Storytelling in Medicine Program
It has been said that humans are the storytelling animal--that our ability to tell, hear, and share stories is what makes us who we are. Stories are one of the most powerful ways for us to connect, empathize, and to heal. The Center for the Art of Medicine’s Storytelling in Medicine Program is committed to promoting the creation and sharing of the rich and varied stories Minnesota's healthcare workers have to tell.
The Storytelling in Medicine Program will build on the work initiated by Drs. Ben Trappey and Maren Olson. This will include: gathering and sharing healthcare worker and patient stories; partnering with minority/marginalized communities to share stories of inclusion and bias through written works, podcasts, story slams; the creation of anthologies of medical stories; teaching reflective writing techniques; and facilitating story slams for students, trainees, and faculty.
Artistic Antidote + Sharing Our Stories
DEEKSHA BORKAR, PEDIATRIC RESIDENT PHYSICIAN, TWIN CITIES
March 24, 2021
A day doesn't go by without caring for them.
The memory, a toddler running down the hallway towards me
Simple words of “I love you doctor” mean so much
With his arms wrapped around my legs, the 4 year old, made me fall in love again
This gratitude, I can’t express the feeling
I’ll choose this again, in each and every life, only to be a part of theirs.
SUSAN LAABS, FAMILY MEDICINE PHYSICIAN, MAYO CLINIC
March 5, 2021
I see you.
Every day you faithfully visit.
Even when the doors were locked and you had to just stare through the windows, waving at a non-responsive her…
There you were.
She knows you:
Even though dementia has stolen her words.
I see it in her eyes when you are there:
A tiny spark in the abyss of her dementia,
That beast dementia that has swallowed so much of her.
Your faithfulness inspires,
Not just her,
But all of us
Who see you.
*This poem is inspired by the love and devotion shown to one of my nursing homes patients by her husband. I have struggled with Social Media during the Covid pandemic. There are so many posts minimizing the horrific effects that Covid wrought in our nursing homes. Posts suggested that the deaths of our elderly nursing home patients perhaps didn’t matter because “they were old and going to die soon anyway”. Posts suggested that I was not being honest in filling death certificates, alluding to some incorrect perception that I would be paid more if I attributed the patients’ deaths to Covid. So many posts are even now anti-mask, anti-vaccine, anti-distancing. Sometimes there seem to be so many people unwilling to do even simple things to protect our elderly and vulnerable. I have lost so many long term SNF patients. Those patients were beloved; they had stories; and they had value despite being old and fragile. I have carried the grief of their loss. That grief mixed with anger at how many did not value those lost lives. This poem reflects not just my admiration of my patient’s husband’s dedication. It is also my reminder to everyone that my patient is still a person despite her dementia, a person who is beloved and has value.
STEFFI MASILAMANI, PEDIATRIC RESIDENT PHYSICIAN, TWIN CITIES
March 3, 2021
How I wish I could feel your pain!
How I wish I understand your mind!
How I wish I could be your friend!
I bet your mom’s heart bleeds like your inflicted wounds
My heart jumps out of my chest to embrace yours
Oh! How I wish this would pass and be normal again!!
TAUMOHA GHOSH, PEDIATRIC HEMATOLOGIST/ONCOLOGIST, UNIVERSITY OF MIAMI
February 26, 2021
The Boy Who Always Smiled
I met him when he was first diagnosed with cancer. He wasn’t even a year old. He got into remission and I watched him grow up as he continued therapy. I saw him learn to run, learn to talk, become a big brother, and be his own person. He loved sharks, and was obsessed with cars. His signature was giving knucks and he always smiled.
Then his cancer relapsed. We made a plan to beat it again, and he was hospitalized for months with a course that quickly became complicated. Unfortunately, he ended up on life support. Simultaneously, the COVID pandemic began. Suddenly, everything changed and new policies were implemented. As an example, his parents now had to take turns staying with him. Beyond his parents, no other visitors were allowed, not even other family. As his primary oncology fellow, I would visit, and became a support system for his parents that they couldn’t have otherwise. But we couldn’t touch and really, there’s something about empathy during a time of grief that needs the feeling of touch. Being touchless makes it feel so much worse.
A month in, we had to say there was no hope. He was dying. I came in for that conversation to be had in person. We had to get permission, so both parents could be present. It happened in a large conference room so we could maintain social distance while sharing the devastating news. While attempting to express our regret, half our facial expressions were obscured by the masks we wore and our body language was suppressed because of the rules to stay 6 feet apart. A plan was made to withdraw care in two days. COVID restrictions at the time dictated a chaplain must escort each visitor one at a time for a timed visit of up to 15 minutes to say goodbye. 15 minutes only. The parents couldn’t stay in his room during those visits. His family, in their grief, came and camped out in the hospital lobby, since they weren’t allowed anywhere else. That last morning, the rules changed again, so at least now his parents could stay when visitors came by. The last two were his paternal grandmother and maternal grandfather. A compassionate exception was made to allow his grandfather to stay for his death. As they held their dying child, his father asked if his mother could come back up. That request went unfulfilled.
In that moment, watching them experience the most horrific moment of their lives without the support they wanted and needed, I felt broken. Where was the humanity in it? I understood the rules and why they were in place, but I felt like I’d failed as a human in not providing the comfort they deserved.
