The Pulse Summer 2022

SUMMER 2022

Memories and Milestones A MOTHER’S LEGACY PG 4

HAPPY NEW YEAR!!

PG 6

WOMEN’S COMMITTEE UPDATE PG 9

WHAT WOULD YOU DO? PG 10

s a g e V s a L Scientific As

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The Pulse VOLUME XLX No. 3

EDITORIAL STAFF Timothy Cheslock, DO, FACOEP, Editor Wayne Jones, DO, FACOEP-D, Assistant Editor Tanner Gronowski, DO, Associate Editor John C. Prestosh, DO, FACOEP-D Christine F. Giesa, DO, FACOEP-D Meagan Comerford, Director of Communications EDITORIAL COMMITTEE Timothy Cheslock, DO, FACOEP, Chair Christine Giesa, DO, FACOEP-D

The Pulse is a copyrighted quarterly publication distributed at no cost by ACOEP to its Members, Colleges of Osteopathic Medicine, sponsors, exhibitors, and liaison associations recognized by the national offices of ACOEP. The Pulse and ACOEP accept no responsibility for the statements made by authors, contributors, and/ or advertisers in this publication; nor do they accept responsibility for consequences or response to an advertisement. All articles and artwork remain the property of The Pulse and will not be returned.

TABLE OF CONTENTS 4

PRESIDENT’S REPORT G. Joseph Beirne, DO, FACOEP-D

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THE ON-DECK CIRCLE Timothy Cheslock, DO, FACOEP

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EXECUTIVE DIRECTOR’S DESK Katie Geraghty

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WOMEN’S COMMITTEE UPDATE Nicole Vigh, DO, MPH

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WHAT WOULD YOU DO? ETHICS IN EMERGENCY MEDICINE Bernard Heilicser, DO, MS, FACEP, FACOEP-D

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Deadlines for the submission of articles are as follows: January issue due date is November 15; April issue due date is February 15; July issue due date is May 15; October issue due date is August 15. Advertisement due dates can be found by downloading ACOEP's media kit at www.acoep.org/advertising. ACOEP and the Editorial Board of The Pulse reserve the right to decline advertising and articles for any issue. ©ACOEP 2022 – All rights reserved. Articles may not be reproduced without the expressed, written approval of ACOEP and the author.

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PRESIDENT’S REPORT

G. Joseph Beirne, DO, FACOEP-D

A MOTHER’S LEGACY

H

appy summer to all! I hope all of you are enjoying the warm weather and spending time with your families. Summer always brings a sense of joy to me, as nature is in full bloom and shows us why life is so special.

I chose the title of this article, because of recent events that transpired in my life. My mother, Christine Beirne, died on June 19, 2022. She had her original diagnosis of breast cancer in 1996, underwent lumpectomy and had chemo and radiation. She had a recurrence in 2004 in the opposite breast and had another lumpectomy and radiation.

In 2009, another recurrence. At that point, mom made the decision to have a bilateral mastectomy. Then in 2015, she experienced another recurrence at the site of the breast reconstruction.

She had surgery and debridement of this area and recovered again. In May 2021, she had pneumonia and was not recovering as expected. My suspicion this was not just pneumonia was confirmed. She had a malignant pleural effusion in the right lung. After thoracentesis, thoracoscopy and talc pleurodesis, she improved and began taking Ibrance.

In July 2021, she contracted COVID and was hospitalized twice.

She then developed a pulmonary embolism in September 2021. From the time she contracted COVID, she was oxygen-dependent. By Easter 2022, her oxygen requirement had increased, and she developed

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EVERY DAY, DO ONE NICE THING FOR ONE PERSON, MAKE A DIFFERENCE IN THAT PERSON’S LIFE.” long-hauler COVID symptoms. She entered the hospital on May 3, had thoracentesis and bronchoscopy. She then was in a long-term acute care facility for about 10 days. On June 15, her pulmonologist called me and told me there was no other therapy they could offer her. I knew the end was coming, but nothing ever prepares you to hear that. She went into hospice on June 16 and died peacefully on June 19 with our family at her side.

My dad asked my brother and I to speak at her funeral. My daughter, Danielle, spoke first and read a poem she wrote for my mom. It was a beautiful way for her to honor her memory. My brother spoke, then it was my turn. As I stood at the lectern in church, I said “how do you summarize a person’s life in 10-15 minutes? How do you capture the quintessential moments that defined who they are, how they lived, their successes, joys, sorrows?” I shared stories of my mom’s life that brought smiles, laughter and tears. As I ended, I shared one very special story. In 2001, when I graduated from my EM

residency, my family and I were at my parents’ house for a family gathering, and my mom pulled me aside and said, “dad and I are so proud of you for what you accomplished. I want you to take this one pearl of wisdom from me. Every day, do one nice thing for one person, make a difference in that person’s life.” I told everyone in the church, “many people ask me over the years, how can I come back to this job, day after day, in the ER with all of the pain, suffering and death that we see.” And what I tell everyone is the same: “the juice that keeps me coming back to the job is the sense of pride and satisfaction that at the end of the shift, I know I made a difference for one person—whether taking an extra 5 minutes to answer all of their questions, getting them a warm blanket, or just smiling and holding their hand and telling them things will be ok.” When I looked out over the crowd in church, I saw heads shaking, faces smiling—they knew this was my mom’s influence on my life. She created a legacy that lives on in each patient that I see every day. Her love,

spirit, will, determination and ability to always see good in everything is a living legacy I carry forward and always will. It has made me a better physician, husband, father and son. I only hope I can leave the same legacy for my daughter and that it measures

up to what my mother left me.

