March_eMagazine Volume 39

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OUR PEOPLE, OUR MISSION Global Health eMagazine March 2022 Promises Written by Stephen Scholand, MD Associate Director of NH/UVMLCOM Global Health Program I held her heart in my hands. It seemed strong, it seemed healthy. It was a deep red, maroon color - saturated now in formaldehyde. The pathologist, an ancient figure, with bone-like hands pointed to the heart valves. His sharply curved knife, of a faded blue steel, had a worn wooden handle. It must have been used for centuries here in the basement of this hospital, this granite tomb. A Note from Dr. Sadigh Reflections on 2021 Highlights Nursing Division SARS COV-2 Pandemic and Us Unification Condolences: Paul Farmer Art to Remind Us of Who We Can Be Articles of the Month Videos of the Month Announcements Calendar Resources I peered closer and could see the clots of bacteria adherent to the valves. “Vegetations” we called them. Those rubbery clots and filaments would break off into the circulation – wreaking destruction in the end organs. Her cause of death was due to infectious endocarditis from Staphylococcus aureus. She had said she wanted to live. She had promised me that she would give up drugs, if she could just get better. But the fevers kept coming, wave after wave of bacteria pulsed throughout her body. By injecting drugs, she had inadvertently inoculated these bacteria into her heart. It was too much for our therapy, the antibiotics could not clear the infection. Her ashen face was completely still, her violaceous lips were parted. Damn those drugs. Damn those Dark Lords who destroyed so many lives! A cold numbness enshrouded me. I would carry her memory on. I promised. 4 Reflections continued on next page >>
OUR PEOPLE, OUR MISSION Global Health eMagazine March 2022 Stay Human Written by Mahsheed Khajavi, MD This pandemic, with its deep human consequences along with its divisive social and economic upheaval has drawn attention to the vulnerability of our critical healthcare system. Heightened stress levels have frayed emotions and the general collective fear has resulted in angry social media disputes, flaming emails, and raised voices in all venues of expression. During these times, it is often easier to accept some version of “thickening one’s skin” and becoming more mechanical and emotionally distant. I have heard this from colleagues and watched as many become so distant that they no longer derive any pleasure or meaning from the mission of medicine. Midway through 2021, I found myself in this same group. Waking up and thinking about getting through rather than getting into my day was the best I could achieve. I would fall out of my bed, go through the ritual of daily preparation, drive with my NPR station discussing SARS-CoV-2, and tune out. A Note from Dr. Sadigh Reflections on 2021 Highlights Nursing Division SARS COV-2 Pandemic and Us Unification Condolences: Paul Farmer Art to Remind Us of Who We Can Be Articles of the Month Videos of the Month Announcements Calendar Resources I would walk into the hospital with a census of 45 patients, the majority of whom had respiratory failure from COVID-19 multifocal pneumonia. Returning home after 16 or 18 hours, I would skim JAMA and NEJM for any new reports or changes in guideline-directed therapy. Becoming less and less present with those around me, the idea of putting my backpack on and going for a walkabout was the most satisfying desire. I thought back to my years of medical school and training. The advice, sometimes implicit and sometimes overt, was that as a physician I had to develop emotional distance. Otherwise, I would be utterly overwhelmed and unable to complete my duties. I remember an attending telling me “you will lose your intellectual acumen if you take these patients home with you.” This was in Atlanta during the early AIDS epidemic. This was the time when Grady Hospital placed eight patients in each room on the AIDS floor, the vast majority of whom were emaciated and unable to stand without assistance. I remember quietly condemning this philosophy. Although I could not articulate my understanding then, I believe that on some level there was an innate and intuitive knowledge that without empathy, both patients and caretakers would be compromised. Twenty-seven years later I found myself becoming the person I had so easily condemned. I told myself to “toughen up” if I did not want to end up on the shower floor sobbing each night. I convinced myself that creating an emotional barrier would help me continue to work in a clinical atmosphere that, up until this point, I had never experienced. I could not have been more misguided. I can’t say when or how I lost myself and truthfully, I can’t really say when I came back. I think part of my return came after reading an article on physician burnout. The article noted that about half of all physicians reported burnout last year, highest among those who worked in the hospital and intensive care units. The article discussed the fact that burnout caused emotional distancing and that the cudgel of “emotional weakness” was a long and ingrained tenant of medicine. And somehow, I realized that demanding “toughness” only resulted in my inability to experience the full range of emotions necessary to connect with my patients. I had this backwards. It was not burnout which caused my lack of empathy. It was my deliberate decision to distance myself (in order, in some bizarre way of thinking, to keep myself intact) which had caused my burnout. 5 Reflections continued on next page >>
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March_eMagazine Volume 39

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