He wasn’t the first patient I’ve seen die and the team went above and beyond to make his death “good” despite the limits of the pandemic. His death nevertheless has hit harder than those before. A week after his death, I still felt so low. Attempting to process my feelings, I wrote the following: “One of the worst parts of this pandemic has been watching people grieve alone. Whether it’s having to share a new cancer diagnosis with one parent in clinic and the other on the phone, or watching parents lose a child without their extended relatives being able to be present, it feels as though their trauma is being intensified by the fact that they have to go through it on their own.” That trauma isn’t just being experienced by patients and families, but it is also being felt by the providers. And it’s tragic.
His death wasn’t from the pandemic, but it was deeply affected by it. If nothing else, this experience has made me give people a little more grace as we all navigate this new and challenging time. I do so to honor him, the boy who always smiled.
SYED ANJUM, CRITICAL CARE PHYSICIAN, MAYO CLINIC
February 24, 2021
Oracle of destruction.
Ravishing through nations,
Ordained to devastation.
Negator of humanity,
Annihilation of Grace.
If this is the beginning
What about the end?
Will it tarnish the soul in quest?
And leave the body to fend.
Isolate, preserve we must.
Save one and all in this tempest.
Future tenuous no end in sight.
Yet why does goodness shine so bright?
We will overcome the inner savage.
Assuage the wounds left by the ravage.
Kindness and hope will forever reign.
One day we will live again.
CHRISTINE THOMAS, INFECTIOUS DISEASES FELLOW, TWIN CITIES
February 19, 2021
20 Questions: An Infectious Diseases Fellow Reflects on 2020
It started as nerdy fascination.
Now the world desperately awaits information.
What is this COVID-19?
In the US.
Is this just another travel-related disease?
The kind comprised of buzzwords on a test?
It’s truly here.
In my state.
In my hospital.
Do I really need all this PPE?
Is this PPE enough?
Will I be offered ECMO?
Hospitals bravely confront the unknown.
Unpublished data form backbones of treatment algorithms.
Will an antiparasitic drug cure this virus?
A list of names stares back at me.
Who gets remdesivir and who gets convalescent plasma?
The Spanish interpreter graciously assists with a string of conversations.
I dial the Oromo interpreter and pause.
The clinical trials don’t allow for consent in Oromo...
Is there anything I can offer instead?
I helplessly try to dial down the adrenaline.
Slow this infusion of paradoxically exhausting energy.
We know more than a month ago…
Like who is shouldering the brunt of pandemic ferocity.
And how do we remedy inequity?
Makeshift ICU beds disappear.
Those ballooning COVID care teams begin deflating.
Where did stroke and cancer cases disappear to?
Thank God I can escape to the lake.
Muscles relax under rays of sun.
Laughter from a handful of friends warms my soul.
I can live life in a bubble.
We can adapt, right?
Foreboding comes with flu visible on the horizon.
There is no option to cancel winter.
Can hospitals handle both COVID-19 and influenza?
Dare we imagine a worse scenario than Spring?
Angst permeates the six feet of air between us.
Shoulders visibly tense across internet connections.
How can a piece of cloth divide a nation – let alone friendships and families?
Aching loneliness appears to be my permanent companion.
Plummeting temperatures hamper those outdoor activities clung to so tightly.
Rising infections drive us further inside our homes.
Can we survive the holidays?
The nation, the world, dares to hope for the pandemic’s end.
But what about those plights unmasked by COVID?
Where is the vaccine for loneliness?
Where is the vaccine for a fractured world?
HEATHER THOMPSON BUUM, INTERNAL MEDICINE PHYSICIAN, TWIN CITIES
FEBRUARY 12, 2021
The New "C-Word"
Every now and then I have a word or a phrase that I can’t get out of my mind, sort of like a song that plays over and over in your head, also known as the “earworm.” A few years ago, for obvious reasons, it was that infamous c-word: cancer. After my diagnosis in 2016, it floated around in my brain constantly, often entering my verbal dialogue as well as my inner thoughts. I recall once, a colleague greeted me in the hallway: “Hey Heather! How have you been?” and I immediately thought: “Hi! I’ve got cancer. How about you?” Somehow I managed to change my response to simply, “Hello.”
Now, fast forward to the year 2020 and the c-word has most definitely been replaced, at least for me. Coronavirus. COVID-19. Not only it is the innate fear and stress and uncertainty surrounding this horrible entity that keeps it stuck in my mind, but also the constant barrage of emails, news reports, text messages, and social media all relating to the same topic. COVID-19 has been circulating around in my brain for months, eerily similar to how I envision the viral particles themselves floating around in the air for some time after an infected person coughs or sneezes. I began to think that even if COVID-19 has not infected my body (yet), it has certainly infected my mind, even my dreams. I’ve had the same recurring dream lately whereby I leave my house to go to work or the store and I am attacked by a stranger in a dark coat. And my daughter shared her recurring dream during quarantine, where she was trapped inside our house and a vicious wolf was prowling around outside; I was fairly certain the wolf represented the pandemic.
In a similar fashion to coping with a cancer diagnosis, I soon recognized that I needed to get my mind off COVID-19, too. Not only a mental break from thinking about it, but a break from the news media and flood of information via email and social media too. While I recognize that as a physician I need to stay informed, I can also set aside specific times to do this, such as when checking email or reviewing the MDH website numbers. I can turn off the TV and handle the news in doses; last week, I had a window of time where I went into the kitchen to cook dinner. I opened the music app on my phone and listened to one of my favorite playlists as I prepared the food for almost two hours. I emerged strangely refreshed, energized; later, I reflected upon how powerful it was to take a break from the news. And music, in general, is another way I helped ease anxiety in 2016.
