixture was occasionally stirred to release its scent and to allow the herbs to mingle. Often the entire mixture would ferment, or even mold, as the summer went by. Nowadays we purchase our potpourri in stores and generally don’t allow pots of moldy substances in our homes. 

What we have here, in our Spring/Summer 2011 edition of MUSE, is a cerebral potpourri from the members of the ACEP Section of Medical Humanities. It is indeed a sweet-scented mix of talent and imagination. It should slowly, and fragrantly, ferment over the course of the summer each and every time you stir it. Stir it with your eyes and your mind and you will treated to its aromatic magic. A number of our members have added their own intellectual and artistic “herbs” to the pot. There is poetry, prose and photography all mixed together and layered lovingly with the spirit of the Section. So sit back, stir the pot, and breathe in deeply the talents of the Medical Humanities Section. 

We begin with a series of photos that I took last spring on a visit to Italy. The first is to set the mood of spring with a photo of Florence taken from the Piazza Michelangelo overlooking the city. Flowers are seen blooming, but the River Arno runs muddy with the silt from spring runoff in the nearby Apennine Mountains. The fabled Duomo rises regally in the background. The second photo was taken in the beautiful Tuscan hilltop village of San Gimignano. Overlooking the honey-colored tiled rooftops with two of the remaining seven towers of the town in the photo, we can see the spring splendor of the Tuscan countryside in the distance. Finally, skipping to the very end of the newsletter and bringing up the rear as the final piece, we have a photo taken just outside the picturesque village of Panzano, in the very heart of the Chianti region. Overlooking the fabled Conca D’Oro (ie, “The Golden Bowl” so called because in the fall, all the grape vines are colored with bright yellow leaves) we have a small statue of one of the four seasons (most fittingly “Spring” holding a bundle of flowers in her arms) in the foreground. 

We then move into a series of very nicely connected pieces beginning with Dr. Erica Adams’  (Emergency Medicine PGY-1, Drexel University College of Medicine) moving story of an exciting night on her OB/GYN rotation called “Flying Solo.” Well told, Dr. Adams! Our old friend from Ireland Dr. Paul Dhillon has a couple of photos taken in Haiti during a pediatric intubation. Dr. Dhillon recently was awarded the Irish Medical Writers Aindreas McEntee Prize for a piece he submitted prior to the book in the process of being published. Kudos to Dr. Dhillon! This makes a perfect segue into a very touching poem by Dr. Ronald Iverson about the unsuccessful resuscitation of a newborn and finally another Paul Dhillon photo. This one is of a makeshift NICU in Haiti after the earthquake. 

We now shift gears and are treated to two remarkably ethereal photos by Dr. Jay Kaplan. While they are winter photos, their otherworldy qualities are a nice addition to our blend. They serve as a reminder that there is grand splendor in the natural forces of our universe, a nice reminder after the preceding works.  

Following Dr. Kaplan’s photos is a piece by first time contributor Dr. Reggie Duling. It is a detailed and opinionated look at the Hippocratic Oath and some of the myth and legend surrounding it. Keep ‘em coming Dr. Reggie!  

Dr. Frank Edwards has the next photo, a picture of whimsy entitled “Niagra On The Lake.”.Enjoy its flight of imagination. Next there is an interesting series of photos by Dr. Paul Dhillon showing his very first “medical” painting, as yet untitled. We can see the actual work in progress as it were, culminating in the finished product. Thanks for sharing this, Paul.  

Finally, we end with a book review by Dr. Dhillon of Milan Kundera’s “The Unbearable Lightness of Being.” I have always found this a fascinating work and Dr. Dhillon captures its essence in his thoughtful review. The last photo, bringing up the rear, the lingering scent of spring/summer can be found in my photo of the Conca D’Oro, as previously described. Feast your mind, your eyes, and your soul as you enjoy the talents of our section.


Spring in Florence, Italy as seen from the Piazza Michelangelo - Medical Humanities Section Newsletter, July 2011

Peter J. Paganussi, MD, FACEP

springinflorence


A Tuscan Spring in San Gimignano - Medical Humanities Section Newsletter, July 2011

 Peter J. Paganussi, MD, FACEP 

tuscanspring 


Flying Solo - Medical Humanities Section Newsletter, July 2011

Erica J. Adams, MD
(Emergency Medicine PGY-1, Drexel University College of Medicine)
 

It was the dead middle of winter, and I was spending my nights on the Labor and Delivery floor which was perched 16 floors above a city eerily silenced by a growing blanket of snow. My task was to learn the finer details of catching a baby during a delivery under normal, controlled circumstances so that I would feel comfortable with the often precipitous deliveries that I would encounter in the emergency department. Prior to this rotation, my single experience with a delivery during residency occurred in the back of a cab parked in front of the hospital during rush hour- complete with a gaggle of onlookers snapping cell phone pictures of the scene. At least one of these pictures must be floating around the Internet by now, and would likely have captured me mis-dressed in trauma gear, sweating in the summer heat beneath my plastic gown and lead apron, proudly holding the thoracotomy tray I had mistaken for an obstetrics kit in my haste.  

