October 2018

 Artwork from svgsilh.com

Artwork from svgsilh.com


The Forgotten Demographic
By Brianna Basinger, M1

My sister’s left leg was twice as large as her right, yet she was still trying to flirt with the much older doctor in the room. She had been hospitalized for three days due to a deep vein thrombosis and pulmonary embolism. She was going to have to have two blood thinner shots a day for the next year, at least, and a multitude of surgeries. However, at 14 years old, she was somehow still her bubbly, flirty, bright self.

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My sister Grace is a unique soul. She survives on Taylor Swift music videos, sings way too loud on her karaoke machine at 7 a.m., loves all things furry, and thinks flying insects are pure terror. The love I have for my sister is deeper than I can describe. Yes, of course she frustrates me from time to time with her stubborn ways, but the love I have for her is similar to the love I would have for my own children. It is so deep, in fact, that any man who loves me would also have to love my sister enough to take full custody of her when my mother can no longer take care of her. Grace is strong, independent, hilarious, and stubborn, and she has a pure, loving soul. I believe she is closer to an angel than any of us on Earth, and people often do not get to take the time to know her because she has Down syndrome.

As future doctors, it is important that we are exposed to people of different cultures, religions, sexual orientations, and the like because these are the people we will help heal. However, I have noticed over time that, although we often stress the importance of diversity, the population of disabled individuals is still overlooked. In his book, Another Season: A Coach’s Story of Raising an Exceptional Son, Gene Stallings, a coach in the College Football Hall of Fame, describes some of the alienation he felt in College Station as the head football coach because he had a child with Down syndrome. His friends did not come over to play with his sweet son, John Mark, because he was not a “normal” child.

I, too, realized that this is often the case with Grace. I cannot count the number of close friends and even family members who get uncomfortable around Grace. They act so aloof, and it can often feel that they don’t even treat her like a human. Some eventually, after enough acquaintance, grow more comfortable with Grace and begin to develop some of the same love I have for her. But it often pains me because many do not try to get to know Grace, or they feel so uncomfortable that they don’t know how to interact with her. As I have gotten older, I realize just how many people are uncomfortable with disabled individuals. They’ll squirm, not know what to say, or treat them as if they are much younger than they actually are. It’s heartbreaking because children with disabilities are diamonds in a coal mine. They are so loving, selfless, and pure, and it often keeps me up at night knowing that people are missing out on an opportunity to know and understand such beautiful souls.

Diversity is stressed in medical schools everywhere. We interact with and treat people from such vastly different walks of life that it surprises me how some medical students have little to no interaction with individuals with disabilities. I think it is essential that medical students get comfortable with different cultures and individuals, including those with disabilities. What could be the end result? A more universal acceptance of those with disabilities, better healthcare for a sometimes overlooked and misunderstood population, and exposure to individuals so full of love and happiness that it might be just what we need to make the world a little brighter.


Take a Step Back
By Radhika Shah, M2

While I was driving to class, someone pulled out right in front of me. I honked my horn angrily at him, a clearly incompetent driver. After class, I went to grab lunch with a friend. The dull waiter drudged about at a snail’s pace AND got my order wrong twice, so I made sure not to tip him. When my food finally came out, it was tasteless. I logged on to Yelp and fervently wrote a negative review. I was expecting a package from Amazon when I got home, but it hadn’t arrived. I called customer service and was placed on hold three separate times, each time for 10 minutes. The next time, I gave the representative a piece of my mind. Later that night, I was supposed to hang out with one of my close friends whom I had known for 10 years, but he didn’t show up. This was the third time he had bailed without telling me why. “Fine!” I told myself. “He’s clearly not a great friend.”

The next day, I was scheduled to see patients in the hospital for my preceptorship. Dressed in my clean, pressed white coat, I greeted my preceptor with a handshake. I walked into my patient’s room with a smile. I noticed that she was in pain, so I sat down beside her bed and held her hand. I asked her about her day, her family, and her hobbies. I maintained eye contact. I wanted to show her that I cared. I told her I was sorry that she was in so much pain. I chose my words carefully, as I knew her medical condition was affecting her life in ways I could not imagine. Before I left, my patient thanked me for being so compassionate toward her and told me that I would be a great doctor one day.