As it turns out, the other coping mechanisms that I utilized for cancer work well for this new c-word, too. Such as exercise; we had such a mild December, I was actually able to run outside up until the gyms reopened--thank God for that. And faith; I have found that I even more appreciate time spent in prayer, reading scripture, and fellowship with my church groups (via Zoom, of course) which keep me grounded in so many ways. Then, there’s humor. But wait; can one honestly find mirth in the midst of a pandemic? I would say yes, based on some memes and facebook posts that have actually made me laugh out loud. Such as the “social distancing dress” with an 8 foot wide hoop skirt attached to it, or the list of COVID-19 pick up lines. My favorite being, “Baby, do you need toilet paper? Because I’m your Prince Charmin.”
Finally, there is writing. To quote Anne Frank: “I can shake off everything as I write; my sorrows disappear, my courage is reborn.” This is especially meaningful considering her situation was somewhat akin to ours, being trapped inside. Whether it’s a blog or a social media post or just writing a few lines in a journal every day, writing is therapeutic, and should be used early and often throughout these stressful times. Because I fear once this is over, or even before that, mental health may be our next pandemic. Sharing our coping mechanisms widely may be the best “mask” or “hand sanitizer” we have for prevention.
I attended a few cancer survivor virtual events in 2020, one of them regarding therapeutic aspects of humor and writing. During this session, a patient with leukemia who underwent a stem cell transplant reflected on many other similarities between cancer and covid; even the everyday mundane such as mask wearing, handwashing, and avoiding the outside world would feel strangely familiar to a patient who had been waiting for white blood cells to engraft. We all shared our observations about the new “c-word” and how cancer might have ironically prepared us for such a time as this.
Meanwhile, I’ll keep pressing on; I’m still fully engaging with the coping mechanisms I listed above. Being able to go to work and interact personally with patients, nurses, and colleagues helps immensely, too. Vaccines appear to be right around the corner. And so I am optimistic, and I’m waiting for the day when this new c-word is eventually replaced by another one.
How about these:
DEANNA SELLERS, CRITICAL CARE NURSE PRACTITIONER, TWIN CITIES
February 17, 2021
As I Lie Here
Breathlessness unrelenting as I lie here
Sensing the hustle saturated in anxiety
Followed with only quiet, but emotionless machines
Unable to hold my hand…
Fear overwhelms my thoughts, my strength
Haunting by squandered time, chances lost
Perseverating on wasted choices, toxic people
Never willing to hold my hand…
Nothing to interrupt the remorse and regret
Isolated, without hope to see that I am
No touch or voice, to prove this is real
No one to hold my hand…
Alone, and finished
Shameful, this is all I will be
My body, my mind, choices no longer mine
Please, I ask… please, Hold my hand.
YU-HUI HUANG, RESIDENT PHYSICIAN-RADIOLOGY, UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
February 10, 2021
The Distance Between
I no longer know how to comfort
The touch once so powerful now frowned upon
In fear of contracting or spreading covid-19
We all keep our distance
Out of safety, respect, and fear
When the tears run down my patient’s face
I consciously restrain my hands to myself
And cautiously nudge the box of tissue
Allowing only our gaze to meet
With my eyes being the only feature visible
Just beyond the shield on my face
There lies so much pain within those eyes
Yet I can only observe them from afar
And hope the box of tissue can keep them at bay
MAIA TWEDT, CHAPLAIN, HENNEPIN HEALTH
February 5, 2021
My grandmother’s chairs are lonely, she says
They sit empty and waiting, Invitations
Issued, and still… nothing.
No one to while away the days,
No one with whom to drink my tea.
The hourglass loses time these days,
Playing around in the 17th century mantelpiece clock,
The one broken for some time
But too precious to fix.
And this time, oh this time,
So much unease, and equivocation
Every move under the spotlight of hazard
And the painter moving deliberately around
The house, making everything shine again
On the outside. But inside these walls,
Loneliness comes through the cracks
And shafts of light reveal
Dust sifting onto family portraits.
REBECCA GROSSMAN-KAHN, RESIDENT PHYSICIAN- PSYCHIATRY, TWIN CITIES
February 3, 2021
What is getting you through these days?
I ask this to faces caged in little rectangles on my computer. Postage stamp-sized faces in dim light, in dark bedrooms, on bedspreads and in parked cars.
A new jigsaw puzzle, they tell me. I splurged on a new pair of fuzzy socks.
In the late afternoon, after I overenthusiastically wave goodbye and close the tiny shutter on my laptop camera, I find solace in taking a pasta making class. The simplicity of mixing just two ingredients to form a mass—flaky, sticky, shedding flour. I knead the craggy dough until it is smooth and elastic. I learn to cut small pieces off a rope of dough, and squish and drag each nub of dough against a surface until it furls into a little hollow. The task is repetitive, satisfying, little pasta potato bugs dancing across the board. This gets me through long days of telemedicine in my cold home office.
What is getting you through these days?
I’m window shopping online,” a patient tells me wistfully. I overflow my virtual cart with every lovely, expensive item I want, and then “x” out the fantasy when it’s time to start making dinner.
Seven full months into the pandemic, a Friday night. My partner looks at me, and deadpans:
“I dunno, maybe we should just stay in tonight?” For some inexplicable reason I can’t stop laughing.
The joke gets me through the next three weekends.
I’m getting really good at Sudoku. I’m rediscovering my love of old Westerns. I watch the squirrels playing outside my window. They distract me.
Last summer, I booked a campsite for one night. Close to the cities. Tent under the trees. Nylon hammock under the stars. Smell of smoke stuck in my hair. Irregular party lights of fireflies blinking above. Cool blues pastel pink sunset over the hill. The shock of two iridescent yellow eyes, peering at me from the forest. The thrill of a harmless scare.
