Tearing down inequities in medicine

How do we treat the often forgotten, overlooked, or easily chastised members of our society in our healthcare system? The homeless, drug addicts, sex workers.. do they receive equal care?

I once walked into a code for a man whom we knew was going to die. This was a man with no family, no resources, and shackled with drug addiction. He had failed a few rounds of resuscitative medications and was still in asystole (flatlined). The nurse lifted the arm of the lifeless patient, and dropped it, as if to say “he’s gone, let’s call it”.  It left me in shock, horrified by what I considered a blatant disrespect for this man’s life. Some would argue that he had already thrown his life away by succumbing to drug addiction. In fact, one physician said just that. When I was later reflecting on this and stating what a sad case this was, he said, “No, it’s not. You live by the needle, you die by the needle.” So empty and so cynical. It added a little extra weight to my shoulders that night.

I understand why health care workers can become so cold about these things. They have seen people at their very worst, people who have experienced such pain and hardship that they seem to lack an ounce of humanity. How can we express compassion for people like this? How can we bridge what seems like such a vast divide and still give the very best of ourselves as health care providers?

What helps me banish away pre-judgments and treat each patient equally is starting out with a clean slate. I can’t help but think, this person was someone’s baby once. Strip away all the bad, the onion layers of hopelessness, darkness and despair.. And we are left with the core of a being, a hurt soul with little reserve to heal. For it is people like this who often need and deserve that extra bit of care and compassion even more than the rest. A little bit of grace can go a long way. 

It is not our job to judge others. It is our job to treat everyone with the utmost respect and  preserve their dignity in the hospital, a place where dignity is often stripped away in the storm of illness, weakness, and powerlessness.

This isn't life-altering stuff, people. It's walking into the room of the homeless man that's been admitted three times in the past month with just a shred of extra patience. A smile, even! Be a beacon of hope, the exception to the rule-- the person who actually steps up to the challenge with humanity. It isn't easy, but that's what makes it all the more important. Just as these patients might feel nourished by genuine kindness, we, too, gain perspective and deeper compassion by hearing their stories, acknowledging their struggles, and supporting their perseverance.

The "Art" of Obstetrics

As a resident constantly striving to do right by my patients as I learn the practice of medicine, I've recently become keenly aware of a major source of frustration in my training-- there is something so maddening about constantly being told different ways of practice. Never has this become more self-evident to me than on OB.

Now don't get me wrong, I absolutely love delivering babies. The joy! The beauty! The pride and excitement on parent's faces! I wouldn't trade it for the world. But with the good comes the bad. And working at a county hospital where extremely high-risk patients come through the doors every day, OB's learn to anticipate the absolute worst. And of course, that influences our practice.

Here's a little taste of the ping-pong of different approaches that I am confronted with every day...

lactivism

my name is julie, and i'm a lactivist.

lactivist  

-n. 

1. a portmanteau of "lactation" and "activism", used to describe a breastfeeding advocate.

why, you ask?

because i believe in the crazy idea that the breast is best for baby.* breastmilk is a free, eco-friendly food source for our babies. and hey, who doesn't want a boost for baby's immune system and innumerable other health benefits? not to mention that it is a sweet way to promote bonding and can be an incredibly empowering experience for moms. words can't express how wonderful it feels to help a new mom learn how to breastfeed her child!

i've taken it upon myself to learn more about the ins and outs of breastfeeding, so that i can really help parents get comfortable with the process, working through some of the common pitfalls, and feeling confident that they can provide this for their baby. in general, i think as physicians we don't do a great job with this. we simply don't talk to our patients about it enough. as health care providers, helping to maximize breastfeeding rates for our patients is a process with several points of intervention:

1. prenatal care (starting the conversation early during OB visits, breastfeeding classes, etc.)
2. labor & delivery, mother-baby hospital stay (kangaroo care, hands-on support with nursing)
3. postpartum care (close follow-up, support groups, newborn clinic visits)

so often on the mother-baby unit, my new moms are seriously deer-in-headlights, scrambling to nurse but unprepared, exhausted, and overwhelmed. overworked nurses, with varying levels of experience and enthusiasm about breastfeeding, are often shouldered with the bulk of responsibility of trying to play "catch-up" and help mothers get competent with breastfeeding in the hopes that they remain successful after discharge home. this isn't right, and this isn't enough.