Keeping this image of my ineptitude close at hand, I had been enthusiastically practicing deliveries with the help of senior OB residents who would hover around me, ready to take over when it became clear that I was in over my head, which at first was often nearly immediately. But this night was a crazy one: back-to-back emergent Cesareans and three women ready to push at the same time. This left me alone in the room with a 17-year-old girl who was imminently ready to deliver after 34 hours of labor. I walked into the room to introduce myself to the patient and her mother the labor coach, taking a deep breath in to aid in the forced projection of competence, and was most immediately struck by the patient’s dramatic false eyelashes, which seemed almost garish against the backdrop of a hospital gown and labor pains.  

At first we practiced pushing, with me and her mother holding her legs in the correct position. I grabbed her left ankle, demonstrating to her mother the best technique, and firmly planted her Betty Boop imprinted sock and attached quivering leg against my hip. I felt suddenly empowered, surrounded by women in various stages of the cycle of life, most notably the impending messy miracle of a new life. When I saw the first shock of the baby’s curly black hair I got into my sterile gown, mask and gloves. I stood between her legs, feeling the path of the baby, making as much room as I could with my fingers, directing her efforts to push in beat with her contractions: "push, push, push, push, push, push, push, PUSH!....and breathe...." Together, her mother and I sang this song in unison, a chorus of encouragement punctuated by the rhythm of her baby’s descent. 

Our melody was broken by the entrance of what the Labor and Delivery nurses often not-so- affectionately refer to as the "FOB": father of the baby. Often, these FOBs have to be torn away from their cell phones to come hold their impregnated girlfriend's hand, or have to be coaxed to hold or look at their baby at the end.  In between contractions, I sized this one up.  He had the kind of pimples you only get in adolescence, the kind informed by hormones and oil and fearlessness, and they were scattered sparsely across his dark skin. His attempt at a beard struck me as that grown almost accidentally by a lion cub: a junior goatee affixed to the chin of a cub who might try to run with the big boys with the big beards when his mother wasn’t looking.  

Beyond his facial hair and complexion, he appeared completely devoid of emotion, standing in the middle of the room, his arms at his side. Try as I might, I could not read his thoughts on the situation. The doctor in me suggested he step out or sit down if he was feeling faint, since sometimes this look of emptiness is simply the prelude to a syncopal episode. "Nah, I'm good," he replied, without a hint of excitability. 

The nurse coarsely directed him to go hold his girl's hand and help her push. He took a few shuffling steps forward, and there he stood, limply holding her hand, looking down in my direction. 

My heart always beats faster when I see the baby actually crowning, that moment when I  know there is officially no going back. Prior to this, it is somewhat possible to take one step forward and one step back with labor, but when the head reaches a certain point, it can necessarily only move forward. I looked around to make sure the cord clamps and bulb suction were on the drape on the bed within reach. 

“Ok....give one more big push....the biggest push you can give,” I commanded. 

“I can't!!! I can't!!!! It hurts too bad… I just can't!” 

“YES YOU CAN!” her mother and I offered in unison. 

With that, she gave a big heave, and suddenly I had a wet and warm baby head in my hands. At this point of a delivery, there always seems to be a moment of deafening silence during which the screaming ceases, everyone is holding their breath, the clock ticks slower on the wall...all in anticipation of figuring out which way the baby will turn before it can be delivered in its entirety. It was in this brief moment that I first made direct eye contact with the FOB. His fingers were shaking, but his face still belied any emotion. He looked down, and I traced his gaze to the baby's face which had turned sideways, meaning it was time to deliver the shoulders. I wrapped my fingers around each cheek, my finger tips gripping tightly around the jaw as I felt for a cord around the neck. None. 

I pulled down on the head to deliver the top shoulder, and then up to deliver the bottom shoulder, and then, just like that I had a slippery, kicking baby girl in my arms. Time now froze completely, my breathing becoming the only sound I could process. I lifted her against my chest to readjust her for suction, and then tilted her down my left arm against her mother's leg and towards the floor to suction her. Her mouth was gaping, as if in a silent scream, and with my second round of suctioning she made more sound than I was prepared for. Her tiny body in my arms, it felt like she was singing her way into the world rather than crying. I thought to myself that she should be called Nina Simone, who often struck me as doing both at the same time. 

