Silver Linings
Vincent Pellegrini, MD
SilverLinings An Arts and Literary Journal ISSUE ONE, VOLUME ONE 2022-23 Reading Hospital – Tower Health All content is the property of each respective author/artist. No part of this publication may be reproduced without the permission of the author/artist. FRONT COVER SWIRL
I am fascinated by flowing water. I capture it over and over again as I try to achieve the image that I have envisioned. I want to show the essence of movement with the blurring effect of a slow shutter speed or by a composite of multiple images to allow the viewer of my work to see what the eye cannot. This particular image was shot in the winter on the Wyomissing Creek near Lauers Lane.
3 Reflections on the name “Silver Linings” ........ 4 From the Editor .............................................. 6 Why a Medical Humanities curriculum in graduate medical education? … ................. 9 Through the Gray .......................................... 12 Floating Jewels .............................................. 15 Blooming Wildflowers ................................... 17 100s of Lights ................................................ 18 Futures ........................................................... 21 Dawn ............................................................. 24 Going Home .................................................. 26 Untitled .......................................................... 28 On.................................................................. 30 Photomicrography ......................................... 32 D.O.C.T.O.R................................................... 38 Respiration..................................................... 39 The Iron Women ............................................ 41 The Message ................................................. 44 Majestic ......................................................... 46 Endless .......................................................... 48 A Tale of Life, Reading .................................. 50 Braving Through ............................................ 52 Sounds of the Season .................................... 53 Legends of the Fall ........................................ 54 Loxley’s Lullaby .............................................. 55 “Coffee, please?” .......................................... 56 Splatter Leaves .............................................. 58 Pride .............................................................. 59 Disco Prism .................................................... 59 Escargotcha ................................................... 60 Farenheights .................................................. 61 Berchtesgaden, Germany .............................. 62 Merzouga, Morocco ...................................... 63 Editorial Team ................................................ 64 Table of Contents
Reflections on the name “Silver Linings”
These past few years may have felt like nothing but a bad situation – an unprecedented pandemic, watching patients die in numbers most of us have never experienced before, lost jobs and political unrest. Many of us have felt a constant state of dread or anxiety and some of our colleagues even left the field. However, there have been some positive outcomes. Technology allowed us to communicate with friends, family, and colleagues instantaneously. The opportunity to work from home has allowed some people to spend more time with their loved ones and many have formed deeper connections than ever before. We have witnessed the development of new pharmacologic interventions at record speed; several people have expressed a new-found appreciation for healthcare workers and hopefully, we all have found a new appreciation for ourselves as human Inbeings.naming this journal, we initially sought a name that would connect our readers to the people of Reading and its industrial history. Reading is most famously known for the Reading Railroad, thanks to Monopoly, but it also has a history rich in industries, including textiles, clothing, and much more.
Caitlyn Moss, MD
Moss, MD, for the editorial team
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While the name Silver Linings may not suggest a direct reference to the industries, we felt it was appropriate, as it spoke to the potential for finding the good in difficult situations. This theme is relevant, whether we are referring to the resilience of the historical figures that lived in this region, our current situation as we emerge from the pandemic, or the hidden gems that lie within the stories that will be shared in this Ourjournal.relationships with people are truly our most valuable assets and we are deeply grateful for all the hardworking people in our community. The opportunity to appreciate and support each other in new ways has truly been a Silver Lining in these challenging Caitlyntimes.
Director of Continuing Medical Education, Department of Medicine Director of Curricular Development, Internal Medicine Residency Reading Hospital – Tower Health Assistant Professor of Medicine, Drexel University College of Medicine
From the Editor
Olapeju Simoyan, MD, MPH, BDS, FAAFP, FASAM
When I moved to Berks County in early 2020, as the pandemic was rearing its ugly face, I had no idea what lay ahead. Becoming the editor of a new arts and literary journal was certainly not on my “to do” list. If anything, it was on my “been there, done that” list! As I settled into my new role and made connections with the larger medical community, I met several wonderful colleagues who welcomed me into their circles. One of them was Lucy Cairns, MD an ophthalmologist who at the time was the editor for the Berks County Medical Society’s quarterly publication, Medical Record. After hearing about some of my professional interests, she informed me that a retired OB/GYN physician was in the process of trying to start a medical humanities curriculum for the medical residents and subsequently introduced me to Dr. Peter Schwartz. The rest, as they say, is history. Dr. Schwartz provides more details about the process in his thoughtful essay about the need for a medical humanities curriculum in graduate medical education. Dr. Caitlyn Moss, who is now spearheading the curriculum has also written eloquently about how we arrived at the name Silver Linings. Alexandra Short, the Director of Library Services, did an awesome job of keeping things organized as we received and reviewed submissions.