Mystery novels and gummy fruit snacks, an adult patient sheepishly confides. I discovered they’re a perfect combination.
An article about baking bread in Lyon, France. It was a small gift, to open a magazine and enter a world of yeast, early mornings, salty French characters, a messy kitchen, pain au chocolat. It came out months ago, when I couldn't read anything else about the virus. I imagined editors fighting over email over whether to still publish essays about pastries, in the midst of 2020. How could they? How could they not? We need it. I needed it.
What is getting you through these days?
CHRISTY ATKINSON, MS4, UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
COVID REFLECTIONS USING VISUAL ART
JANUARY 29, 2021
After spending a few weeks training in a St. Paul ICU over the holidays, I needed to spend some time reflecting on the experience. I decided to use a visual piece as a reflection tool instead of trying to process my thoughts line by line in an essay. The SARS-CoV-2 virus is invisible in its path of spread and only when it finds a home in a human body does its wrath become tangible. I felt numb to emotion following my time in the ICU; I wanted to bring myself closer to the experience of treating COVID-19 on the frontlines by writing the words and experiences that lead patients to become sick as the air that moves into their lungs, and words spoken within the hospital by health care providers as the lung structures trying to keep everything together.
The circumstances that cause one to contract the coronavirus are as diverse as the people affected. Although the lies and conspiracies I have heard through the pandemic are infuriating and most definitely contributed to viral spread and increased death tolls, I needed to open myself up to the other reasons people become sick, which I have learned about through listening. Some Americans have no choice but to go to work, and they may not have the resources or support to protect themselves. Some Americans had no choice but to send their children to school or to a daycare because adding ‘schoolteacher’ to their list of titles was simply not possible. Some Americans became so lonely and depressed over the last year that the risk of getting sick was worth it in order to see family. Other Americans simply became overwhelmingly fatigued in following the rules, perhaps despair and severe economic hardship contributing quietly to their exhaustion.
No matter the circumstance, people become sick and come to the ICU for care. I used the words I heard spoken by critical care providers as the bronchi and bronchioles of the lungs. As the lungs became host to the coronavirus, so did our teams become host to our patients.
In the end, seeing the greater picture of the rhetoric and circumstance of the pandemic, paired with the reality of caring for sick patients and the eventual death of many, I am in awe. In awe of a terrible thing we are still living.
ANTHONY WILLIAMS, HOSPITALIST-MED-PEDS, TWIN CITIES
JANUARY 27, 2021
“Isn’t that just the sweetest thing you’ve ever seen?” The nurse whispered, her eyes glistening with unshed tears. “If we could all be so lucky.”
I nodded and carefully closed the blinds to my patient’s room. Septic shock versus the precarious balance of ninety-three year old physiology could only end one way. The sight of ancient hands clasped together in what was likely their final prayer left me raw. Even from outside of the room, the weight and strength of their connection was palpable.
People tell me I’m lucky too.
“The wife understands he could go at any time.” Continued the nurse. “She has some questions, but nothing urgent.”
I nodded again, my face a facade of detached professionalism, my defense mechanisms well-stocked with muted humor.
“In my personal opinion, if you’ve been married to the same person for more than fifty years then you’ve earned some privacy, even in the hospital. They’ve been together for seventy-two. I can come back later to round.”
The nurse smiled, slight but genuine. “That sounds reasonable. It’s only been two years for me. Anyone who has stuck it out for fifty-plus deserves privacy and a medal.”
“Amen to that!”
Even though I’m engaged in this conversation, it can’t keep my mind tethered to the present.Do you remember that argument we had when you bought me new shoes? You felt the old ones had worn out and didn’t listen to me when I said they were still comfortable. If you were going to ask how I felt and then ignore it, why couldn’t we just skip the first part? You wasted my time when I had shit to do.
“Just page me if you need anything right away.” I told her.
“Sounds good. When can I tell her you’ll be around?”
I silently consider the answer as if it’s my rounding schedule—and not my emotional state—that’s the problem.
You would have seen right through that. Remember those nights when you had a checklist of items you wanted to talk about right when I got home? I’d just worked all day and I usually had notes to finish. I didn’t want to talk about anything. You pushed. I lashed out. We fought. You cried. Sometimes we made up.
“I could come back between…noon and one.”
“That’ll work!” She nodded and seemed satisfied with that plan.
Why did you always interrupt me with frivolous questions that could have waited until later, simply because they were on your mind at that moment? And why, if there was even the slightest thing wrong with my facial expression, did you go all Inquisition on my emotions right then, even if I didn’t want to talk? I thought you valued satisfying your own curiosity at the expense of my peace of mind, which was infuriating.
"Oh, I almost forgot!” The nurse said, glancing up from her notes. “Can I get some more ativan for him just in case?”
“Of course. Anything else?”
In the beginning I was clueless. I recognize that now. Later though, realization forged its own double-edged sword. The depth of a connection can be traced in the evolution and nuancing of our fears. I feel each of my mistakes as another grain falling through the hourglass of our relationship. When the top half is empty our song will end. The vows of marriage are a solemn promise that those grains are infinite. The inexperienced worry that they aren’t; the seasoned are terrified that they are.
“No, I think we’re good.” The nurse tells me. “Thank you for being so flexible and trying to give them some time together.”
I thought you were selfish. The sincerity of my apology is necessarily bounded by my insight. It never occurred to me that your acts of devotion, like all the best parts of you, are driven by the inertia of inevitability. You were saying ‘I love you’ and I replied with recrimination. More than failing in my duty, more than being unworthy of your dedication, I fear being blind to the contours of a blessing in my hand, and denigrating it in my ignorance.
