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September/October 2020
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Sierra Sacramento Valley
MEDICINE 4
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The High Price of Disinformation
Why We Fail to See the Racism Before Our Eyes
Faith Fitzgerald, MD
PRESIDENT’S MESSAGE
John Wiesenfarth, MD
RACISM AND MEDICINE
Jonathan Breslau, MD
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Joy of Medicine: It’s Needed Now More Than Ever
Lindsay Coate
EXECUTIVE DIRECTOR’S MESSAGE
Aileen Wetzel, Executive Director
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OPINION
Life, Reinvented
Caroline Giroux, MD
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RACISM AND MEDICINE
#MaskUp and Stop the Plague Of Misinformation
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Suiting Up and Swabbing at the State Fair Mara Ta Cao, MS IV
It’s Against the Law to Die of Old Age
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Board Briefs
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New SSVMS Members
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We welcome articles from our readers by email, facsimile or mail to the Editorial Committee at the address below. Authors will be able to review articles before publication. Letters may be published in a future issue; send emails to SSVMedicine@ssvms. org. All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the Sierra Sacramento Valley Medical Society for permission to reprint.
OBITUARY
Ray F. Fitch, MD
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Wasted Opportunities George Meyer, MD
Tears of a Black Family Physician
Visit Our Medical History Museum 5380 Elvas Ave. Sacramento Open free to the public 9 am–4 p.m. M–F, except holidays.
J. Bianca Roberts, MD
Cover photo: Lightning arcs among the Sutter Buttes, the world’s smallest mountain range, in Sutter County.
Photo by Mark Finan, markfinanphotography.com
VOLUME 71/NUMBER 5 Official publication of the Sierra Sacramento Valley Medical Society
5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax info@ssvms.org
SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx
September/Octobert 2020
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Sierra Sacramento Valley The Mission of the Sierra Sacramento Valley Medical Society is to bring together physicians from all modes of practice to promote the art and science of quality medical care and to enhance the physical and mental health of our entire community.
2020 Officers & Board of Directors
John Wiesenfarth, MD, President Carol Kimball, MD, President-Elect Christian Serdahl, MD, Immediate Past President District 1 Jonathan Breslau, MD District 2 Adam Dougherty, MD J. Bianca Roberts, MD Vanessa Walker, DO District 3 Ravinder Khaira, MD District 4 Ranjit Bajwa, MD
District 5 Sean Deane, MD Farzam Gorouhi, MD Kristin Gates, MD Paul Reynolds, MD Roderick Vitangcol, MD District 6 Marcia Gollober, MD
2020 CMA Delegation District 1 Reinhardt Hilzinger, MD District 2 Lydia Wytrzes, MD District 3 Katherine Gillogley, MD District 4 Anand Mehta, MD District 5 Sean Deane, MD District 6 Marcia Gollober, MD
District 1 Alternate Brian Jones, MD District 2 Alternate Vacant District 3 Alternate Toussaint Mears-Clark, MD District 4 Alternate Vacant District 5 Alternate Joanna Finn, MD District 6 Alternate Natasha Bir, MD
At-Large Delegates R. Adams Jacobs, MD Barbara Arnold, MD Megan Babb, DO Helen Biren, MD Jonathan Breslau, MD Amber Chatwin, MD Mark Drabkin, MD Adam Dougherty, MD Gordon Garcia, MD Farzam Gorouhi, MD Ann Gerhardt, MD Richard Gray, MD Richard Jones, MD Mohammad Khan, MD Carol Kimball, MD Charles McDonnell, MD
Leena Mehta, MD Sandra Mendez, MD Tom Ormiston, MD Sen. Richard Pan, MD Neil Parikh, MD Hunter Pattison, MD Paul Reynolds, MD Ernesto Rivera, MD J. Bianca Roberts, MD James Sehr, MD Christian Serdahl, MD Ajay Singh, MD Lee Snook, MD Tom Valdez, MD John Wiesenfarth, MD
At-Large Alternates Christine Braid, DO Angelina Crans Yoon, MD Lucy Douglass, MD Rachel Ekaireb, MD Karen Hopp, MD Arthur Jey, MD
Steven Kmucha, MD Sam Lam, MD Taylor Nichols, MD Alex Schmalz, MD Ashley Sens, MD
CMA Trustees, District XI Douglas Brosnan, MD
AMA Delegation Barbara Arnold, MD
Editorial Committee
Margaret Parsons, MD
Sandra Mendez, MD
Megan Babb, DO Sean Deane, MD Caroline Giroux, MD Robert LaPerriere, MD George Meyer, MD
Meghana Pisupati, MS II Karen Poirier-Brode, MD Gerald Rogan, MD Glennah Trochet, MD Lee Welter, MD
Executive Director Managing Editor Webmaster
Aileen Wetzel Ken Smith Melissa Darling
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HOSTED BY LOCAL PHYSICIANS
Listen and subscribe to Joy of Medicine - On Call on your favorite Podcast App or visit joyofmedicine.org
Sierra Sacramento Valley Medicine, the official journal of the Sierra Sacramento Valley Medical Society, is a forum for discussion and debate of news, official policy and diverse opinions about professional practice issues and ideas, as well as information about members’ personal interests. Advertising rates and information sent upon request. Acceptance of advertising in Sierra Sacramento Valley Medicine in no way constitutes approval or endorsement by the Sierra Sacramento Valley Medical Society of products or services advertised. Sierra Sacramento Valley Medicine and the Sierra Sacramento Valley Medical Society reserve the right to reject any advertising. Opinions expressed by authors are their own, and not necessarily those of Sierra Sacramento Valley Medicine or the Sierra Sacramento Valley Medical Society. Sierra Sacramento Valley Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Š2020 Sierra Sacramento Valley Medical Society SIERRA SACRAMENTO VALLEY MEDICINE (ISSN 0886 2826) is published bimonthly by the Sierra Sacramento Valley Medical Society, 5380 Elvas Ave., Sacramento, CA 95819. Subscriptions are $26.00 per year. Periodicals postage paid at Sacramento, CA and additional mailing offices. Correspondence should be addressed to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396. Telephone (916) 452-2671. Postmaster: Send address changes to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396.