Olapeju Simoyan, MD, MPH, BDS, FAAFP, FASAM Editor in ExecutiveChiefDirector of Research, Fran and Doug Tieman Center for Research/Caron Treatment Centers Director of Scholarly Activity, Caron/Reading Hospital Addiction Medicine Fellowship Professor, Department of Psychiatry, Drexel University College of Medicine
- Hippocrates
On behalf of the editorial team, I invite you to join us as we explore the connections between healthcare and the arts in this very first issue of Silver Linings. We hope you will enjoy reading it as much as we enjoyed the process of bringing it to life, and that you will share it with your friends and loved ones.
This first issue includes heartfelt reflections on a range of topics, including our collective experiences with the COVID - 19 pandemic, loss and reminders of those simple but meaningful gestures that can make a lasting impact on the patients we care for. The stunning pieces of art that are included here are only a sample of the artistic talent that lies within our medical community, proof that indeed, the left and right cerebral hemispheres actually do work together! We hope that you will be encouraged to find the silver linings in life’s challenging situations, which can indeed be transformative. Just think about the caterpillar who didn’t know it was destined to be a beautiful butterfly!
“Wherever the art of medicine is loved, there is also a love of humanity.”
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Why a AmedicalcurriculumHumanitiesMedicalingraduateeducation?fewpersonalthoughts…
After residency at the Yale New Haven Hospital, I was in the private practice of obstetrics and gynecology (OB/GYN) in Northampton, Massachusetts for 13 years. I really enjoyed working with our patients, staff, and my three partners. We paid our staff at the top of the city’s scale, accepted Medicaid, and we (physicians) were never aware of our patients’ insurance. We personally answered all messages before we went home at night. If we referred a patient to the emergency room, we always went there to see her personally. It was a great practice! We were adequately compensated, though in the lower half for our specialty in the state, but we got great satisfaction out of our work and the appreciation our patients showered upon us. The practice was very popular, caring for about 80% of the women in the city. I am still close friends with my partners. I loved my practice, but I also appreciated that life was finite and wanted to have professional experiences in more than one setting. In 1987, I was recruited to the OB/GYN department at Reading Hospital, as its first full-time physician, Chair and Program Director of the 50- year- old residency program. I welcomed Peter A. Schwartz M.D.
Withrelationships.instantaccess to databases, the internet and the advent of augmented intelligence, there is less of a need to spend time memorizing inordinate amounts of material. Perhaps we can rescue some of that time from the graduate medical education curriculum to enhance humanism in medicine. With that in mind and after some research, I created a list of topics that might be valuable in a Medical Humanities curriculum. It was easy to create excitement for the concept. Our Medical Humanities Curriculum Committee fine-tuned the list of topics to include medical ethics, professionalism, communication skills, personal development, narrative medicine, diversity, equity and inclusion, spirituality and medicine, and the history of medicine.
the opportunity for teaching and administrative work, while establishing a small clinical practice. As Department Chair and Residency Program Director, I developed an interest in medical ethics, chairing Reading Hospital’s Ethics Committee for approximately 20 years. I also chaired the American College of OB/GYN ‘s Committee on Ethics, and now chair the American Medical Association ‘s Council on Ethical and Judicial Affairs. I have loved my career! So, how do I understand my colleagues who talk about being burned out? How do I understand my colleagues who talk about the need for work-life balance when, to me, they’ve always been inseparable? I conclude that “burn out” is the result of the loss of joy in the practice of medicine, the joy of helping people with illness or in pain, the joy of working with our colleagues in medical teams. I believe the need for “work-life” balance becomes a need when work is not joyful, but other aspects of “life” are. I recognized that many medical schools had begun to teach Medical Humanities. I also recognized that although medical students may experience significant interpersonal challenges, they generally don’t appreciate the tensions that have swept much of the joy out of practicing medicine. Those challenges begin in residency and continue on in practice. So, if we can understand the problem as diminished joy from the human relationships of medical practice, perhaps the solution, or at least an inroad into the solution, is to enhance those
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The creation of a medical arts journal to showcase the artistic talent of the people with whom we work was discussed with Dr. Olapeju Simoyan, who had been the Editor in Chief of a similar journal at another institution. The goal of Silver Linings is to bring the joy of the arts back into the lives of so many of us whose commitment to science has essentially divorced the arts from our lives. The Medical Humanities curriculum brings learners from different disciplines together to enhance collegiality and will utilize a variety of educational modalities. We are dedicated to making the curriculum one of active participation and experiential learning. We are well on our way! We have had five presentations and experiences as of this writing, and the publication of this journal marks another milestone! Many more medical humanities experiences are planned for the second year as the leadership has been transferred to Caitlyn Moss, M.D, the director of curricular development for Reading Hospital’s internal medicine residency program. The members of our committee have been enriched in preparing the curriculum and we anticipate our learners will experience careerenhancing enrichment.