Maybe I also could not imagine the following:

The person who pulled out in front of me—his father had just passed away that morning. The waiter whom I chose not to tip—he was recently diagnosed with cancer. The owner of the restaurant that I wrote a negative Yelp review about—she struggles to feed her family. The customer service agent whom I yelled at—he found out that his wife of 23 years has been cheating on him. My close friend—he has been suffering with severe anxiety and was too scared to tell me about it.

Why is it that we practice compassion only with our patients? Why is it that only when we wear our white coats do we heed caution to others’ feelings? Why is it so easy to express anger and frustration but so hard to just let things go? Compassion shouldn’t be conditional. It isn’t a switch that we can turn on and off. Just because the people we interact with on a daily basis aren’t our patients doesn’t mean they aren’t someone else’s. Unfortunately, we won’t always be aware of the terrors a person is dealing with on the inside, and, for that reason, we should take a step back from our own frustrations and try our best to show people the same kindness and respect that we show our patients.

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Interview with Bryn S. Esplin, JD
By Sarah Joseph, M2

Dr. Bryn S. Esplin became an assistant professor in the Department of Humanities in Medicine at the College of Medicine after completing a two-year clinical ethics fellowship at the Cleveland Clinic in Cleveland, Ohio. Before pursuing her law degree, she graduated cum laude from the University of California, Berkeley, with a degree in rhetoric. During law school at the University of Nevada, she participated in externships with both the Supreme Court of Nevada and the Lou Ruvo Center for Brain Health in Las Vegas, Nevada. At the College of Medicine, Dr. Esplin brings together law, medicine, bioethics, and popular culture to help students critically examine the social, ethical, and political implications that underlie medical decision-making.

  Bryn S. Esplin, JD, assistant professor in the Department of Humanities in Medicine at the College of Medicine

Bryn S. Esplin, JD, assistant professor in the Department of Humanities in Medicine at the College of Medicine

Dr. Esplin frequently speaks at international conferences in bioethics and humanities, and her work has appeared in numerous peer-reviewed journals, including Psychosomatics, Harvard's Health and Human Rights Journal, The Journal of Clinical Ethics, and The American Journal of Bioethics. Additionally, Dr. Esplin is the principal investigator on a recently awarded Texas A&M T3 Grant, titled "Impact of Immigration Enforcement on Border Heath in Texas: Improving Health Outcomes for Patients & Identifying Best Practices for Health Care Professionals through Law, Medicine, and Public Health.”

Sarah: Could you tell me a little bit about how your career led you to the Health Science Center at A&M?

Dr. Esplin: Career paths are notoriously varied in bioethics, and mine is no exception. I majored in rhetoric and philosophy of mind at the University of California, Berkeley, and then, during my second year of law school, I did an extern clerkship with the Supreme Court of Nevada with the Honorable Justice Michael L. Douglas. That was a wonderful experience, and my window from the court just so happened to look straight over to the majestic building that is the Cleveland Clinic Lou Ruvo Center for Brain Health, which specializes in neurodegenerative disease and clinical research.  (Seriously, check out this crazy building! It’s a Frank Gehry!)

I started daydreaming about all the ways I might bring these disciplines together, and I realized that my passion for law was inextricably linked with my passion for psychiatry, neurology, philosophy and ethics. I was able to connect with their director of education, Dr. Dylan Wint, who is one of the most phenomenal clinicians you will ever meet, and he graciously took me on as the very first neuro-legal intern.

The Cleveland Clinic’s main campus in Ohio offers one of the world’s preeminent fellowships in bioethics, so I set my sights on it, and ultimately got it.

When I interviewed with Dr. Watson here at BCS, the rest was history. I was so inspired by the mission of the Department of Humanities in Medicine, as well as our students, faculty, and staff, that I knew A&M was where I was meant to be. And I was right—it has been the joy of my life to be here doing exactly what I get to do.

Sarah: You recently returned from a brief intersession at Yale University. Tell me about your time as a Yale/Hastings visiting scholar!