“It’s no problem at all.” Ironically, my tone is perfect for the situation. “What they have is precious. We should give them every second of it we can.”
DANIEL TOWNSEND, PALLIATIVE AND HOSPITAL MEDICINE, TWIN CITIES
January 22, 2021
Who Is Palliating Us?
A cacophony of beeping IV poles greets me as I enter the ICU. My eyes follow their thin long tubing as it snakes its way through closed doors marked “covid positive”1. IV poles, ubiquitous to the bedside of intensive care life, now litter the halls. They appear out of place and apprehensive, as if yearning for the comfort zone of their patients’ presence. I feel the cognitive dissonance as I stroll through taking stock of this new normal. What once was a pristine sterilized corridor is now lined with folding tables covered with a litany of disinfectants. The tables seem more appropriate for holding potato salad at a church potluck than virus killing chemicals at this state-of-the-art hospital. I peer into a family meeting room that’s now packed with containers that look like children's toy crates. Each tub filled with PPE and marked with a name in permanent marker on duct tape. The exhausted owner has staked their claim to its unwanted contents: the reused germ-ridden protective equipment is mine and mine alone. Even our attire feels the sting of isolation.
My mind nostalgically wanders to all the discussions that had happened in this room. Joy, anger, fear, grief, and all the byproducts of unexpected change had coursed through these walls. The family meeting is the palliative care doctors' greatest tool. The strategically placed box of tissues, chairs positioned in an inviting circle, the note on the door reserving the time and place- the ultimate setting in which to align our treatment plans around the central focus of patient values 2. Nowhere is the intensity, complexity, and limitations of medical care more realized on a daily basis than in these rooms and it is an honor to bear witness to it. It is a sacred space, and the ghosts of conversations past linger in my mind. Now it’s filled with plastic bins, industrial storage shelves, and a dusty dialysis machine.
A nurse enters the room to grab her gear for the monotonous task of donning. Her eyes are weary and I wonder how we got to this point. Early in the pandemic, there was a collective societal push towards facing this together. The world, mostly oblivious to hospital life, suddenly was teeming with interest. “Support our frontline workers” became a rally cry: handwritten signs, military jet flyovers, and daily meal deliveries from local restaurants. The tired battle analogies that often ring hollow in medicine sprang to life again. My stethoscope became my dog tag, my isolation gown my armor, my N95 my helmet. It really felt like going off to war, and to call it a life-or-death battle is not an embellishment. We held our loved ones more tightly not knowing the extent of our exposure risk and the fear of facing an invisible enemy.
Death is no stranger to hospital work, but there is often an expected rhythm to life's inevitable end. What causes it, when it should happen and what we can (and cannot) do to stave it off. But the pandemic has washed away the solid footing of our assurances. The chasm between the expected and unexpected, the known and unknown, has left us with trepidation. It is a vast cavernous abyss we aren’t sure how to traverse. And although the uncertainty and anxiety of a crisis not yet fully realized brought its own weight, there also was a sense of “this is what we are meant to do”. So we got in our cars, took a deep breath, and pulled out onto eerily quiet highways. We, the healthcare workers of the world, drive towards the problem; because if not us then who?
But that was the spring. The summer days have slipped into the predictability of fall leaves and winter chill. The world has moved on. The lunches, cards, and social media hearts have slowed to a trickle. Medical advice has been politicized so that unity seems impossible and suspicion reigns. The initial push that catered to our better human characteristics of duty, selflessness, and courage has been clouded. Overworked, underappreciated, and often underpaid workers across the healthcare spectrum have felt their resiliency wane as the slow burn of an unrelenting enemy leaves silent scars from untreated emotional wounds. A staggering array of healthcare workers are experiencing symptoms of burnout 3,4,5. The horrors of pandemic work are pushed down deep for none to see, but the simmering strain is etched into the eyes. You just have to look in their eyes.
I ask our palliative care team, “What can we do to better support our frontline staff, nurses, and providers?”
“But who is palliating us?” comes the response.
This consequential question strikes me as I try to process what seems to be incomprehensible. Palliative care is a unique brand of medicine and baked into our very definition is the proverbial ideas of minimizing suffering and supporting others. The blending of the metaphysical with the historically rigid science of modern medicine continues to baffle many in the general public and healthcare community alike. We believe there is healing power in advocating that medical care be more than just about the longevity of our cells. But our tools of value alignment, emotional validation, and walking alongside our most vulnerable have been stripped bare by visitor restrictions and layers of protective gear. Holding a patients’ hand skin-to-skin feels like a distant memory.
It’s then that I allow myself to recognize- I’m not well. The trauma and grief of the unexpected mixed with the “norm” of isolation created a concoction of unsettling stew that I realize I am not well equipped to digest. I wonder if the draw of palliating others creates an ironic dichotomy of not palliating ourselves. We are the steady hand, the emotionally centered stabilizing force that willfully wades into the most traumatic, volatile and chaotic cases our hospitals can throw at us. But behind the scenes we are still people: who mourn, and break and desperately need help beyond our own willpower. And if this is true for me, it must be true for many who find themselves at the crossroads of unrelenting pandemic work and crumbling resolve.
We are in the chronic, liminal phase of the pandemic. And now more than ever we all must find within us the unnatural ability to raise our hands and acknowledge that we cannot do this on our own. Yes, for the sake of our patients, but also for ourselves. We don’t need a military flyover to feel appreciated, but we do need help.