The success of this initiative will be a major achievement of my Petercareer.A.Schwartz M.D. Chair Emeritus, Dept of OB/GYN, Reading Hospital – Tower Health Chair, American Medical Association (AMA) Council on ethical and judicial affairs
When the pandemic abruptly entered our lives in early 2020, I felt moderate concern. I thought surely, as a global community we would unite and contain this virus in a short amount of time – 3 or 4 months at the most, right? It didn’t take long to realize the naivety of my thinking. By late summer of 2020, life was an isolating existence. Even the simplest of things in life were off limits, leaving each day feeling like everything in it had faded to gray. This painting of small, gray-shaded flowers represents all of us, individually, yet collectively being impacted by the pandemic. Their basic structure insinuates the simplest of pleasures in life so easily taken for granted, and the absence of color represents the wash of despair felt by so many during this time. With the slow return towards “normal”, we began to shed despair and find enjoyment in life again. The random punctuations of faint pink symbolize this slow return, but remain delicate in color to reflect on the lives lost along the way.
THROUGH THE GRAY
Laura Kane, MSN, RN-BC
Reading Hospital – Tower Health
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FLOATING JEWELS
After the tight restrictions for travel relaxed, one of the first things I was able to do was visit one of my grown children out of state. While there, we visited the gorgeous Duke Gardens. There was so much “blooming life” to take in, but I was particularly mesmerized by the Koi fish in one of the feature ponds. Their fluid movements and translucent colors catching the sunlight made me think of them as floating jewels. As I sat there, soaking up the sun and watching the Koi swim, my son put his arm around my shoulders. I was profoundly aware that suddenly, everything felt…normal. That was the first time I felt untethered from the pandemic since it all began, and I’ll never forget how it changed my outlook. The fluid motion of those floating jewels, and that well-placed hug, stopped me long enough to be in the moment of a perfect, delightful, normal day.
Laura Kane, MSN, RN-BC
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BLOOMING WILDFLOWERS
This painting represents the return to a new normal as the pandemic slowly simmers to a calmer state. With this new normal, “rules” and “guidelines” have become as wild and random as the conspiracy theories and public opinions of the past two years. A field of random wildflowers is how I think of this time we are in; a very random, wild, varied, and emotionally colored world.
Laura Kane, MSN, RN-BC
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100s of Lights for the 100s of Deaths, 100s of Survivors, and 100s of Heroes of COVID! Mark B. Woodland, MS, MD, FACOG Chair OB/GYN, Reading Hospital – Tower Health, Academic Chair OB/GYN, Drexel University College of Medicine Chair, PA State Board of Medicine Good morning, We are your nurses, your facility persons, your lab technicians, your doctors, your pharmacists, your food service persons, your hospital administrators, your spiritual leaders. We will take care of you. We are sorry that you cannot come with them, but we will take care of them. There are so many people, but we will be right back. We need supplies; Wear your PPE! We need help in this room, they are not going to make it. We need to call their family. We are so sorry; we did everything we could for them. We were with them when they passed.
19 Reading Hospital’s Spring 2021 COVID Candlelight Memorial Pause! Good evening, We are your nurses, your facility persons, your lab technicians, your doctors, your pharmacists, your food service persons, your hospital administrators, your spiritual leaders. We will take care of you. Repeat! Written in April 2021, in response to the pandemic and the 100s of experiences we as frontline healthcare responders had in dealing with crisis in healthcare facilities and in our own personal lives at home.