Dr. Esplin: The Hastings Center is the world’s first bioethics research institute. It is a nonpartisan, nonprofit organization of research scholars from multiple disciplines, including philosophy, law, political science, and education. The Hastings Center and its scholars produce publications on ethical questions in medicine, science, and technology that help inform policy, practice, and public understanding.

My research interests in bioethics, immigration law, and public policy culminated in a research project to devise institutional systems of safety for undocumented patients in Immigration Customs Enforcement (ICE) custody, particularly when presenting to outside hospitals for higher-level care. It was inspired by a case I worked on directly and similar cases that keep surfacing about disparate treatment of this growing patient population. 

I was selected as a Yale-Hastings Center Visiting Scholar, which meant that I split my time between The Hastings Center and the Yale University Interdisciplinary Center for Bioethics in New Haven, Connecticut.

It was definitely a once-in-a-lifetime opportunity to work so closely with experts in the field of bioethics, especially Dr. Nancy Berlinger, whose ardent passion and expertise for ensuring equitable treatment of undocumented patients, and many other landmark bioethics issues, has inspired me to no end.

Sarah: Do you think there is a place for law and politics in medicine and medical education? If so, in what way?

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Dr. Esplin: To think that there is not always already an element of law and politics in medicine is to be woefully uninformed about its impact on your practice, and therefore its impact on your patients. For example, the law obviously dictates the kinds of requirements and obligations you have to patients in establishing elements of informed consent, negligence, and professional responsibility, but we’re also seeing value-laden policies about what you may or may not offer patients based on rules being written by politicians, not physicians. Examples include code status or genetic testing or, recently, redefining the categories of sex/gender not based on medical expertise but administrative interpretation and rulemaking. In these ways, the legislature has already inserted itself into the medical encounter, and it’s unlikely to discharge itself anytime soon.

Medicine is a humanistic and simultaneously political endeavor—the Hippocratic Oath obligates you to not only refrain from harming your patients, but to advocate for them as well. As medical educators, this means we must make it part and parcel of the curriculum to teach you how to do so. Bringing a little bit of law school into medical school—but without giving you all too much more homework—can be an effective and engaging method of teaching these skills.  For example, a surprise subpoena!

Sarah: How do you think we might best implement the topic of ethics in medical education?

Dr. Esplin: Currently in medical education, we treat the humanities as separate from medicine and, in doing so, we reify a mistaken dualism between what we call “hard” versus “soft” science. I think one solution is to continue to highlight the ethical components in every aspect of the curriculum. It’s valuable to practice asking things like, “What assumptions does this case scenario make or perpetuate about patients?” or, “How objective is the nature of this journal article? Who are the authors? Are there conflicts of interest here?” We don’t do this as often—which makes it seem as though ethics and ethical dilemmas are not present in medical decision-making. The reality is that they are always involved, and they heavily influence how physicians interpret information, manage treatment, and care for patients.

There are many ways we could integrate ethical questions into lectures and examinations. For example, in pediatrics we might ask students, “What happens when a baby is born intersex under the new guidelines that have been released? What are the necessary steps; what are best practices in this circumstance?”

Sarah: What advice would you give to medical students who find themselves in an ethical dilemma?

Dr. Esplin: First, it is crucial to recognize that you are, in fact, experiencing an ethical dilemma or hidden power differential that precludes you from doing the right thing, or even being unsure of what the right thing in a certain circumstance means. Often, a helpful next question is to determine the level of urgency or if you can ask someone for guidance.

It is important for us to show students that they don’t have to practice in isolation. Isolation is toxic when wrestling with moral distress, and we know it leads to depression, compassion fatigue, and burnout.

If you have to make a decision in the moment, the most supportable course of action is to think through the possible options and weigh their risks and benefits. If you can say you analyzed your decision systematically and weighed all possible options and outcomes, then it is defensible—and as a professional and as a person, you can fall asleep knowing that you did your very best.

Sarah: Tell me about one particular turning point in your career. What did it mean to you, and how did it shape the way you think?

