Ebola, Personal Risk and Our Trainees

Around the world, Ebola and other infectious diseases take the lives of mothers, fathers, sons and daughters … and place at risk those who care for them. This risk is known to all who choose medicine as their career.  It is part of caring for the ill, and always has been.

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 A healthcare provider has an ethical and professional duty to address a patient’s needs, as long as the patient’s diagnosis – or when the patient’s initial complaint, on the face of it – falls within the provider’s scope of practice. Refusing to do so is not consistent with the ethical principle of beneficence. “ Twardowski, et. al. RI Med Jl October, 2014

Around the world, physicians, nurses, and all healthcare workers willingly fulfill their duty to care for patients who are or might be ill with Ebola and other dangerous diseases, reflecting the altruism and compassion of those who choose medicine for their career.

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Emory Nurse ‘Could Not Be More Proud’ of Those Treating Ebola

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Ebola doctors sacrifice all to bring hope.

However, the duty to care for these patients does not automatically extend to those who are learning medicine.  Without the experience, context and well developed skills of established providers, trainees are potentially at greater personal risk.

When I operate on patients with HIV, Hepatitis, or any blood-borne pathogen, I take every precaution possible for myself and the staff who are scrubbed. I also take advantage of the “teachable moment” to discuss ethics and universal precautions with my trainees…. but I don’t allow medical students or junior residents to directly participate in the case. Likewise, I am sure that learners will not be allowed to provide direct care for patients known to be infected with Ebola or other dangerous diseases… or to travel to West Africa for clinical experiences while the epidemic is still present.

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All of us in medicine honor those who provide care to the ill despite the risk …and we thank you for the example you are setting for those learning to heal.  We hold our colleagues in Dallas, Atlanta, Africa and around the world in our thoughts as they work tirelessly to heal the sick and contain this terrible disease.

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Here’s a list of aid groups working on the Ebola crisis — and how to donate

Fast, Easy Recipes: Naturally Ella

I’m always looking for websites with great recipes that meet the “pizza rule” for medical students, residents and busy docs. (Food that takes take less time to prepare than it does to order a pizza).

Naturally Ella is a website by Erin, who “grew up on fast food” but, along with her family, made significant changes when her father had a heart attack at age 45. Her blog has healthy vegetarian recipes that are easy to prepare and make great #callfood*. Even if you aren’t a vegetarian, these recipes will convince you to join the Meatless Monday movement!

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Avocado Chickpea Salad

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Hummus and Grilled Cheese Sandwich

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Sweet Potato Sriracha Noodle Soup

 

*Search for #callfood on Twitter for other “pizza rule” recipes that are great to take to the hospital for call!

Words of Welcome and Advice to New Medical Students: The DeBakey Scholar Convocation Address

Convocation1-2 copy“Whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is gracious, if there is any excellence and if there is anything worthy of praise, think about these things.”

It’s so good to be here with you—what an exciting day.  I was asked to share some thoughts that might be relevant to you all as you get started on this incredible ride.  I’ll get back to the Paul in a moment—just to say here that, from a purely literary sense, there’s something to admire in his lists, their cadence and directionality.  Most of the rest of what I’ll have to say is from Greek pagans but they just can’t compete with this poetry, so I put it first.

I remember sitting where you are now on my first day.  The woman who is now my wife was halfway across the country; I was in a new city, sweating profusely, with a slowly dawning perception that I didn’t actually know what I was getting myself into.  Over time I found a place, some solid friends, some good study habits.  We all helped one another through.  I’m sure you will do the same.

What I wanted to share with you today, though, is something that I think is pretty important you know up front.  Here it is: You are all about to devote a tremendous amount of time and energy over the next four to…fourteen years…on something that is not enough.  I’ll say it again: a tremendous amount of time and energy will go to something that isn’t enough.  Medicine—the science, the practice—won’t get you through.  It can’t sustain you on its own, through all through the hard days, the specter of burnout, nor can it sustain the lives we will cultivate with others while we are here in school.  There’s a temptation sometimes to think it will, or at least to slip into the illusion that the whole world is just a somewhat distracting corner of medicine, instead of remembering that medicine is really just a small part of the world.  But we can’t forget that—and our patients, if we listen to them, won’t let us.