The room was familiar, although it was the first time I was stepping inside. I was struck by her sparkling oval ring, incongruous in the hospital fluorescence. I wondered if she ever thought she would be here. This was not the story she agreed to the day he asked, the day she said “Yes.” She looked up expectantly, and I knew I could do nothing but let her Idown.hadspent the past ten months trying desperately to escape those ICU rooms in the sunny hallways of the outpatient office. I learned new aspects of medicine to drown out the sounds of the ventilator that I could still hear with my eyes closed in my dark bedroom. I still felt blood on the bridge of my nose even though the sores healed months ago. An afternoon came to mind during which I sat at a family meeting and said, somewhat abstractly, “Our dads have the same name”. I wondered how many 57-year-old Thomases were lying prone in ICUs, and how many daughters sat staring blankly when terminal extubation was gently encouraged. It was a suggestion that didn’t make sense until they stood outside the glass door and watched as we gingerly bandaged necrotic toes and tried to sop up the anticoagulation-induced epistaxis. In a recurring nightmare, it became my own father’s face upturned towards the ICU ceiling, and me outside the door, pounding
FUTURES
Rebecca Brown, DO Hematology/Oncology Fellow Reading Hospital – Tower Health
“Even if”: ”Even if his tattered lungs were to recover to the point that we could take him off this ventilator…” “Even if he could learn to walk again after a month of “Evenparalytics…”ifhe were to recover neurologically from the innumerable strokes he suffered due to his hypercoagulable state...”Ifought the urge to jump to my feet and shout, “Even if he opened his eyes right now, he would beg us to let him die.”
The same blank stare emerged on her face that I had seen, by that point, at least one hundred times. He was obviously dying: two bruised and bulging eyes where theCONTINUEDimmature
A year had passed before I felt once again that sense of vacuous loss, but I recognized it immediately when it arrived. It made no difference that the culprit was leukemia rather than a virus. The words were nauseating in a familiar way when they came out of my mouth, like a poorly made sequel.
21 on the glass. That afternoon, it was me holding a phone to the patient’s ear, sweat-drenched under a gown, hearing his daughter choke out the words “I love you, Dad” over and over in the twelve minutes that it took for him to die after his extubation. It’s hard to say if the nightmare was worse. At least in the nightmare, I eventually woke up. I felt the way a doctor should never feel: I was relieved when they died. As I become further removed from those days, that sentiment is harder to justify. But in those dark months, it was freeing to let go of the kite strings being pulled by hurricane winds. We were lost in a storm that we were powerless against. The relief was born of repetition; these catastrophes occurred several times a day. They were perpetual conversations held with gentle honesty about the futility of the care we were providing. They were experiments in decay throughout a 44-day ICU stay, during which families tested a theory that God would save their son, uncle, brother. It didn’t feel like God was really there. The only clarity we had was grim: they would all die. It wasn’t hard to explain to the families how the body was dying. It was hard to explain how the future was dying. Everything that made this body a person was no longer a possibility. We overused the phrase
being lowered into the cold earth. She would never hold his hand and walk down the aisle. She would never again wake up in the middle of the night to see his face or fall asleep to the slow cadence of his breath. I knew I’d wonder about her from time to time in ICU rooms to come. We stood motionless on opposite sides of the hospital bed. She began to cry, and I selfishly felt a twinge of my own sadness. I thought of the face I used to see so many mornings after opening my eyes to a predawn alarm, silently slipping into scrubs to avoid waking him. An hour before sunrise, only his dark tangle of curls was visible on the pillowcase next to mine. During the bleakest days, I breathed slowly through an N95 mask and dreamt about our future, the happiness that had to lie ahead after all of this. I would think of the time before,
cells replicated furiously, the cloudy ET tube, the cherry red urine. Relaying this in the conversation was always difficult, but it was the aftermath that was the most damaging. I thought back to the phone calls I had made, one morning telling a 15-year-old girl that her 42-year-old mother had died. I wondered about her often, even when it was inconvenient. While washing my dishes in my apartment, I would wonder who made her dinner that night. I would order a bourbon at the bar and wonder who would take her photos at prom. A ventilator alarm snapped me back to the present. I watched the woman in front of me touch her ring and wondered how soon she would take it off after he died. It would shimmer in the sun the day of his funeral, gleaming above the casket
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sun drenched days sitting with him near the vineyards, cold nights when his smoky flannel kept me warm. The luxury of watching him walk into the hospital, carrying a cup of coffee to keep me awake. The champagne trepidation of the day that he, too, would slip a ring onto my finger. The happiest day of my life. A day which, of course, never came. Consumed by the loss of dozens of futures I couldn’t preserve, I watched ours slip away too, standing on the wrong side of the metaphorical glass. No disease to blame for his departure, he was alive but out of reach. Suddenly and somewhat uncharacteristically, tears welled in my eyes as the patient’s fiancée asked a question about chemotherapy. Taped to the wall across from his bed was a photograph that I had not noticed before, in which he was with his fiancée, smiling broadly from a balcony somewhere tropical. Somewhere else. When I saw it, I excused myself from the room. The glass door clicked shut behind me, and I felt the full weight of two years’ worth of grief. As if for the first time, I stood in the noisy hospital hallway and mourned both futures, robbed from the living and the dead.