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Dr. Esplin: Nothing has shaped me more than the privilege of being involved in patient care. Over the two years of my fellowship, I honestly recall almost every single one of over 300 cases in which I was involved. It also helped that I kept a journal—where I de-identified my patients, of course!

There is one particular case that I will never forget. Four years ago, on one of my first days in the burn unit, I saw an injury that I thought was, to put it mildly, incompatible with life. Beyond just reading the chart, the visceral impact of what it means to see more than the injury itself, to see your patient as a person, knocked me out—literally. Once I stepped into the room on rounds, I fainted, and I was so embarrassed. That was a lesson in so many things, including the ability to recognize and accept that I was human, too. Seeing suffering not only affects the rookies like I was that day, but even impacts the most seasoned clinicians, and that’s not a bad thing. It’s the ability to lessen suffering—”to heal often, but comfort always”—that makes medicine so meaningful.

Sarah: What do you believe is the best way to have positive, engaging conversations with someone whose views completely differ from you own?

Dr. Esplin: This is something I think about a lot, and I’ve learned just how powerful it can be to lay down your armor and try to understand where someone’s views and assumptions are really coming from without being in battle mode. As someone legally trained, I always go back to the adage that “reasonable minds differ.” 

Over the course of my career, I’ve had the privilege of living in a number of places with diverse societal and cultural views: Utah, California, Ohio, New York, and Texas—just to name a few! This has affirmed my eagerness to listen to different viewpoints and actively seek them out, in order to better understand my own values and deconstruct preconceived biases that I may have once had.

In the end, I always come back to the fact that humility, vulnerability, and kindness are fundamental to formulating not just our professional identities, but making sure we’re the best version of ourselves that we can be. That takes practice, but like medicine, it’s an ever lasting and noble pursuit.

 

Fun Facts about Dr. Esplin!

Favorite food: Whatever my wife cooks!

Favorite hobby: Armamentaria collector. I have so many medical curiosities and antiques that our house is always ready for Halloween … even in summer! And I’m pretty sure it’s always haunted because surely some spirits were caught in these contraptions.

Favorite book: Nightwood by Djuna Barnes, 1936.

Even though we strive to keep medicine human, unfortunately, a lot of your exams won’t ask questions about the more profound qualities of being alive. For me, coming back to literature that captures what it feels like to be alive, the visceral joy and the sorrow of being in love, all of it, is necessary to remind myself that what I do has a purpose. I can’t recommend this book highly enough for those very reasons. 

 Here are some of my favorite quotes from the book:

“Our bones ache only while the flesh is on them.”

“The unendurable is the beginning of the curve of joy.”

Favorite movie: Harold and Maude.

This movie is the reason why I learned how to play the banjo!

Most memorable travel experience: I am so lucky to have been able to travel widely. My wife is Turkish-Egyptian and was raised in Alexandria, Egypt. Last year, we planned a vacation to Morocco and went on a motorcycle tour of Old Marrakesh. That was the most exciting, fabulous time of my life!


Consent
By Hasan Sumdani, M3

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informed consent is not possible

patients don’t know what they’re agreeing to

doctors don’t even know what happens until it’s done

sometimes, not even then


what does sternotomy mean? opened chest? i don’t know what that means either

the surgeon explains the thing he studied for twenty years in twenty minutes

and he still can’t know what’s going to happen to me

i certainly can’t know, i can't consent, i can only trust

if the surgery works

if it doesn’t


i don't know what CABG stands for

i don't know what the tubes do

i don't know that 6 hands will work inside my chest

i don't know that

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even the layman's words don't make sense

the complications happen to other people

not to me, right?

i don’t consent to infection, bleeding, pain

i don’t consent to being intubated for a week

i don’t consent to my sternum ripping apart post-op


there’s a chance i’ll die on the table, he says

i don’t want to know what that means

i don’t know what that means


 


Maintaining Honest Communication Even When It Is Difficult
By Sebastian Powell, M2

One of my deepest passions has been patient advocacy and patient-centered care. During a Practice of Medicine 3 panel focusing on having difficult conversations with patients, Dr. Pieratt showed heartfelt emotion, pain, and vulnerability as he described a touching encounter with one of his patients—it was beyond inspiring. In that moment, Dr. Pieratt became the culmination of everything I hoped to become one day—someone who cares about my patients unapologetically, even after having practiced for years.