the postpartum period is a very vulnerable time, and it is EVERYONE's job to help women feel supported in their breastfeeding efforts. family docs, ob/gyn's, pediatricians, nurses, lactation staff, and family/friends need to all be on board. we need to send a consistent message to mothers that they CAN do this, that they ARE enough and that they are doing an incredible job.

this deserves a whole other blogpost (stay tuned!), but full disclosure that i have taken it upon myself to reignite the lactivism flame at our hospital and people are, no pun intended, PUMPED. i sense a sea change, and amazing things are happening that are supporting a more breastfeeding-friendly culture and dare i say, possibly a baby-friendly hospital designation in the long-run?! a girl can dream, can't she?

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*as a lactivist, i want to make it clear that i am not a "bottle basher". every woman has the right to choose for herself whether she wants to breastfeed or bottle-feed her child, or both. i simply want to help encourage society to learn about the benefits of breastfeeding and to help women feel supported in their decision to nurse their children if they wish to do so.

"being with"

how many times a day do i tell my patients, 
take some slow, deep breaths.
as i listen to their lungs
and how many times do i tell myself to do the same?
not often. 
physician, heal thyself.

in true reflection, we embrace our existence.

i miss the therapeutic outlet of writing. i've been clammed up, probably from working so hard that the last thing i want to do is sit down and think through everything that's happened in the whirlwind of the last 5 months. also, with HIPAA rules i absolutely have to be very judicious about what i even process through about work on the public channels.

it's hard. which puts the onus on me to really take the time to debrief in-person on challenging or emotionally rending patient situations with my co-residents and faculty, so that it doesn't become a big ball of darkness and fury that continues to consolidate over my residency, leaving me drained and burned out. i refuse to lose my personhood! i will fight the tendency to minimize my feelings and experiences in an effort to be stoic and advance forward.

Senior Moments

Oh elderly folk, how I adore ye.  

A little background on my interest in senior citizens-- apart from some geriatric medicine experiences during inpatient and outpatient rotations, I had not had a chance to really spend some quality time with senior citizens in a few years, and I missed it.  Before med school, I served as a companion for hospice patients and learned a great deal about how  hospice programs do such excellent work in holistically taking care of the multifaceted needs of dying patients and those who love them.  I also had the chance to work with an awesome grassroots org, Bridging Communities, where I assessed the needs of at-risk Detroit elders and connected them with resources to ensure basic needs were met and support services in place, allowing clients to age with dignity, surrounded by supportive community.

Which brings me to my most recent experience, volunteering at Luther Manor, a skilled nursing facility right down the street from where I used to live.  There is something so excellent about being connected to someone familiar with a past you've never personally known - to hear their perspectives on how things have changed, or stayed the same.  To bask in nostalgia over a cup of ice cream with 50s tunes filling our ears.  To do a twirl and a dance step from decades past.  With every set of fingernails I painted, every family photo album we paged through, each row of knitting/pearling that we took turns on, something special happened.  These simple activities allowed me to see a light in each resident I had the chance to get to know - their passions, values, heartaches...

It was not always fun and games.  No matter how excellent the care a facility offers, I expect that there is always going to be some element of suffering that permeates any "old folks' home".  Common themes that I noticed were expressing frustration of overwhelming physical ailments, reflecting on the pain of injustices endured from their past, and mourning lost independence in the face of isolation.  I think it's easy for younger, able-bodied people to think, it's for your own good that you're here; it's not safe for you to be home alone.  But we don't often acknowledge the trauma of being forced to leave one’s home due to inability to live independently, and having to live in an unfamiliar environment against their will.  It was good therapeutic practice to explore some of these feelings with residents, and to remind myself that this is a not uncommon sentiment that I should continue to be aware of as I care for nursing home residents in the future.  

Soup Kitchen Insights

I wanted to highlight another pretty great organization I volunteered with in Saginaw, the East Side Soup Kitchen.  This is a charitable organization that has been around for almost 35 years.  We had originally learned about ESSK through our Leadership in Medicine for the Underserved (LMU) program, but unfortunately I hadn't had a chance to work closely with them until after graduation because they operate a full-service kitchen Monday-Friday (a great service to its attendees, but not an ideal schedule for a busy med student!).  In addition to the daily lunches, ESSK also provides bag lunches to latch-key programs and hosts periodic optical & medical volunteers.