By Christina Fleckenstein, MD OB/GYN Resident, Wake Forest University School of Medicine
Drexel College of Medicine Class of 2022 “Dawn” was created in 2018 to celebrate the Centennial Anniversary of women attending the College of William and Mary. At the time, I was a senior art student at W&M. Inspired by this landmark. I created “Dawn” to celebrate these pioneers, who marked the start of greater inclusion of women in higher education. The piece was also created with a greater audience in mind -- I hoped to represent all individuals who challenge status quo in their communities, to broaden inclusion, equity, and opportunity, particularly among marginalized groups. I hope each person who reflects on the piece, sees a part of themselves who wishes to make their world a better place. DAWN
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GOING HOME
On rainy April night many years ago, a baby boy named Trent was born at Reading Hospital. His mom was concerned because minutes after his birth, the delivery room was suddenly swarming with people. He wasn’t breathing. “I hear bowel sounds in his chest”, a nurse said. Trent was quickly taken to the neonatal intensive care unit (NICU) and diagnosed with a congenital diaphragmatic hernia. Trent was later transferred to Hershey Medical Center via helicopter, but his mom was allowed to see him in the NICU before he left. She touched and kissed him. On meeting the flight team, she was informed that the flight to Hershey would only last twelve minutes, which was reassuring. The pilot promised to call her when they landed because she was concerned about the stormy weather. Back in her room, lying on her bed with tears in her eyes, Trent’s mom heard the helicopter take off. Her arms reached towards the window as the helicopter flew away. The roaring sound of the helicopter was one she would never forget. Several hours later a nurse called from Hershey to say Trent was stable. What a relief! The next morning, Trent’s mom was driven to Hershey Medical Center. Soon after her arrival, his condition turned grave, and he was placed on extracorporeal membrane oxygenation (ECMO) for ten days. Tammy Trace, OB/GYN Residency Program Manager Reading Hospital – Tower Health
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On day 12, Trent’s diaphragmatic hernia was repaired, and although he was initially stable, his condition declined rapidly several hours after the surgery. The doctors did not expect him to survive. Angry and frustrated, his mother yelled at God, “Trent is not ready to die.” She prayed and cried until she finally fell asleep. Surprisingly, she slept so well that night and woke up realizing she never received the dreaded call. She called the NICU and the nurse reported that a miracle had happened, and Trent was beathing room air! She cried tears of joy and gave thanks to God. On day 43, Trent was discharged from Hershey Medical Center. He was finally going home! He had a few complications after discharge but overcame them all. He grew up to be a determined three-year-old, small but mighty. Trent loved all creatures in life and had an affection for snakes and bumble bees. He would catch them with his bare hands and then bring them to his mom as gifts. One night in August 2002 Trent was going to spend the night with his great-grandmother. He kept telling his mom that he wanted to go home. When she responded, “Ok, I’ll take you home”, he would say, “No! I want to stay with Grandma Grace.” So, his mom dropped him off at Grandma Grace’s house and with a sparkle in his eyes and a grin on his face, he turned to her, waved, and said, “See ya!”
Post script: Little did I realize those would be the last words my son said to me. He went to sleep that night and went “home”. I learned the true meaning of “going home”. I cried and gave thanks for the gift Trent had given me, the gift of knowing. From the wisdom of a three-year-old I learned that his homegoing did not have the finality of “good-bye” but rather, someday I will “see ya”.
Reflect Pause
29 Breathe
My instinct is to blame To accuse and to isolate It’s all of them, not me.
My clarity is not shared I am misunderstood As I no longer fit In the space I occupy. Frustrations mount around me
Why don’t they all see How clear it all is to me? New ideas come Before I am ready I have 500 channels But not the remote. Others obstruct Why can’t they appreciate?
I recognize you immediately When the first light beckons. Sunlight and shadows dance The air is crisp and alive. I’m going to be on today. The ideas flow Like water from the shower. Complex problems dissemble Hidden solutions present In rapid succession. Senses are sharpened Subtle notes are perceived Colors are more vibrant Hidden connections are obvious Confidence brims Mood is elation.
ON Anonymous In this piece, the author tries to capture the feelings of mania, including the rush of ideas, the frustrations of being misunderstood, the teetering out of control, and when it’s over… picking up the pieces, and pining for its return.