Our parents brought us into the world and provided for us, cared for us and taught us how to live a life of service and responsibility. When they need you the most, do the same for them that they did for you. It will never

be enough, but it is one way to say thank you and honor those who gave us life and taught us to be who we are today.

In loving memory of Christine Y. Beirne, 12/14/42-06/19/22 –•–

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THE ON-DECK CIRCLE

Tim Cheslock, DO, FACOEP

HAPPY NEW YEAR!!

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ou may be wondering just a bit about the title of my article.

It’s the middle of July in the heat of Summer. For so many though in Emergency Medicine, July 1 is the beginning of a new year. I wanted to appropriately acknowledge so many on their achievements and transitions.

First to those that have recently completed their residency training and are embarking on their first shifts as a new attending physician, welcome to the first day of the rest of your career! All the hard work and long hours have now paid off! You have reached that ever elusive goal of becoming a full-fledged EM physician.

ACOEP is excited to celebrate your achievements, and everyone here at the college cannot wait to see what you will accomplish professionally and personally as you take this next huge step. ACOEP will continue to be here for you to meet all your needs as you prepare for boards, begin your CME licensing cycle and seek to continue your professional development. We need motivated physicians to take part in committees, leadership and other projects to make the college successful into the future. I hope I can count on you to be there for the college. I pledge we will be there for you in return!

To all our residents in the GME cycle, whether you are a first-year intern or resident, a second year or embarking on that last year before graduation – ACOEP is here to help make this new academic year a successful one. There are so many opportunities to take part in this year

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ACOEP IS A CLOSE-KNIT GROUP. WE TAKE PRIDE IN OUR MEMBERS AND OUR COLLECTIVE ACCOMPLISHMENTS. WE SUPPORT EACH OTHER AND SHARE A COMMON THREAD THAT MAKES US AKIN TO A LARGE EXTENDED FAMILY.” to further your knowledge and show off your research. Take advantage of as much as possible to make this year the best it can be. I invite all of you to take part in our upcoming Scientific Assembly in Las Vegas. There will be academic competitions, oral abstracts and the CPC sponsored by FOEM. Show off what you have been doing in the academic realm. In addition, Las Vegas provides a great opportunity to let loose and have some fun as well.

I look forward to seeing many of you there!

Finally, to our new medical students aspiring to become the future of Emergency Medicine.

Welcome to ACOEP. Take a look at all we have to offer. There are many activities throughout the year both online and in person that will enhance your education clinically, but will also help prepare you for clinical rotations, clerkships, residency applications and interviews. The list goes on. ACOEP is here for you! Don’t be afraid to reach out and say hello. The more you put into your efforts, the more you will be rewarded down the road. It is not a

race but a marathon. Let us help you prepare for the long haul. Together we can get you to your goal!

Many of our members are far removed from the academic cycle, but still have had personal transitions in jobs this year. There have been any number of personal transitions as well. Children graduating from high school or college, moves to new locations, weddings and births. We all have things to celebrate. One of the greatest parts of being in ACOEP is the relationships that I have come to develop with so many of you through the years. Whether it is connecting in person at our events or seeing you on Facebook or Instagram celebrating, I feel very grateful to be a part of your world. ACOEP is a close-knit group.

We take pride in our members and our collective accomplishments.

We support each other and share a common thread that makes us akin to a large extended family. Thanks to all of you for continuing your journey with ACOEP. Let’s continue to do great things! –•–

EXECUTIVE DIRECTOR’S DESK

Katie Geraghty Executive Director

ACOEP STRATEGIC GOALS DEVELOPED FOR 2025 AND BEYOND

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he ACOEP Board of Directors met on Saturday, April 9, 2022, in Ft. Lauderdale, Florida, to establish a Strategic Plan for 2022-2025, and subsequently on May 23, 2022, to finalize the discussion. The strategic plan will focus on two major objectives: (1) membership growth and (2) educational growth (both in-person events and expansion of the digital classroom, which led to the CME Your Way marketing campaign). The ACOEP Board is currently reviewing the priorities and finalizing tactics for the committees and staff to execute.

Do you want to add your voice and experience to help grow the ACOEP family? Please reach out to me if you would like to join the new Membership Marketing Committee or CME Committee. The Membership Marketing Committee’s main tactics will include evaluating ACOEP’s current dues cycle, membership categories, and benefits; tracking membership statistics and KPIs; developing and evaluating membership surveys; and working with staff on renewal and recruitment campaigns. The CME Committee is also welcoming members to source and secure high-quality speakers who will enhance all ACOEP educational events.