Before entering medical school, I participated in an internship at a medical school in Peru alongside a team of medical interns and residents. This experience cemented my desire to become a physician. During rounds one day, we were checking in on a patient with terminal cancer. As the attending described the differences between Hodgkin and non-Hodgkin lymphoma, my eyes remained on the patient. The rise and fall of his chest became shallower and shallower until moments later, I realized it had stopped moving altogether. I looked up at his face, and the eyes that had been filled with pain no longer carried the burden. As a matter of fact, they no longer held anything. Our patient had passed away right before my eyes.

While this moment expanded my understanding of the role physicians play in our patients’ lives, it was what followed that shook me to the core. Our patient’s family was right outside, and somehow (which to this day I do not understand) I was chosen to deliver the news. I would love to say I handled it with grace, that I was poised and eloquent in communicating the news,  that having observed the residents and other physicians do it helped in some way, but with every step came a tumultuous instinct to turn and run. I can’t remember the exact words I used when I finally stood in front of the patient’s wife and children, though it didn’t take much for them to understand that something was wrong. Before I knew it, I was hugging his wife as she wept on my shoulder—instantaneously becoming a participant in the family’s most devastating moments.

Looking back now, I have a deeper understanding of the many ways physicians touch the lives of their patients. In that moment, I was not only the bearer of terrible news but also the trusted representative to the team of doctors who had been working day and night fighting to save the patient. It mirrored the event that Dr. Pieratt emotionally described. I was the patient’s  teammate. I was a trusted advisor. I was the one the family turned to for answers and explanations. The experience highlights the gravity of the duty physicians willingly undertake. Of course, the role is not always a somber one; we also participate in myriad joyous moments. At times, we will be blessed with the pleasure of delivering good news, such as remission, healthy births, and recovery. But, when delivering difficult news, we are still obligated to maintain that same honesty and integrity.

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As we listened to the panel, it was clear that difficult conversations include a multitude of topics—some good and some bad. The overarching theme is that we must still have all of those conversations—whether it is explaining a faulty diagnosis, noting a mistake that was made in patient care, or delivering news that a newborn child won’t make it through the year. Patients begin their journey in healthcare inherently trusting their physicians. Why shouldn’t they? After all, we have years of classroom training, years of practicing under observation, and years after that building experience. By that point, we should have some idea about what we are doing. But, if we do not maintain our integrity in practice, our credibility disappears. We cannot be their advocate if they do not believe in our honesty—honesty we owe to them. For if we expect them to trust our judgment, they should expect that we communicate our faults.

When I begin my rotations, I plan to stay humble in my role in patient care. Being humble early on in the learning process is a precedent I want to establish so that it becomes a cornerstone of my practice over time. I will always be a team member in my patient’s care, not the coach. I also want my patients to feel that they are participants in their own care, and that no matter the circumstance, I will be honest with them. More importantly, I want my patients to know that I care. I want them to believe that while I may have many other patients, I genuinely care for their well-being and want what is best for them.

I expect it will be more challenging at some times than others. Life has a habit of creating monotony out of routine. With multiple losses, cynicism may begin to creep into practice. Maybe after years of practice, it may feel easier to give orders to patients with the expectation that they will follow them without question. Maybe, I will even begin to take questions with reproach and perceive them as challenges to my knowledge and intelligence. Society has had a poor habit of inflating a physician’s ego, oftentimes rewarding arrogance and self-entitlement. It is a pitfall—a pitfall I plan to avoid by incorporating active checks into my practice. By holding myself accountable to all staff, patients, colleagues, and loved ones, I hope to maintain humility throughout the length of my career. I hope to always be able to set aside my ego and have open conversations with my patients. And I really hope that losing a patient, or even delivering bad news, always hurts as much as it did the very first time.