For us, medicine is (or will soon be) a way of life.  We’ll eat and sleep in the hospitals—and sometimes, we won’t eat or sleep, but we’ll still be in the hospitals.  But for the patients we serve, their days are anything but normal.  They—often regardless of how sick they are—are in extremis.  This day that you just walked into represents to them disorientation, rupture, interruption of their story and sense of self, reckoning with an unseen, threatening force.  We would do well not to forget that.

Narrative theorist Arthur Frank writes of what he terms ‘spaceship ethics,’ named after a physician’s anecdote of leaving his home and imagining his car a spaceship, carrying him to a distant world where “terrible things happen,” all the while refusing to acknowledge that his planet and the planet of the hospital are one in the same.  The problem here is that the physician is isolated—from his patients, his role, and even from himself.  What Frank proposes instead is to invest deeply in stories–essentially, being willing to be open to the ways that stories are the first inroads to a more personal and specific way of being-toward-the-other. Others have picked up his argument to strongly argue that we as clinicians need also to look outside of medicine, and toward things like living traditions, authentic relationships, good art, the natural world–not just to relate to our patients better or to help ourselves recharge but also to help us do the work that, ideally, we’re trying to do.  Medicine—the science—pushes us to efficiency, effectiveness, near-perfection.  There is a lot of power in that.  But healing—I hesitate to call it an art because it is more than that, more than artifice and closer perhaps to a way of being—healing sometimes requires inefficiency.  Hesitation.  Our wounded nature encountering another wounded nature, and stopping long enough to witness their suffering and, even if we cannot take it away, being willing to be changed by it.  How?

I promised you pagans.  Aristotle said, “the virtue of a man…will be the state of character which makes a man good and which makes him do his own work well.”  There is a sense, in his writing, that virtues—from virtus, excellence, worth, developed through habit—are the raw materials for a well-favored life in which work is integrated into a greater and more important pursuit of being a good human being.   Philosopher Craig Irvine at Columbia wrote, “I must care for my hands, if I am to lift the fallen; my heart, if I am to love the stranger; my mind, if I am to cure the ill; my eyes, if I am to find the lost, and my soul, if I am to guide them home.” I would challenge you to find a few ways to sustain yourselves that are not simply disconnected from medicine, and to avoid the slow gravity toward “spaceship ethics”—but instead to look to each other to begin to cultivate those strengths—humility, courage, charity, patience—that can sustain us as we remain human in the face of the suffering we will inevitably see.

Baylor has given me a tremendous education.  Now in my fourth year I can almost feel the first little shoots of competence poking up over the vast freshly-fertilized fields of my inexperience.  Thomas Merton said, “The world is made up of people who are fully alive in it: that is, of the people who can be themselves in it and can enter into a living and fruitful relationship with each other in it.”  Education, then, should be one of the ways that we learn who we are, what we have to offer, and how to make that offering valid to the contemporary world.  Baylor has provided that type of space for me while laying a solid foundation, and I have confidence that the faculty here will do the same for you.

As I look ahead, there’s one particular virtue that I would personally like to cultivate, that seems especially fitting especially after this last month at Texas Children’s Hospital with patients and families who are uprooted from home.  Here’s a long quote from Henri Nouwen from his book called “The Wounded Healer,” and then I’ll wrap up.

“Hospitality is the virtue that allows us to break through the narrowness of our own fears and to open our houses to the stranger, with the intuition that salvation comes to us in the form of a tired traveler…Paradoxically, by withdrawing into ourselves, not out of self-pity but out of humility, we create the space for others to be themselves and to come to us on their own terms…But human withdrawal is a very painful and lonely process, because it forces us to directly face our own condition in all its misery as well as all its beauty…[W]hen we have finally found the anchor place for our lives within our own center we can be free to let others enter into the space created for them, and allow them to dance their own dance, sing their own song, and speak their own language without fear.  Then our presence is no longer threatening and demanding, but inviting and liberating.”

Enjoy this time—it is fun.  Study hard, and try to do it for someone else.  Be good to one another, to your patients, to yourselves.  I wish you all the best.

The address given by the Mark Kissler, MS4, the 2014 Debakey Scholar of Baylor College of Medicine on July 30, 2014 at convocation for the class of 2018.

Learning to Run Meetings

Whether you are a college student, medical student, resident, faculty member or physician in practice, you can’t get around the need for meetings. Having watched some masters (and some “masters to be”) I thought it would be worth a little research on what makes a meeting work well. Here’s 12 ideas to help learn the skill of running a great meeting.