After cutting the cord and handing the baby to the nurse, I immediately became distracted by the less lofty details of birth: delivering the placenta, inspecting for tears, massaging the uterus, cleaning up the usual mess of birth from the floor. As I removed my mask and gown and walked towards the trash bin, I caught a glimpse of the FOB, who was slowly inching his way towards the incubator, where the nurse was cleaning, processing and dressing his daughter. He was sucking his lips in between his teeth, and I realized that this was his attempt at holding back a smile, that he was actively waging a fierce battle against runaway sentiment. 

“It's OK, you can go see her,” I said. 

With that, he finished his long journey to her side, where the nurse was now finishing the swaddling process. She picked the baby girl up and marched her towards the FOB. “Here, hold your baby,” she commanded.  

He reached out, and as if holding a fragile bundle of explosives, brought her delicately closer to his chest. His face again was expressionless, but rather than emptiness I detected the presence of a blinding degree of emotion coming at him at once; completely unfiltered, completely uncensored. He turned to face the MOB, and again I saw him forcing back a smile. I watched the baby looking at her father with a silent curiosity, and as I looked up at him again our eyes met, and his face finally gave way, shattering into the biggest smile I have ever seen. It was the kind of smile that filled the room with equal parts sound and light. 

It's hard to get words out in an intensely private moment such as this, one in which I am but a privileged bystander, but I did my best to squeeze out a sincere “congratulations.”  

This time, he kept smiling and didn't break his gaze with his daughter to say, simply: thank you, as he brought her closer and began rocking her gently back and forth.


Haiti Pediatric Intubation Photos - Medical Humanities Section Newsletter, July 2011

Paul Dhillon, MD

haitinicu

Haitiintubation 

haitipediatric

 

 


Baby Not Breathing in Four Acts - Medical Humanities Section Newsletter, July 2011

Ron Iverson, MD, FACEP 

Act I
Baby not breathing
Who’ll take the call?
CPR in progress
Tube in place
IO infusing
Epinephrine in. 

Act II
Baby is dead
Face covered with Bruises
Yellow, Purple, Brown
I’ve seen this play before
It always ends the same 

Act III
Mother Screaming
That dead baby scream
Her Grief raw, uncontained
Crowds gather
Police mull 

Act IV
Nurse holding baby
As if her own
One family’s life torn asunder
Our healing begun 


Angel Halo - Medical Humanities Section Newsletter, July 2011

Jay Kaplan, MD, FACEP

angelhalo2
 

 


Spirit in Residence at Beaver Creek - Medical Humanities Section Newsletter, July 2011

Jay Kaplan, MD, FACEP

spiritinresidenct


Can We Please Stop Referring to the Hippocratic Oath? - Medical Humanities Section Newsletter, July 2011

Reggie Duling, MD, FACEP  

At the next committee meeting of The Powerful Who Decide Everything, I’d like to make a motion:  Can we please stop referring to the Hippocratic Oath as the reason we do anything in medicine?           

I’m as much of a traditionalist as the next doc, but I’m tired of hearing everyone from the press to the lay public to politicians telling me what I should and should not be doing because of the Hippocratic Oath.           

First of all, I’ve never taken the Oath or any altered form of it, so stop telling me “You have to do this… or you can’t do that… because you took the Hippocratic Oath.”  No, I didn’t.

Second, there aren’t many documents that are two millennia old that have remained relevant in the present day (see the Bible).  Medicine was fairly primitive one hundred years ago, back when the Joint Commission was telling field hospitals “You have to keep your clean saws over here, and put your dirty saws over there. And don’t forget to label your leeches.”           

Third, has anyone ever actually read the Hippocratic Oath our profession espouses to uphold?  I’ve included a complete version of it below so as to avoid being accused of taking the following excerpts out of context, primarily because my whole point is that many seem to use the one or two passages they like precisely so.           

I swear by Apollo the Physician and Asclepius and Hygeia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant.            

I don’t swear anything by Apollo.  I don’t even use his name in vain, which is more than I can say for some other gods.           

To hold him who has taught me this art as equal to my parent and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art--if they desire to learn it--without fee and covenant.            

While I have great respect for those who taught me this art, I’m still making payments on the six-figure debt I racked up while learning it. That’s about all the money my med school professors are getting from me, and if their kids want to become doctors, I’d recommend a 529 plan rather than counting on my teaching them for free. Also, I’m not clear on whether this means I can justifiably charge their daughters tuition, or are their daughters forbidden from practicing medicine altogether? 

I will apply dietetic measure for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.            

Keeping anyone from harm and injustice always sounds pretty reasonable. This correlates with another dictum of medicine: Primum, non nocere, or “First, do no harm.” While I agree with the sentiment, I, and Dr. Kevorkian, for example, may define doing harm differently than many doctors. 