31 But I know you And the chaos you’ve sown. Like a runaway trolley I hold on gingerly Ready to let go When you pass my place. I love when you come (although I am alone) I try to scrawl notes Sleep will not interfere. The tsunami recedes As sleep pays a visit. I assess the damage Make amends and apologies Reassess scribbled musings And secretly long for your return.
“I have a longstanding passion for photography. My most recent adventure into the photographic world is that of Photomicrography. That is preparing various substances on a microscope slide , and with using cross polarization techniques, my camera, and my microscope, photographing the crystal formations that develop. No two slides are alike, and each different substance will produce its unique set of patterns, colors and images under cross polarized light. The slides can be prepared in various ways such as melting the substance on a microscope slide and allowing the crystals to form, or by making a supersaturated solution of the substance using distilled water and at times also adding isopropyl alcohol, and with drying the crystals form. I have been experimenting with different substances and am constantly amazed at the results.”
Ivan Bub, MD Family Physician, Reading Hospital – Tower Health
Photomicrography
33 acidsaminoGlutamineL-andB-AlanineofcombinationA
CVitamin
35 Urea
Urea
37
AcidCitric
Determined to provide care Objective in treatment plan Compassionate - empathetic Trustworthy - gaining rapport Optimistic, hopeful in outcome Respect for patient D.O.C.T.O.R.rights Davin Evanson Drexel University College of Medicine MD Class of 2025
39 RESPIRATION Wendy Young, RRT the exchange of oxygen and carbon dioxide in the lungs covid-19 helped the world understand how vital RESPIRATORY THERAPISTS are
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CONTINUED
I was a fourth-year medical student when I crossed paths with the Iron Women of Uganda. We met on the labor and delivery unit in Kawempe Women’s hospital, Kampala. It did not take me long to garner an immense respect for the women who become mothers here. They came in with their own delivery supplies packed in large backpacks, plastic buckets, or suitcases, walked up the hospital’s swirling ramps to the waiting room. Those who were admitted were assigned to beds. The ones who weren’t far enough along in labor waited on a wooden bench or took a seat on the floor. There was no modesty here. The best way I can describe it is that their bodies were… “open.”
Open to be examined, open to assistance, and open to trust. Initially, it was quite a shock for me – seeing so many women so freely “open.” However, I quickly understood that they weren’t on “display.” They were there for assistance through one of the most painful and natural processes known. The mother I was to deliver, Afiya*, was a 19- year- old prime gravid. I had watched all morning as she handled the intensifying phases of labor. She began by pacing, bent at the hips, back and forth beside the bed, tethered by her IV line. When the contractions grew stronger, she moved to the floor, repeatedly hitting her thighs, desperately trying to distract herself from the pain. Her cries moved from a sort of rhythmic chant in her native Lugandan to full-bodied screams she tried to stifle.
Brittney Bruno, MD, MPH
The Iron Women
OB/GYN resident, University of Arizona College of Medicine - Phoenix Drexel University College of Medicine Class of 2020
I had seen women on the floor endure the process silently, with pressed lips and beads of sweat on their skin. Others would cry out with stretched arms, reaching for something I could not see. Some women would tremble uncontrollably with their eyes wide open. They slapped their thighs, backs, the wall, anything to draw their attention elsewhere. They felt each and every contraction, as they received no anesthesia, except if they were going for surgery. The only anodyne they have is whatever mental strength they can muster. “Mi-sa-woah!,” they all eventually called out, desperately. At first, I thought it was a cry for God. But it is the name for medical personnel. The moment came when they would call for a doctor, nurse, midwife, or a medical student, —anyone to help them. With over thirty women in one labor room, and little the staff could do for their pain, the women were often silenced, and told they would have to endure the pain.