Compassion: An Exploration
By Rhett Butler, M2

“A human being is a part of the whole called by us the universe, a part limited in time and space. He experiences himself, his thoughts and feeling as something separated from the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty.” – Albert Einstein

While Merriam-Webster defines compassion as a sympathetic consciousness or awareness of others' distress together with a desire to alleviate it, understanding the derivation of the word will help us explore how to better serve our future patients both physically and psychologically. In fact, the derivation offers a much more profound means of connecting with not only patients and co-workers but also with those in our personal lives.

The root of compassion, “passion,” comes from the Latin pati.  Pati, later passio (to suffer), is closely associated with the Christian story of the suffering and death of Jesus. The prefix “com” means together.

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At first glance, the subtle diferrence between a sympathetic consciousness or awareness of others' distress together with a desire to alleviate it and to suffer together may seem insignificant and trivial. A closer inspection reveals that the second, more literal, definition implies that the person feeling compassion for another has taken an active role in sharing the suffering. The person feeling compassion now has a personal stake in the suffering and seeks to relieve it, not only for the sufferer, but for himself or herself as well.

What is suffering? A quick glance down the rabbit hole reveals that suffering is universal to the mortal condition; the root of all suffering may well be related to the fact that our time in this plane of existence is not permanent. What is true is that everyone suffers, and the ability to share in that suffering connects humans in unique ways.

A prevailing explanation for why humans have evolved to feel compassion relates to the size of the human brain/skull and the long period of vulnerability of the human infant compared to other species.  Basically, we are more connected because our brains are bigger. To accommodate this brain, the human infant skull is large relative to the rest of its body. This makes us more dependent, and we therefore spend more time in close contact with other members of our species, usually our mothers. We are more concerned with other members of our species because this has offered us an evolutionary advantage. The result is that humans are among the most social of species.

Now I am going to incorporate science and religion/philosophy into the same sentence.  If Buddha was correct in his assessment that all life is suffering, then the human (social) evolutionary path was to suffer together. Considering that this is the literal definition of the word compassion, we can say humans have evolved through compassion.

It is with this assumption that I propose that students of medicine do not need to be taught compassion, but rather be given the opportunity to purposefully practice the compassion innately present. Our objective should be to demonstrate compassion without becoming debilitated by suffering, which might impair the delivery of technical expertise.

The interesting circumstance and opportunity for medical students is that the academic rigors of studying medicine will be one of the most stressful times of their lives—dare I say a time of great suffering. By reconsidering our understanding of compassion, students have the opportunity to practice suffering together so that they will one day better suffer with their patients.

Why would anyone want to become an expert on suffering?  How does one practice suffering? What if I don’t have the ability to demonstrate my compassion?

The answer to the first question has a surprisingly straightforward answer. A patient wants to be treated like a human being, not a collection of symptoms.

Compassion is consistently rated as an important quality when patients evaluate physicians.  In 2015, Wen et al. published a study in which 85% of surveyed patients stated that “having a doctor who listens to them” was a critical component of positive patient/doctor interaction, and 71% stated that “having a doctor who was caring and compassionate” contributed to a positive experience. By contrast, the technical expertise of the doctor was mentioned so rarely that it was statistically insignificant.

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Stated another way, patients want doctors who can demonstrate compassion.  One of the easiest and most effective ways to demonstrate compassion is through listening, which was the only quality mentioned in the survey more than compassion.

A friend of mine, let’s call him Joe, who makes his living as a clinical psychologist, works with married couples daily. These couples struggle with intimacy problems, infidelity, distrust, and jealousy, among other complaints. Joe is 45 years old and has never been married. He claims that he can easily identify causes and solutions for his patients because he is not mired in the same issues in his personal life. He is thus detached from the suffering associated with marital problems and presumably more objective in his work as a result.  

Joe recently confided in me that he wants to find a new exciting hobby.  He went on to explain that he gets very bored and lonely on the weekends. Joe is suffering despite his decision to “rise above” the complaints that plague his clients. He has traded one form of suffering for another.  Stated another way, detachment from one form of suffering will often make room for another type. It’s always there.

