Cleveland Clinic Lerner College of Medicine 2016 of Case Western Reserve University Table of Contents Dean’s Introduction 3 Touching and Examining 23 James B. Young, MD Kaitlin Keenan, CCLCM Executive Dean of Cleveland Clinic Lerner College of Medicine This White Coat I Wear 24 Editor’s Introduction 4 Elizabeth Shay, CCLCM No Longer Broken 5 Louisiana Swamp: Don’t get lost in Appledene Osbourne, CCLCM a Louisiana swamp 25 Shaker Lakes: Fall season at Shaker Lakes 6 Datta Sudarshana, CCLCM Datta Sudarshana, CCLCM Words 26 A Cleveland Story 7 Radhika Rastogi, CCLCM Rebecca Achey, CCLCM Skipping Stones 27 A Job 8 Mike LaBarbera, CCLCM Yuanjia Zhu, CCLCM Details You Won’t Find in An Operative Report 28 Moon My Lovely Friend 9 Jessica Jones, CCLCM Datta Sudarshana, CCLCM Trapezing 29 City at Night 9 Katie Daley Rachel Elkin, CCLCM Impersonations 30 My father’s doctors 10 Katie Daley Kathleen Quinn, MD, CCLCM Faculty Hey Doc 31 Nymphaeaceae 11 Katie Daley Mike LaBarbera, CCLCM Mary Katie Gets Diagnosed with Cancer 32 Word Medicine 12 Katie Daley Jordan Gales, CCLCM Flip It 33 To the one that gives me strength 13 Stephen Raithel, CCLCM Nemat Sharaf, CCLCM Shaker Fall Trees: Sunlight through fall trees 34 Waiting 13 Datta Sudarshana, CCLCM Heart Nemat Sharaf, CCLCM Seizure: A Differential Diagnosis 35 Anne Runkle | CCLCM Class of 2017 Yellow Eyes to Remember Me 14 Jessica Jones, CCLCM Daniel Firl, CCLCM Waves 36 The Sacredness of Standing Shoulder Nemat Sharaf, CCLCM to Shoulder with Death 15 Soccer as Self-flagellation? 37 Brian A. Shields, M. Div., Staff Chaplain Daniel Sexton, CCLCM What is the color of your faith? 15 Why? 38 Radhika Rastogi, CCLCM Elizabeth Shay, CCLCM Editors-in-Chief: Josephine Volovetz and Stephen Raithel On the Day We Met 16 On Approach 39 Kate Ituarte, CCLCM Stuart Zeltzer, CCLCM Issue No 6 Co-Editors: Rachel Elkin, Rebecca Achey, Karen Fang, Alexander Chaitoff, Tulsi Patel, 2016 Constructs 17 Our Cages 40 Datta Sudarshana, Beau Hilton, Kaitlin Keenan, Christina Snider, Emily Zhang Bob Sun, CCLCM Joseph Abraham, CCLCM Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Chateaubriand Shenanigans 18 Losing the Love of Your Life 41 James Witten, CCLCM Stethos Logo designed by Medrano Design (www.medranodesign.com) Brian A. Shields, M. Div., Staff Chaplain Context 19 Layers 42 Kate Ituarte, CCLCM Radhika Rastogi, CCLCM All copyrights for individual articles revert to the appropriate authors. The Good Teacher 20 Things that enter by way of silence (after Mark Strand) 43 Richard A. Prayson, MD, MEd Jessica Jones, CCLCM The opinions expressed within this journal are solely those of the authors, and do not necessarily reflect the views A Babe Once More 21 On Kindness and Compassion 44 of the Cleveland Clinic Lerner College of Medicine. Elizabeth Shay, CCLCM Johanna Goldfarb, MD, CCLCM Faculty New Growth 22 Imperial Palace 46 Mike LaBarbera, CCLCM Front Cover Artwork Michael LaBarbera, CCLCM Integration Josephine Volovetz | CCLCM, Class of 2019 INTRODUCTION | Dean’s INTRODUCTION | Editor’s The cover art for this year features a skeleton hand engaged in to the sixth issue of It’s Time for a Time Out Welcome writing—it acknowledges our anatomical and medical expertise while Stethos, the medical humanities James B. Young, M.D. reminding us that it is the human stories in medicine which are so Professor of Medicine & Executive Dean journal of the Cleveland Clinic Lerner critical to our work. In the words of the famous doctor and poet Cleveland Clinic Lerner College of Medicine of Case Western Reserve University College of Medicine. William Carlos Williams, “But the haunted news I get from some obscure patient’s eyes is not trivial. It is profound.” This year’s issue We have reluctantly admitted medical professional burnout we So it is time for a Time Out. is filled with such profound stories from our patients, stories haunted at that mistakes made by our are hearing so much about? It And to that point, here comes times, but also joyous, both tragic and triumphant. profession are killing us – or is a real problem, but it always STETHOS 6th Edition - 2016. rather, our patients. It has been has been present. It seems, Once again ably assembled Many of the stories this year focused on a sense of place: a patient suggested that hospital errors, however, the difficulty is getting by CCLCM Editors-in-Chief(s) with a life story inextricably rooted in Cleveland, another story about for example, are the third leading worse. Some reports suggest Josephine Volovetz and Stephen the ability of place to assume the power of metaphor and transport us cause of death in the United that nearly half of physician Raithel, with co-Editors Elkin, away from the mundane, and other reflections about what it