I watched as Afiya became increasingly restless, rocking back and forth on her hands and knees as sweat dripped from a face that grimaced with every contraction. Finally, it was time and the midwives called me over. With careful hands and a pounding heart, I delivered her baby boy! Headfirst, he slipped into my hands. Vigorously wiping him down, I placed him into his mother’s waiting arms. Not realizing I was holding my breath, I said “Happy birthday,” knowing that neither the baby nor his mother understood. Afiya smiled back at me, and that was enough. After the delivery, Afiya was moved to a mat on the floor to begin recovery. She lay there, calmly, with her baby. It was such a transformation. She had gone through one of the most natural and painful experiences known and looking at her now, so quiet and reposed, no one would have guessed what she had just gone through. I often reflected on my time spent with the Iron Women of Uganda. As my admiration for their perseverance continued to
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grow—so did my desire to be a part of their journey. What an incredible experience, bringing someone into the world. It is immensely painful, terrifying, and at times prolonged. My hands ached to do more for women, helping them through this phenomenal undertaking. I wanted to ease the discomfort of the process in any way possible, coach them through the difficult moments, and walk them through undesirable outcomes, should they occur. More importantly, I wanted to be the one in the room to catch babies as they enter the world. After medical school, I started training in family medicine. I hold immense respect for this extraordinary discipline, but it became clear to me that my passion lied elsewhere. As a result, I recently made the difficult decision to change specialties and start training in Obstetrics and Gynecology. Beginning the journey through residency yet again as an intern, my heart is full, knowing that I am on the path I was always destined for. I intend to pursue my professional goals by working in global women’s health and eventually be of service to the Iron Women.
The Message
I met Grace* years ago when she was admitted with a frustrating lower gastrointestinal bleed. She was in her eighties, nearly blind from macular degeneration, and crippled from significant arthritis, but neither could dampen her wit and humor. Grace loved to tell jokes and her infectious laughter guaranteed amusement for all. She was one of my favorite patients and I even visited her a few times after she had been assigned to another Asidephysician.from an occasional card from Grace, our paths did not cross again until years later. She was admitted again, this time suffering from progression of her arthritis and now an abscess that made it nearly impossible for her to get comfortable. She was admitted under another physician’s care but happened to be the roommate of a patient of mine, giving me the opportunity to stop by multiple times a day. Only I didn’t. Or couldn’t. I could insert whatever busy hospitalist excuse that I could come up with - her roommate needed a lot of attention or the hospital was super busy with a flu outbreak. For a million reasons, I just didn’t make beyond a cursory greeting as I dashed in to fix her roommate’s latest crisis. Nearly two weeks later, I was surprised to see her on the hospitalist census. This time I was not on a clinical service and was out of excuses. Finally sitting at her bedside, I found that Grace was about to be transferred to a nursing home, and she was feeling very down. We exchanged a joke or two, but she told them without her trademark laugh. I introduced a conversation about her life goals going forward. She wanted to make it to her grandson’s graduation but was beginning to believe that it would not happen. She still was in too much pain to sit due to her abscess and had not stood under her own power in weeks. She was willing to try therapy,
Anthony A. Donato MD, MHPE, MACP Associate Program Director, Reading Hospital – Tower Health Internal Medicine Residency Program Professor of Medicine, Drexel University College of Medicine
“Play saved messages,” she said to the phone. “An odd time to see if the cable guy called,” I thought to myself. “Here,” she said, passing me the phone. To my greatest surprise, I heard my own voice. I had apparently called to thank her for sending me a Father’s Day card 19 months prior. It wasn’t funny, clever, or even witty. It was just a brief thanks and a reminder that I was thinking of her. “That. That message sustains me when I am down. I just play it and I feel better. My daughter almost erased it and I about killed her.” That call- less than thirty seconds- was all she needed. Yet I hadn’t been able to find thirty more seconds in the previous two weeks. It’s easy to get lost in our work as physicians. The pace is relentless, and digesting data is akin to drinking from a fire hose. But opportunities for small acts of kindness and moments of presencealmost always trump an exhaustive list of differentials. *The patient’s name has been changed.
“Give me my phone,” she said. I handed her the museum-ready flip phone on the table, expecting her to show me a picture - a pet, her daughter, the grandson who was about to graduate, or perhaps her late husband.
45 but not very hopeful. I then asked what gave her strength in tough times.
47 Majestic Vincent Pellegrini, MD Retired OB/GYN This is Torres Monzino, one of the three dominant granite towers of the Paine Mountain Range. This mastiff is located within the Torres del Paine National Park in Southern Chilean Patagonia. Glaciers adorn its walls & Lago Pehoé sits at its base.
49
Endless Vincent Pellegrini, MD Shot off State Hill Road in early Spring, this scene gave me the impression of a never ending road into the countryside. It is so typical of the many beautiful back avenues throughout Berks County farmland. It evokes peace & harmony to me.
51
A Tale of Life, Reading
Vincent Pellegrini, MD I came upon this scene near the former Reading Railroad Franklin Street Station in downtown Reading while meandering around town with my camera. Many people had traveled past this exact spot by train between 1930 & 1981 when it ceased its operation. I envisioned this wall showing a day of life in Reading as it had been seen by those passing as they glimpsed out their train windows over the years.