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1. Start on time, stay on schedule and end on time. “Set the ground rules – meeting does not equal chillaxin in a room with a big table” from the MIT meeting Primer

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2. Don’t use PowerPoint.

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3. Make meetings as short as possible. Just because Outlook defaults to an hour doesn’t mean a meeting has to be an hour. I’m a fan of 30 minute meetings (max).

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4. Never have a meeting without a clear purpose. If it’s just “getting together” to talk, it’s not a meeting. (Face to face time is important socially, but don’t confuse the two). That being said, a little social interaction at the beginning of the meeting is important to set a collegial tone.

5. Invite the appropriate people. Nothing is worse than sitting through a meeting about a topic that doesn’t apply to you. Limit the number, too – more than 8-10 people limits the ability of the group to interact effectively.

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6. Make an agenda and send it out before the meeting. If you are using Outlook to schedule your meetings, you can include the agenda (or add it later) with the invitation. The best agendas use the DRI approach adopted by Apple. Every item on the agenda should a) have a time limit for the item b) lead to an action item, and c) should list the “Directly Responsible Individual” for that item.  If it’s a smaller meeting, a formal agenda may not be necessary, but setting goals (and letting everyone know in advance) is still crucial.

7. Share documents with the team. Create folders on a shared drive, SharePoint or use Google (or other) apps. Otherwise, make sure these are shared by email.

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8. Include “brainstorming” as an action item at the end of every meeting. When people bring up items that aren’t related to the task being discussed, stop them, write it down and bring their idea up during the brainstorming session.  Reinforce that there is no judgement in brainstorming – this is where the great ideas come from!

9. If you are running the meeting, control the conversation without stifling the creativity of the group. If one person seems to be dominating the conversation, gently (but firmly) steer the conversation to the other people. Go around the table to ask for opinions. If it’s a controversial issue, ask people to write their decision/opinion on a piece of paper and “pass the hat”. You can then read what are essentially “anonymous” responses to the group.

10. No texting, emails or other technology during the meeting. If it’s an hour long meeting, think about a 5-10 minute “bio break” to let people check their phones mid way.

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11. Send an email within 24 hours summarizing the action items, deadlines and DRIs. Alterantively, you can send the  the minutes instead (but do it within a few days, not just before the next meeting so people know their responsibilities)

12. Kindness matters. These are your friends and colleagues who are all trying to do a good job and help.

 

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Seven Steps to Running the Most Effective Meeting Possible

How To Run Your Meetings Like Apple and Google

University of Wisconsin-Madison guide to running good meetings

MIT Meeting Primer

Fast and Easy Recipes – Protein Bars

The senior class ends their formal education at Baylor with a capstone course called “APEX”. In addition to reviewing critical medical information, communication skills and other important aspects of becoming an intern, there are also wonderful lectures from faculty on “how to be an intern”.

One of the APEX speakers this year was Dr. Sally Raty, who stressed how important it was to take time to care for yourself.. but that you had to look for efficient ways to do it! She promised to share recipes that are easy and take very little time to cook. I’ll share the rest of the recipes on future posts… but here is the first one (which she adapted from this recipe).

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These bars have a ton of ingredients, but they are easy to find, and this bar is way better for you than those processed, chemical blobs you’re spending $2+ on. I keep all of the dry ingredients for these bars in a basket in my pantry. I just pull the basket out and make the bars. The crumbs are amazing on vanilla ice cream….not that I would ever do that, but I’ve heard it is good.

3 cups raw oats
(nothing fancy. Quaker 3 minute (not instant) oats are fine)

1/2 cup whole sesame seeds, or shelled sunflower seeds

1/2 cup shredded coconut (unsweetened is best, but sweetened is easier to find)

1 teaspoon ground cinnamon

1 teaspoon salt

1/4 cup brown sugar

1 cup vanilla Greek yogurt

1/4 cup + 2 tablespoons pure maple syrup or honey

1 cup peanut or almond butter

1 teaspoon vanilla extract

1/4 cup coconut oil, liquefied if solid (or just use canola oil)

1/2 cup chopped chocolate chips (> or = 70% cacao is best)

1/2 cup chopped nuts (almonds, walnuts or pecans)

1/2 cup chopped dates, raisins, figs or other dried fruit–optional (I don’t typically add these)

1 cup vanilla or chocolate whey protein powder– Garden of Life Raw Protein is a good one and is available at Whole Foods Market

2 eggs

½ cup egg whites (or add a 3rd egg)

Heat oven to 350F. Spray an 11 X 7 inch glass baking dish with nonstick stuff. Throw everything in a big bowl. Mix well with your hands. Place in the baking dish, press into the pan to eliminate bubbles and try to get it level. Cook for about 20-25 minutes. Let cool completely to room temp. Refrigerate for a few hours before cutting into bars. Cut into about 48 bars. Refrigerate the cut bars.