I walk away from the family meeting room turned storage closet and look at my consult list. It’s long and I sigh deeply. My patients need me and I must have the fortitude to do my job well. But I think I’ll also call a friend tonight and actually schedule that appointment with a therapist that I’ve been putting off for years. Because the reality is, it must be ok to not always be ok.
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Weissman DE. Decision Making at a Time of Crisis Near the End of Life. JAMA. 2004;292(14):1738–1743.
Matsuo T, Kobayashi D, Taki F, et al. Prevalence of Health Care Worker Burnout During the Coronavirus Disease 2019 (COVID-19) Pandemic in Japan. JAMA Netw Open. 2020;3(8):e2017271.
Azoulay, E., De Waele, J., Ferrer, R. et al. Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak. Ann. Intensive Care. 2020;10(110)
Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976.
NICKEY JAFARI, RESIDENT PHYSICIAN (OB/GYN), TWIN CITIES
JANUARY 15, 2021
was it not already enough?
was it not already enough
the microscope you cannot escape being examined under
the isolation of missing your loved ones
a new anxiety
an additional anxiety
I could actually die
I might kill my loved ones
how much anxiety can we bear
you do as you must
thats how you got here
what is a resident if not resilient, obedient, determined
you learn how
you adjust to your new normal
and all the new layers it comes with
you have forgottenthe joy of sharing a smile with your patient
and then one day
a deep ache inside your bones
youve never really felt your spine
you sit in your car, you wait patiently, you do it yourself
one inch back, she tells you
three turns in each nostril
you sleep through several days
“You have a POSITIVE Covid-19 Test Result”
you survive it
you have survived everything else so far
you worry when you see something catch your eyein the periphery
youve read the litany of possible sequelae
its just the kitten
you feel lighter, too
for six months
you had slowly forgotten
and eased into carrying
the heaviness of
what if I really get this
will I become one of the 200,000
may they rest in peace
DEIRDRE CROKE, RESIDENT PHYSICIAN, TWIN CITIES
January 8, 2021
“Shut up” I say to my smart device as the alarm goes off. It’s the evening and I am facing another night shift at the hospital. It doesn’t respond to that, so I groan and politely say “Please stop” and the chirping halts. I feel particularly tired and chalk it up to working two weeks of long shifts.
My phone buzzes: a text from my friend Liv. “Any best finger to put the pulse ox on? Todd seems to be 91-92.” Her husband was diagnosed with Covid about a week ago. She’s one of the most even-tempered people I know, but had asked if there was anything they could do at home to monitor symptoms. I suggested she buy a pulse oximeter and check it periodically.
“Any finger is fine. The pointer is usually easier. Have him take some deep breaths and see if it comes up.” I begin to pack for the night shift. Go to the kitchen and get food together. Start making coffee. Come back in a few minutes to her text: “He can’t take a deep breath.” I reread it. She must have mistyped. As I’m staring at the sentence she sends more.
“His O2 is 90. His heart rate is 130. He can’t take a deep breath.”
I’ve known Liv for twenty-five years. We grew up across the street from each other in New York. We played on the same soccer team and our moms would trade off pick-ups and drop offs from practice. Our families vacationed together every summer. Had even been suckered into buying timeshares together. We spent weekends driving to Jersey for soccer tournaments, nights sneaking beers to the playground of the nearby school, days after school listening to the local boys’ punk band in their basement. My mom tutored her sister for her nursing licensing exam. I went to prom with her brother at his Connecticut prep school where I smoked weed for the first time. Her dad, a man who didn’t graduate high school and joined the military when he was seventeen, had beamed at me when I came back to the neighborhood with a medical degree. In his thick Brooklyn accent: “I never thought I’d know a doctor.”
I pick up the phone to call her and pronounce our usual greeting in my calmest voice: “Hey girl”.
She’s crying. “I’m so scared. I don’t know what to do. His breathing seems labored.”
I’m on speaker now and talking to Todd. “Take your first two fingers and place them under your jaw until you feel a bounding pulse. Set a timer on your phone for 30 seconds and count your pulse.” What feels like an hour goes by. Liv says “What is it Todd?”, and he answers “66.”
“Ok so multiplied by 2 is 132, so the pulse oximeter seems accurate. I think you should go to the emergency department. Hopefully they’ll just get some labs and an X-ray or CT scan, prescribe you steroids and send you home.” I try to sound reassuring. But I also tell him to pack a bag with extra clothes and his charger, because I know there’s no chance he’s coming back home tonight.
I send a message to my mom. Our moms are still best friends, and I want to warn her of the anxious texts she’ll inevitably be getting shortly. She responds “Oh that’s not a good sign. And the typical course. Need to rule out PE vs ARDS/COVID pneumonia.”
She’s been a medical ICU nurse in the Bronx my entire life, which means two things: she’s probably the smartest person I know, and she’s seen some things I can’t even imagine. When Covid hit the city, it hit her hospital hard, and she started working sixteen hour shifts for weeks in a row. Her employer even put her up in a hotel near the hospital just so she’d be able to stay later at work but still get some sleep.
One day the nurse manager approached her and said “I don’t know how this is my responsibility, but I need your help.” He led her to a room with the air conditioner blasting, filled with about two dozen dead patients. They had long run out of room in the morgue, recently ran out of space in the cooler trucks outside, and now were out of toe tags for the bodies. So my mom wrote their names in permanent marker on their feet, and went back to the unit and finished her shift.