When we can accept that suffering is a natural part of life, we can more objectively identify the cause of our suffering and exercise some influence over what we suffer for. Realizing that we are going to suffer to some degree, regardless of our choices, affords us the opportunity to change our perspective. Instead of being victims of suffering, we can become students of suffering. As students, our goal should be to learn the lessons that suffering teaches in pursuit of wisdom. Once the goal of wisdom is visualized, we only have to follow the steps to attain the goal.

There are clinically diagnosable disorders that feature a reduced capability of experiencing empathy. These disorders include narcissism and Asperger syndrome. It is important to recognize that these disorders are most commonly defined in terms of empathy and not compassion. The two terms are similar, but not interchangeable.

Empathy is the ability to understand and share the feelings of another. Compassion, as we discussed earlier, includes the act of suffering together. The definitions suggest that empathy rises to a high standard, as it requires an understanding of feelings that may not be universal to the human condition. Empathy, at times, will require imagining how someone must feel. However, if we accept that everyone has experienced suffering, then we can categorize compassion as a more basic human emotion and empathy as a higher-order process.

I want to point out this distinction to help answer the question about not having the ability to show compassion. The implication here is that even if physicians have a diminished ability to understand their patients’ specific emotions, especially ones that they have never personally experienced, they can likely recognize suffering as a more basic emotion. With this distinction in mind, it is not a stretch to propose that all physicians have the ability to demonstrate compassion.

Unfortunately, many patients describe having bad experiences with unsympathetic, abrupt doctors. In an attempt to explain their experience, patients may label these physicians as cold or narcissistic. It is possible that the physician, for some reason—their training, burnout, or just having a “bad day”—has not shown compassion in an appropriate way.

These explanations do not justify a physician’s insensitivity toward a patient, but they highlight the fact that showing compassion is a choice physicians must actively make every day. By supporting one another as medical students, we can practice choosing compassion every day so our future patients never feel unheard or alone in their suffering.

Wen LS, Tucker S. What do people want from their health care? A qualitative study. J Participat Med. 2015 Jun 18; 7:e10.


Cramming
By Kevin Chin, M1

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Leadership Lessons from the Last Jedi
By Bobbie Ann Adair White, EdD, MA

Editorial note: Dr. Bobbie Ann Adair White is an adjunct assistant professor in the Department of Humanities in Medicine at Texas A&M Health Science Center.

My obligatory viewing of The Last Jedi turned out to be a lesson on leadership. As a good wife, I knew I was obligated to watch it at least once, and as a busy person I can appreciate just about any movie as a distraction from life, but about halfway through the movie, I started to see the value of the leadership lessons that came to the forefront in many of the exchanges. On the drive home, I turned to my husband [Heath] and said, “Did you notice all the parallels between the lessons in the movie and the leadership literature?” Heath and I both study leadership, because of my degree and his necessity, so we often discuss leadership development. However, this was the first time we analyzed a movie in the vein of leadership lessons. We ended the conversation with a resolve to go see it again, so we could write this reflection. As an ICU director, Heath was too busy to contribute to the write-up, but he was glad to go and see it again.

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Leadership Lessons from The Last Jedi

Leadership Lesson 1: Introspection and self-reflection are important parts of leadership.

Don’t be afraid of introspection and self-reflection. In one scene, Yoda and Luke are watching the tree of knowledge go up in flames, and Luke’s expression conveys that watching the ancient teachings and books go up in flames creates stress for him. Yoda sees his stress and hesitation and reassures Luke that everything, including the knowledge of being a Jedi, is inside Rey and only needs to be explored. This is often the case with leaders. Leaders have the heart and knowledge but lack the confidence to step forward and lead, and doing so through introspection and self-reflection is rare in many professions (including medicine).    

Leadership Lesson 2: Failure is a great teacher.

Don’t give up when you’ve failed. Learn from that failure and move on. Luke had significant shame and embarrassment about his feelings of failure in his role of training Kylo Ren. Instead of learning from that mistake and moving forward, he stayed secluded and removed himself from leadership, retiring from Jedi ways. Leadership and education literature both heavily document the fact that failure is a necessity for learning and that a lack of failure most likely means the individual played things safe, not that they were exceptionally successful.