 

Top 10 ways to survive (and maybe even enjoy) being on call

Like our residents (but not nearly as frequently), my group has started taking “in house” call.   For every one who is currently or has been a resident, this is an experience we all know…. and one that’s hard to describe to those that haven’t experienced it.   Spending 24 hours on call in the hospital can be emotionally and physically draining, but it has moments that make it a special experience, too.

There are ways to make the experience easier.  Here are my top 10 ways to survive (and maybe even enjoy) being on call:

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1. Drink water. Put a water bottle in the lounge refrigerator, drink from every water fountain, put your water bottle next to your computer, or come up with other ways to stay hydrated. If you want more flavor, bring a zip-lock with cut up lemons or limes to put in your water or add a splash of fruit juice.

2. Be kind. No matter how stressed or busy you are, knock on every patient’s door and enter their room with the intention to help. Sit down or put a hand on their arm when you are talking to them. Smile.

3. Take breaks. On purpose. No one really expects you to work non-stop for 24 hours and it’s not good for your patients. Deliberately stop to do something else every few hours, even if it’s just for 5 minutes. Go outside for a few minutes for a short walk to catch some natural light and breathe some fresh air. Get a good cup of coffee or tea, listen to some music or just sit. If you want something more active, climb a few flights of stairs, stretch, or even do a light workout.

4. Eat well and eat often. Do not rely on fast food or the hospital cafeteria. By far the best plan is to bring really good food from home. You need to have “comfort” food on call. If you don’t cook, buy really good prepared food that you can look forward to. Make sure you have “plan B” ready if your call day gets completely out of control by having an energy bar (my favorite is Kind bars), peanut butter sandwich or other “quick” food in your white coat pocket.

5. Be part of the team. Notice and encourage the unique camaraderie you share with everyone else who is on call. It’s a small “band of brothers” who find themselves in the hospital at 3am. Be kind to each other, help each other, and use this unique opportunity to get to know someone you might otherwise not get to know.

6. Wear good shoes. If you are in house for 24 hours, bring a second pair that’s completely different (clogs and running shoes for example). Ditto socks. Buy really good socks and change them after 12 hours if you can.

7. Use caffeine wisely. It’s practically essential for many of us at the beginning of the day, but beware trying to “wake up” with caffeine after 2pm.   Not to mention that if you “caffeinate” all night, you’ll have that sickly post-call-too-much-caffeine feeling in the morning.

8. Take naps. Any sleep is good sleep on call. If it’s possible, 20 minutes will make you more alert and effective in your work.

9. Make your beeper a “Zen bell”. Use your pager or phone as a tool for mindfulness. When it goes off, take a deep breath, relax the muscles in your face and shoulders and be present.  This is a proven practice to decrease stress – try it, it works!

10. Learn. Take advantage of the unique educational opportunity of being on call. The fact that there are fewer people around at night and on the weekends has a real impact on how and what you learn on call.   If you are a student or junior resident, you are more likely to be the first person evaluating new consults and admissions. You are also more likely to have one on one time with your senior resident or faculty as you care for patients together.  If you are further along in your training,  the “down time” on call (if there is any!) is a great time to catch up on reading.

 

 

Healthy Recipes: 101 Cookbooks

It’s been a while since I posted about cooking and the pizza rule”. If you are trying to eat well as a medical student or resident, the key to success is planning, finding simple healthy recipes, and cooking for yourself.

101 Cookbooks has recipes that are healthy and many that are fast… but a few minutes on this beautiful blog will also feel like a “mini-vacation”. Heidi Swanson’s beautiful writing about food and travel, her award winning images plus the wonderful recipes make this time well spent.

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Summer Vegetable Curry

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Kale Market Salad

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Best School Lunch: Sicilian Broccoli and Cauliflower Pasta

 

* The “pizza rule”: Find recipes that let you cook dinner in less time than it takes to order a pizza.