I go to work, tired, but can’t stomach coffee for some reason. It’s a quiet night so after “tuck-in rounds” with the charge nurse I head to the call room to lay down. My muscles feel heavy. I’m exhausted but can’t sleep and blame it on my flipped schedule. I lay on the uncomfortable call room bed and reminisce about intern year, when I had a thirty-six hour stretch off between a day and night shift. I flew to South Carolina, where Liv and Todd had moved, and missed the rehearsal dinner but got ready with her the morning of their wedding. The next day I went from the airport straight back to the hospital to work.
The rest of the night is a blur of answering pages, distraught texts from Liv, phone calls from nurses, wondering why my throat feels scratchy and realizing I forgot to take my allergy medication, updates of Todd’s vital signs and lab results, taking ibuprofen for a headache that must be caffeine withdrawal, but no sleep. The sun rises and on the drive home my throat feels raw, and I start coughing. I tell myself I’m being dramatic, but by the time I’m at the door I have chills in my spine and make an appointment for a Covid test.
I call in backup coverage for my last night shift and feel guilty and like a fool. It can’t be Covid. All I’ve been doing is working, and I’ve followed the PPE protocols. I’ve worn a mask so much my face is littered with maskne. While I wait for my test results, I convince myself the symptoms are just allergies combined with working nights for a few weeks.
I toss and turn the rest of the day. Todd is on four liters of low flow nasal cannula, his oxygen saturation hovering in the low nineties. He started dexamethasone last night. The hospital is full, so he’s admitted but won’t leave the ED for a while. Liv wants to bring him a pillow to make him more comfortable but has their eight month old son to take care of and wouldn’t be able to see him anyway. They’re probably going to start remdesivir tomorrow.
At two in the morning I wake up clammy. I check my phone and see a new email: “You have results in MyChart.” My face goes numb. I try to log in but my shaking fingers can’t correctly type the password. I get it right on the fifth attempt and read the results, my heart pounding and then a pause: positive.
KRISTINA KROHN, HOSPITALIST, MINNEAPOLIS
JANUARY 6, 2021
ONE DAY TOO LATE
“Could be COVID?” I asked
“She’s been here 142 days, it’s not COVID”
Standing outside her room, N95 on mere hours later. “Her husband got Covid“ the nurse tells me.
For 135 days you came to her side. You protected her. You prayed for her. You did everything. for her. She was your life.
You stayed until the very last moment of the very last day before we forbid you, or any visitors, from returning.
Two days later you sneezed. You thought you’d been careful. It was just a sneeze.
Three days later the coffee tasted bland. You knew.
You got tested.
A day later you told us your result.
At the same time, she was getting worse. The nurse handed me the phone, “ The doctor wants to talk to you.” You already knew what I was going to tell you.
“I’m Dr. Krohn. I’m one of the night docs.”
“Thank you for taking the time to talk to me“ you say. Neither of us want to have this conversation. We both know already what I’m about to say, and what I leave unsaid. You’ve already been crying. Probably since the moment you couldn’t taste the coffee. You’ve known. And you knew it was already too late.
“She’s not doing well. We’re going to intubate.” There is no way for me to be kind, so I just lay it out there. The sounds on the other end of the phone, … I can’t repeat that sound of anguish, but I felt it.
Through cancer. You were there. Through the various infections. You were there. Every day. You tried to be safe. But you still needed food. You still needed gas to get to the hospital. You still needed to work.
Her body could not handle one more thing. Especially not Covid. We both know that she won’t survive if this is Covid. For now, we don’t say that.
We wait on the test.
She in her room, on a machine.
You alone at home.
Me alone in a night workroom.
You came every day we let you. Until we forbade it. And you and I both know we probably stopped you one day too late.
ANDREA TATLEY, PALLIATIVE CARE CHAPLAIN, MINNEAPOLIS
Prayers in the ICU
Writing before the sun comes up. It is quiet, only a wandering deer near the line of pines searching for a frosty apple or two from the small grove. A lonely cat sits by the computer screen looking at me, purring in request of a soft lap for a nap. Sirius to the East, Arcturus to the South, and a brilliant beaver moon gently blanketing the garden where tomatoes reddened, just a couple months ago. The spirit of the land has rested and speaks in soft tones only heard in the pre-dawn hours.
Yesterday I received a request. Not an odd request, but a very simple, quite normal request. They usually start with the same words, “I have a patient for you to see….” The phrase is then followed by, “I know you are busy…” or “if you have time…” A story follows, part tragedy, part complexity, sometimes with a dash of hope because after all, these folks are really sick by the time they land on our doorstep. But this request was not complex. A daughter, hundreds of miles away, her mom swept away to another state, to a hospital equipped to care for her when the local hospital ran out of answers and beds. Mom and daughter both alone with miles separating them in the midst of a pandemic; a virus standing in the way of being together… This is a common and heartbreaking occurrence.
The request? A prayer. That was it. A prayer, tearfully requested by the daughter. Of course. Of course I will go pray with your mom, in the ICU, on a breathing machine, sedated. Theory has it that one of the last senses we maintain is hearing. I share this with patient families all the time. “Assume they can hear you. Say whatever you need to say. Say it all.” Grabbing the mask I hate, shoving my claustrophobia into the depths once again, I head up to the ICU.