Braving Through Ren Hernandez, BSN, RN-BC Reading Hospital – Tower Health
ofSoundstheSeason
Scott Calpino, CST, BFA Reading Hospital – Tower Health “Sounds of the Season” is one of eight bird paintings from a series called “The Fence Post Sitters”. The title makes reference to not only the sights, but the sounds of the winter season. The whispering of the wind in the pines, the silence of the snowfall, the clear, crisp call of the cardinal in the morning air.
53
ofLegendstheFall Scott Calpino, CST, BFA “Legends of the Fall” portrays a pair of Wood Ducks in a Fall scene, as they prepare for the upcoming migration.
55 Loxley’s Lullaby Scott Calpino, CST, BFA
Exploring the stories behind a simple request
Debbie J. Rahn EdD, MSN, RN, Director, Reading Hospital School of Health Sciences
“How can I best help you right now?” Ah…the unfulfilled hours-long request for coffee. It’s the coffee…it’s about the lack of coffee. “Let’s take care of that”. Done. A warm cup of coffee, a slight touch of the hand, and a smile seen only in the eyes and not evident beneath the mask.
Windows open, doors swing wide, tears flow with each teardrop representing heartbreak and sadness, stories of what it is like to live as a young man with a colostomy with bodily wastes flowing out on one’s abdomen. Stories about what it feels like to think that life is worthless; how it feels to know that illness will always be a part of every rising morning and every night. Stories of those who’ve been abandoned by their families; what it feels like to lack control of one’s life, losing autonomy and embracing uncertainty. Stories…stories…. stories…. “Tell me about your story.” There are so many stories to be heard. No surprise…it wasn’t the coffee at all. It was stories with hidden emotions secretly veiled in nonconformity and defiance. The stories help them. The stories also help us to understand, to be less frustrated and more compassionate, seeing beyond the visible. The “Coffee, please?”
A call is placed for assistance with noncompliance…. those who anger us with their lack of respect for our medical wisdom and our vast experience, the “time wasters”, who act out their insecurities and frustrations in ways that are offensive to our sense of what is right; those whose decision- making skills we question…because they do not agree with what we believe is best for them. Upon arrival, the negativity can be seen, smelled and felt. It permeates the air, is on the face, in the voice and in the posture.
57 stories are humbling; they allow us to be thankful for our own multitude of blessings and help us learn and grow. They help us care when caring seems
Coffeeimpossible.comes in many forms: a simple request, very easy to forget among all of the important things, with no significance in the big picture. But sometimes coffee says “I care”, or “You are worth the time.” The frustration and anger about the omission of a seemingly simple request may have a deeper meaning. A simple gesture like getting coffee for a patient can have a much deeper impact. Sometimes that’s what it takes to turn things around.
Splatter Leaves Jeff Sibbett CT Technologist, Department of Radiology, Reading Hospital – Tower Health
59 Disco Prism Jeff Sibbett, RT, (R)(CT), ARRT Pride Jeff Sibbett, RT, (R)(CT), ARRT
Escargotcha Jeff Sibbett, RT, (R)(CT), ARRT
61 Farenheights Jeff Sibbett, RT, (R)(CT), ARRT
Located in southeastern Germany, near the border of Austria, Berchtesgaden is a beautiful mountainous region that exudes calm and peace. This waterfall was found in a forest past the gorgeous fjord-like Königssee lake, past the field of roaming cows, and nestled deep into a seemingly untouched nook of tall trees, vibrant ferns, and fuzzy moss.
Sarah Luber, DO Internist, Reading Hospital – Tower Health
Berchtesgaden, Germany
63 Merzouga, Morocco Sarah Luber, DO
65 SilverLinings Editorial Team Left to right: Caitlyn Moss, MD Peter Schwartz, MD Olapeju Simoyan, MD, MPH Alexandra Short, MSLS, AHIP
We are deeply grateful to the Reading Hospital Foundation for providing the funding for this publication. Background photos courtesy of Dr. Olapeju Simoyan.
Vincent Pellegrini, MD
This image was taken looking into the City of Reading at the Penn Street Bridge. There was a rising full moon over looking the city. The special significance of this night to me was that it was just two days before New Year’s Day 2021. Having a full moon timed as the old year ends and the New Year enters symbolizes to me a fresh start to the upcoming year, for Reading and the beyond, as we all wrap up the old year. A time to renew. A time to move on.
BACK COVER A NEW BEGINNING 2021