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.            

Sorry, but after seeing my share of patients dying with indescribable suffering, as well as a lot of drug seekers, I can’t make any promises.           

Similarly I will not give a woman a pessary to cause an abortion.            

I’m an ER doc. I don’t perform abortions. If I did, however, I suppose I would agree that a pessary is not the best way to go about it, though I defer to my colleagues in OB/GYN. 

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.  

I understand why I shouldn’t have sex with my free male or female patients, but not even the slaves? This passage illustrates the problems with any document; even a comparatively brand new document such as the U. S. Constitution. While the Constitution was designed to be a living document, it seems to be living in much the same manner as many of the nursing home patients we see. I’m not saying the Constitution has a sodium of 170 and renal failure because no one gives it water, or that it developed pneumonia after falling out its bed in the Smithsonian and no one found it for 16 hours. I just mean it might technically be alive but isn’t really enjoying the same quality of life envisioned at a younger age.  I don’t blame the Founding Fathers. I have no doubt that they would have updated the Constitution periodically so that niggersNegroescoloreds  blacks  AfroAmericans African Americans would count as three-fifths of a person. 

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.  

Who put the HIPAA in Hippocrates? 

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come.  

Being honored with fame among all men for all time to come?  Now that sounds impressive.  Sign me up. 

If I transgress it and swear falsely, may the opposite be my lot.  

Never mind.  The risk to benefit ratio just isn’t there. 

I understand that the part about gladly providing over half our services free of charge thanks to an unfunded government mandate was lost in the original translation from Greek.  I’m afraid that without it, though, the Hippocratic Oath just isn’t a document I can get behind.
Do I hear a second?


Niagara on the Lake - Medical Humanities Section Newsletter, July 2011

Frank Edwards, MD

niagraonthelake


Medical Art – The first draft - Medical Humanities Section Newsletter, July 2011

Paul Dhillon, MD

medicalart1


Medical Art – The detail begins - Medical Humanities Section Newsletter, July 2011

 Paul Dhillon, MD 

medicalartthedetailbegins 

 


Medical Art – The finished product - Medical Humanities Section Newsletter, July 2011

 Paul Dhillon, MD

medicalartthefinishedproduct 

 

 


Book Review: The Unbearable Lightness of Being by Milan Kundera - Medical Humanities Section Newsletter, July 2011

Paul Dhillon, MD 

Originally published in France in 1984, Kundera’s work follows Tomas, a surgeon,
as he moves through the intellectual, personal, and philosophical circles of his life
during the 1968 Communist period in Prague.

Part novel, part philosophical tome, it explores Nietzsche’s idea of eternal
recurrence, or ad infinitum, where the universe and all of its events have occurred
in the past and will recur again and again. Through the main characters Tomas;
Tereza, his loving but distraught wife; and Sabina, Tomas’s lover, a challenge is made
to Nietzsche. What if, in fact, nothing is ad infinitum, what if life is expressed by the
German Ein mal ist keinmal (once is nothing). With this idea, a life is lived once and
never again creating a situation where choices are insignificant, the lightness of life
is drawn from this idea. The converse of this situation is the fact that then our lives
become completely insignificant and without any meaning, difficult to handle when
we expect life to have meaning, leading to the unbearable lightness of being.

Reflections on God, love, and sex play heavily throughout the novel and reflections
on the act of surgery are compelling and beautifully written.

“Surgery takes the basic imperative of the medical profession to its outermost
border, where the human makes contact with the divine…He [God] did not take
surgery into account. He never suspected that someone would dare to stick his
hand into the mechanism He had invented, wrapped carefully in skin, and sealed
away from human eyes. When Tomas first positioned his scalpel on the skin of a man
asleep under an anaesthetic, then breached the skin with a decisive incision, and
finally cut it open with a precise and even stroke (as if it were a piece of fabric—a
coat, a skirt, a curtain), he experienced a brief but intense feeling of blasphemy.”

Although more challenging to follow than a simple protagonist-antagonist novel the
result is a beautiful novel that opens up discussion on the relevance of our lives and
an intriguing area of philosophy. Simple yet powerful notions that we may take for
granted, life and love, are dissected open to reveal an emptiness that we may not
have ever expected.

“The heaviest of burdens crushes us, we sink beneath it, it pins us to the ground. But
in the love poetry of every age, the woman longs to be weighed down by the man’s
body. The heaviest of burdens is therefore simultaneously an image of life’s most
intense fulfillment. The heavier the burden, the closer our lives come to earth, the
more real and truthful they become.”

 


Spring in Chianti – La Conca D’Oro (ie, “The Golden Bowl”) - Medical Humanities Section Newsletter, July 2011

Peter J. Paganussi, MD, FACEP 

springinchianti 


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