Leadership Lesson 3: Don’t make assumptions about others’ intentions.

Rey says that Luke may have seen Kylo Ren’s thoughts and there may have been darkness, but his mind wasn’t made up.

An important leadership lesson about communication is not to make assumptions about others’ intentions. Because Luke saw darkness in Kylo Ren’s mind, he assumed his decision was made and that he would choose the dark side. Instead, we are led to believe that Kylo Ren’s decision was not necessarily made, but he potentially turned to the dark side when he felt betrayed by the one person who was supposed to have his best interests in mind. The take-home here is to never make assumptions about others’ intentions.  

As a physician in training, you are similar to a Jedi in that you must master many skills, while also honing the ability of being a leader in your community, and at work. Positive leadership in medicine has proven to reduce burnout, enhance team trust, and improve patient outcomes. Although leadership has recently become a focus in medical education, there remains a void in quantitatively proven curriculum. Therefore, I encourage you to create your own opportunities to learn about leadership by using a great Jedi Physician master as a mentor, self-reflecting, and always remembering that failure can be a great teacher.


Photos by Xin Wu, MD, MS

Editorial note: Dr. Xin Wu is an adjunct assistant professor and research assistant professor in the Department of Neuroscience and Experimental Therapeutics.

COM in the Mirror

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Current

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Future

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Listening

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Self Care
By Hannakate Lichota, M2

My name is Hannakate Lichota, and I’m an M2. It’s kind of a running joke for me to get asked, “How many cats do you have now?” Seriously—it happens a lot. You know how many cats I have? Just one. One cat, one dog, and a billion plants.

It’s October now, and what began as an exhilarating first year for our M1s has started to settle into a routine. If you’re where I was at this point last year, you’re probably starting to feel exhausted. If you need a new reason to keep working hard or a reminder to take care of yourself, this advice is for you: Go out to your local shelter and adopt an adult cat or dog! (Or, if you’re not ready for that, then the plant section at Lowe’s will suffice.)

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Here’s why I encourage this: As an undergrad psychology major, I spent the majority of my classes learning how to promote healthy human behavior and emotions. Yet at the same time, I was living in a dark, stressful home situation. I avoided home as much as possible, working night shifts and taking classes all day to stay busy. The time commitment was similar to year 1 of medical school, and so was the stress. But every morning and every night, I had to come home to administer medication to my epileptic cat. I had to feed him, clean up after him, and comfort him. When I had time to sleep, he would always be curled up right next to me. His love and support helped stabilize my life during a difficult time.

My story is an example of how owning a pet encourages self-care by setting a rhythm of giving and receiving. An animal has needs and will often be persistent with you until you meet them. (My cat, for example, likes to jump on my face until I wake up to feed him.) This rhythm is important to establish in medical school! When you’re studying long hours, attending lecture all morning, and dissecting a cadaver all afternoon, self-care can often go out the window.

Don’t let it. When your pet needs food, you should eat, too. When they fall asleep at night, you should, too. Medical school does funny things to you, like convince you that you don’t have time for a 30-minute walk outside with your dog. You have time, I promise. Getting outside for 30 minutes is good for your pet and incredible for your mental health. An adult dog or cat has a huge amount of love and comfort to give, with much fewer care requirements than a puppy or kitten.

If you don’t want a pet but you could still use help setting a schedule for self-care, then get a houseplant. A pothos or heartleaf philodendron is a great low-maintenance plant. When you take care of it, make sure you’re thinking of yourself, too. The habits you set now will carry you through this first year and into the next!

Above all, good luck. Remember that you really CAN do this. Remember to relax, eat, drink, sleep, and keep your head up. Enjoy every second. And if you DO take my advice to get a pet, you know I want to meet them!


Hustle
By Iqra Qureshi, M3

Don’t worry;

time moves slowly but passes quickly.

Hustle,

but don’t force yourself to keep sprinting on empty.

You have a long way to go

and many sights to see,

so take it a little slow,

but keep up and keep on moving.


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A special thanks to... 
Dr. Karen Wakefield for being our faculty editor,
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