means States with hospital safety scores caregivers have symptoms Achey, Fang, Chaitoff, Patel, to devote ourselves to places of healing. Many of the photographs in only slowly improving. One suggesting burnout, which is Sudarshana, Hilton, Keenan, this year’s issue show us beauty can be found in places both near and initiative to address the problem significantly higher than that Snider, and Zhang. The far, providing a reminder that profundity lies in the particulars of color, is mandating a “Time Out” be noted in the general population. extraordinary photography, texture, shadow, light, which can also be said for the details of our done before any interventional There was seemingly more poetry, reflective writing, and patients’ stories. procedure is begun. Labeled the burnout reported by physicians narrative stories re-energize me This year’s “A Different View” section features several pieces by Universal Protocol the procedure who are “first responders” – that and help with my own personal Katie Daley, a Cleveland based poet who reflects in her writings was initially focused on surgical is, those in primary care and burnout. The contributions tell about the personal nature of illness of body and mind. Her writing is suites in order to prevent emergency medicine settings. me great things about what compassionate and insightful as it focuses on the human narrative that wrong site surgery, which is an Of course there is a differential we do and the resilience of our must remain central to our medical encounters. egregious error that can have degree of resilience in any own caregiving team. There is significant consequences. When population and so it is with bountiful joy in my heart when I We hope you enjoy this issue of Stethos. It was our great pleasure done correctly, I believe it is an healthcare professionals. How look at what has been done, once to review the works, and as always, we look forward to your future effective preventive medicine might we address the challenge again, with STETHOS. Please submissions! practice. The concept is to step and increase our own resilience? enjoy it, swallow it, and help back and have the team (led by I believe that embracing the yourself heal with it. Take a time Warm regards, the captain of the ship which is arts and humanities broadly out. Reflect on your part in this The Editors usually the surgeon in the case and individually will help us complex system – what it means of the operating room) go over understand the nuances of to you, your patients, your family, all particulars of the procedure professional challenge and friends and loved ones. planned for any patient. purpose. Yes, it is a hard and …and consider contributing to frustrating profession at times. So what might time outs have to next year’s edition. Help yourself, But the rewards far outweigh any do with us outside of the hospital me and the team! pain caused by the challenges. or clinic? And what about 3 4 No Longer Broken Appledene Osbourne, CCLCM | Class of 2018 We want to be physicians that revealed the renal mass, arm immobilized while working because we want to heal the a nephrectomy was thought to to control her pain and other sick. For me, this meant treating be curative. But two years later, symptoms that were increasingly illness and promoting health. a surveillance scan and biopsy limiting her ability to perceive Furthermore, we all want to revealed disease recurrence. At her own remaining existence. relieve “pain and suffering,” and this point the destiny of her life She needed pain medications in many of us, including myself, as dictated by cancer became quantities sufficient enough to would like to believe that if we inescapable. She had metastatic numb her discomfort yet leave treat the pain, then we treat disease and had to come to terms her with enough mental facility the suffering. Spending time with the fact that this is how to get through her days. She with patients at the end of life her life would end. Still, there needed other agents to treat the has redefined my perspective. was more to be done. Novel nausea that was brought on both I have come to appreciate the agents could avert her fate for by her disease and the very pain less frequently mentioned role some time – the masses shrank, medications we gave. There of the physician – that is, to but side effects followed. The was no simple recipe for any of relieve suffering. Very often, masses inevitably regrew and this. Her medications had to this takes us to the bedside of a the side effects worsened. She be constantly adjusted and our dying patient where delivering told me no one wanted to give treatment plan further refined to care can become complicated, up. She was switched to a then reflect new realities.