CME Your Way

Thank you for your support as an ACOEP member – if you want to get involved as a committee member or a micro-volunteer opportunity, please reach out to me: kgeraghty@acoep.org. If you have a suggestion on additional membership benefits, please also reach out; I love hearing from members on how we can make your membership even more beneficial. –•– Sincerely, Katie Geraghty ACOEP Executive Director kgeraghty@acoep.org

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WOMEN’S COMMITTEE UPDATE

By Nicole Vigh, DO, MPH

I

t was so great to finally be back at an in-person conference for our ACOEP Spring Seminar in the beautiful Fort Lauderdale, Florida!

As always, the Women’s Committee was thrilled to have such a great turnout for all of our events! We were honored to have welcomed a new speaker to the ACOEP conference, Dr. Alin Gragossian, DO, MPH, a critical care fellow post emergency medicine residency, who received a heart transplant in 2019 during her EM residency when she was unexpectedly diagnosed with a familial dilated cardiomyopathy which was worsened after she contracted a virus in 2018. She has a podcast and blog, https://www.achangeofhe.art. Her story is truly inspiring and definitely worth checking out.

We are now in the process of planning for the ACOEP Fall Scientific Assembly which will take place October 24-28 in Las Vegas, Nevada.

We are currently recruiting speakers for our women’s track lecture series.

We will again be hosting our semiannual Women’s Committee luncheon where we will honor our 2022 Willoughby Award winner.

We are excited to announce a new position within our committee, the Resident and Student Representative.

Congratulations to student doctor Kailey Goebel who was elected to this position. Kailey is currently a second-year medical student at the University of New England College of Osteopathic Medicine. We are excited

to work with her in recruiting more student and resident members.

In honor of National Women Physicians Day, February 3, we organized a weeklong social media blast on our ACOEP Committee for Women in Emergency Medicine Facebook page in order to honor each of our past Willoughby award winners as well as each our officers. Each woman was highlighted with a brief biography which recognized all of their incredible accomplishments. Our officers and members have achieved some amazing accomplishments, serving as program directors, core faculty at their institutions, professors at their affiliated medical schools, chief residents and moms! We are proud to honor each of our Willoughby award winners and our officers each and every day.

had such a great turnout. Please remember to check out our Facebook page to stay informed regarding future events. For a short time only, you can purchase ACOEP Women’s Committee merchandise, please see our committee page at https://acoep. org/acoeps-committee-womenemergency-medicine. All proceeds go to funding our committee’s philanthropic efforts. We look forward to seeing you all at ACOEP Fall Scientific Assembly October 24-28 in Las Vegas, Nevada! –•–

We thank all those who participated in the ACOEP Spring Seminar; we are so excited to have

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Bernard Heilicser, DO, MS, FACEP, FACOEP-D

What Would You Do? Ethics in Emergency Medicine

In this issue of The Pulse, we will review the case submitted by George Miller, DO, in the Spring 2022 issue.

The patient is a 16-year-old male brought to the ED by EMS accompanied by his mother. The patient was in respiratory distress, tachycardic, tachypneic and hypotensive. He was conversive and demonstrated decision-making capacity.

Work-up revealed a Hgb of 1.5 and a Blast Crisis.

The patient refused blood on religious grounds. When questioned what religion, he stated his church of which he was the pastor, and his was the only congregation. His mother concurred and stated he was also the “man of the house”, with the father having left them during his infancy.

Should we honor his wishes and withhold transfusion, or transfuse? And if, if so, under what premise?

This presents a profound dilemma. Does a 16 yearold have the autonomous right to make his own decision to refuse blood, and likely die? Furthermore, the pretense for this decision is religious, based on a self-created and shepherded sect.

We received the following response from Cathleen McGovern, DO: Another interesting case!

Under the concept of the Mature Minor (which is recognized in all States), the patient could conceivably make this decision. Especially, with the acknowledged background. However, with death of a 16 year-old as an outcome, one would be wise to pursue legal determination.

With time not available, what option is present?

Fortunately, the patient consented to needed intubation.

At that point, his mother was approached and agreed to blood transfusion. Was this ethical?

WHAT HAPPENED? The patient was subsequently transferred to a tertiary medical center, accepted a bone marrow biopsy and comprehensive workup and treatment, and had a good outcome.

Did we violate the beliefs of a 16 year-old? Perhaps.

Does a 16 year-old fully understand the reality of their decision? Maybe. Did the patient eventually agree to continued medical care and ultimately survive? Yes.

WHAT WOULD YOU HAVE DONE? Please visit the ACOEP DocMatter community forum and share your thoughts on this case.

I don’t feel we can consider the 16 year-old an emancipated minor. He still lives with his mother (and gets some level of support from her??). Even though there is no father in the picture, it does not automatically emancipate the minor.

I would ask the mother for direction, hoping she would act in the best interest of her child and give consent for the transfusion.

We thank Dr. McGovern for her thoughts and insight.

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If you have any cases that you would like to present or be reviewed in The Pulse, please email them to us at mcomerford@acoep.org.

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