Arriving, there are two beautiful nursing souls tending to the body of mom. Gently moving her, guiding tubes, moving cords, changing sheets, checking monitors, adjusting IV bags and on the IV pole, next to a clear liquid filled bag, hung a beautifully simple rosary. Pale pastel beads held the pieces together, Hail Mary full of grace…
I asked the nurse if we could place the rosary in her hand; she tenderly wrapped it around the weathered hand, “I’m not Catholic, she said.” “Me neither…” I replied. Hail Mary, full of grace. The Lord is with thee…
Masks make it difficult to hear and so to pray, even with the knowledge that she might be able to hear me, above the drones of the breathing machine and the bells and whistles of the intensive care unit…Blessed art thou among women, and blessed is the fruit of thy womb, Jesus…my prayer was loud, it felt as if it reverberated down the hall, wafting into neighboring rooms, soaking into wounds physical, emotional…
The nurse shared an “amen” with me, and the rosary was replaced on the IV pole as to not get lost in the sheets. I thanked the nurse who had remained, joining the prayer while she was changing the urine bag. Warm water and soap suds flowed over my hands as I looked around the unit. Social workers on the phone, doctors in consultation, nurses in and out of rooms, it all looked the same as when I had walked in just moments before.
The visit wasn’t long, it wasn’t complex. Prayers through a thick mask, for someone on a ventilator, whom I hoped heard at some impossible level of awareness above all the noise of the ICU feels like screaming a prayer to a deaf God.
The spirit of the land speaks in soft tones only heard in the pre-dawn hours.
Holy Mary, Mother of God, pray for us sinners, now and at the hour of our death. Amen.
Jon KenKnight, General Pediatrician, Duluth
I have asthma and sarcoidosis and I am not the most healthy and I don’t want to leave my wife and kids and I can’t stop it I can’t stop thinking about it and I don’t want to stop thinking
I get tested. I wait. And wait. I feel guilt for leaving my patients as I wait over a week at home. I worry about my patients coming to clinic - is the Monster in the waiting room? We strip it bare. The usually happy toys and books in the waiting room are gone. The families are gone. We all fear each other, our food, everything we touch. It feels so alien and lonely.
We transition to the new normal - video visits from home, only seeing kids in the office if necessary. I wear the same sweatpants all week. I still don’t have the right PPE. I frantically order CPAP filters and an anesthesia mask and cobble together my own elastomeric mask. I hope it works. My eye is twitching. It won’t stop.
I drink more than I care to admit, to drown my fears, stop my twitching eye. I have panic attacks. I tried meditation, it didn’t really work for me. I wait patiently to become numb.
I’m ashamed of the numbness.
I am pricked back to alertness at the death of a black man by the police. The streets rage. The Monster is present. How can this year get worse. I want so badly to scream and to stop all the hate the cruelty the racism the division. I am appalled when a militia blocks the hospital because they think masks infringe on freedom. I want to yell, it’s not the mask it’s the Monster. The Monster took our freedom, our grandmothers, our grandfathers, our friends, our mothers, our fathers, our brothers, our sisters, our sons, our daughters. US. It took us.
It took us.
And now as I reflect on the journey, the Monster and how it has changed us, on the eve of a life giving vaccine, I am ashamed of my numbness. I see my colleagues stuck in the fight against the Monster, in the never ending hospital shift, the holding of hands as the life flitters away, comforting strangers when no one familiar is near, trying to fill the emptiness left by the Monster.
I sit in clinic seeing kids with symptoms. Families thankful for seeing me as other clinics and urgent cares turn them away. I see their fear in their eyes when I tell them their children may have COVID, that the Monster may be here. I struggle and am awkwardly apologetic after telling families of babies with low grade fevers and coughs that even though it *may* be teething or a cold, the Monster doesn’t care. It shows up as anything.
I am proud to help these families. They need reassurance, guidance, to feel grounded.
But that pride is smothered by the numbness.
It continues. I don’t know when it will end. I know the numbers - hundreds of thousands. And yet I am numb. There are murmurs of other feelings - rage, fear, and sometimes, if it’s a good day, I find just a bit of hope shining through the gray as I look to coming changes next year, as I look at my children smiling faces when I come home, when my dogs wag their tails so hard I think they may pee on the floor, the comfort provided by a warm hug from my equally exhausted and understanding wife and partner.
But for now the numbness continues like a warm blanket protecting my fragile soul, letting it drift asleep on a dreamless sedative.
And I’ll get up and do it again tomorrow.
See you there on the path.
- Story Slams
- Reflective Writing
Drs. Olson and Trappey have organized and facilitated 4 Story Slams, sponsored by our colleagues at MMCGME. These events have become a treasured opportunity for physician trainees and faculty across the Twin Cities to share stories of wisdom, bravery, insight and vulnerability. The need for this type of meaningful connection has been greatly enhanced by COVID-19. Read more about these important community-building gatherings.
Drs. Olson and Trappey and colleagues published a paper on the first MMCGME storytelling event in the Journal of Graduate Medical Education. They have also presented on this work at the Association of Pediatric Program Directors annual meeting and at the American Society for Bioethics and Humanities annual conference. In addition, they are engaged in research exploring the use of storytelling events as a tool for promoting resilience in graduate medical education trainees.
Drs. Olson and Trappey are leading ongoing reflective sessions within the medical school’s Becoming a Doctor course. These sessions, entitled “The Physiology of Reflection”, provide background data on the physiological and psychological benefits of reflective practice and provide participants with skills, time and space for reflection.
Drs. Olson and Trappey are leading the Storytelling Collaborative, monthly gatherings during which participants read and discuss recently published pieces of medical reflective writing and then provide time for the creation and sharing of personal reflection, and a reflective writing elective that gives an opportunity for medical students and residents who are interested in developing their creative and reflective writing skills. The elective provides dedicated time and guidance for the creation, editing, and submission of pieces with the goal of publication in medical or creative writing journals and anthologies.