| FEATURED CONTRIBUTORS |
John Wiesenfarth, MD
Caroline Giroux, MD
Fighting COVID-19 is difficult enough without also having to fight for the truth, SSVMS President John Wiesenfarth says. Wearing a mask can really just mean that you don’t want to put anyone at risk.
It’s an understatement to say 2020 has been a grueling year, and getting away from it all can be a welcome respite. For Dr. Giroux, a visit to rustic Mono Lake and its unique tufa towers was the right trip.
Dr. Roberts, who has been named chair of the new SSVMS Health Equity Advisory Committee, shares an emotional recollection of the obstacles faced by Black physicians and patients alike.
Jonathan Breslau, MD
Faith T. Fitzgerald, MD
Mara Ta Cao, MS IV
Dr. Breslau, chief at Sutter Imaging, is a member of the Health Equity in Medicine Advisory Committee. He says physicians— especially white physicians—need to do more to recognize and fight racism.
Faith Fitzgerald, MD is back to recount the first death certificate she had to complete and the surprise she got when she listed the cause of death for a 98-year-old woman.
In January’s issue, Mara wrote of her intial experience as a medical student in the ICU. This time, she’s at the COVID-19 testing site at Cal Expo for the day where she had to calm nerves while fighting the virus.
drjohn@winfirst.com
breslaj@sutterhealth.org
George Meyer, MD
geowmeyer@icloud.com
cgiroux@ucdavis.edu
ftfitzgerald@ucdavis.edu
J. Bianca Roberts, MD
j.bianca.roberts@dignityhealth.org
mtacao@ucdavis.edu
Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ssvms.org.
Americans waste as much as 40% of all food produced in the U.S. each year. Not only does that cost American families money, it has public health and environmental implications as well.
September/October 2020
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| PRESIDENT’S MESSAGE |
The High Price of Disinformation
W
hen I started in medicine, the truth seemed pretty straightforward. When researchers, clinicians and professors gave us information to use when treating our patients, and provided clinical or other evidence to back their statements, we had a pretty high level of confidence that what they were telling us was based on quality science and fact. In those days, there was a limited pipeline of information: respected journals, medical school and ongoing training helped us learn the latest about what science supported, and it was often summarized for the American public by trusted anchors on the evening network news. While there were always those on the fringes, there was widespread acceptance of science as a way to better health and a better life for everyone. Fast forward to today, and social media and a partisan rebuke of science has upended the whole equation. As a doctor trying to help patients, it’s frustrating. It’s also dangerous, as we’ve seen from the tens of thousands of lives lost while people dither over things like whether wearing a mask is succumbing to an overzealous government. Dr. Joseph Varon, the chief medical officer of United Memorial Medical Center in Houston, said it better than I can about the two fronts we face daily fighting COVID-19. “At the present time, I’m pretty much fighting two wars: a war against COVID and a war against stupidity,” he told public radio’s The World. “And the problem is that the first one, I have some hope about winning. But the second one is becoming more and more difficult to treat. Why do I say that? Because people are not listening. Whether it’s backed up by science or just plain old common sense, people are not listening throughout the country.” Vietnam had its first COVID-19 case the same week the U.S. did, but it wasn’t until the first week of August that the country had its first death. Admittedly, the social and political structures of Vietnam and the U.S. are very 4
Sierra Sacramento Valley Medicine
By John Wiesenfarth, MD drjohn@winfirst.com
different, but there had to be a difference in the way the two countries handled the pandemic to produce such different results. There was. In Vietnam, the population began to wear masks right away, even before the government required it. Wearing a mask was the right thing to do, and not wearing one wasn’t a statement of defiance—it was perceived as putting more people at risk. Ba-Linh Tran, a political analyst in Ho Chi Minh city, explained why masks were so widely and immediately accepted. The perception was that “masks are masks and that’s it,” he said. “They are not a personal liberty issue.”
“At the present time, I’m pretty much fighting two wars: a war against COVID and a war against stupidity.” — Dr. Joseph Varon, chief medical officer of United Memorial Medical Center in Houston
I’m not a black helicopter, conspiracy-theorist type, but it’s clear there are attempts to manipulate science to gain some sort of advantage, political or otherwise. It wouldn’t be the first time: During the “Spanish” flu epidemic a century ago, the U.S. was in the middle of World War I. Even though there is significant evidence that the first cases originated in Kansas and hit areas such as New York City hard, wartime censors minimized reports of those cases. That led to more coverage of how hard the virus hit Spain, which was neutral in the war, and rather than being called the “Kansas flu” and possibly undermining support for the government it is still attributed to a country that simply experienced the devastating effects of the pandemic just as others did. Mark Twain has been attributed with the adage that a lie can travel halfway around the world while the truth is still putting on its shoes, and he hadn’t even experienced Twitter or Facebook. Science has shown that is
indeed the case: A recent study at MIT found that it took the truth about six times as long as a falsehood—a nice way of saying lie—to reach 1,500 people. Even worse, the truth doesn’t catch up, and more people eventually hear the lie rather than the facts. In “The Art of War,” Sun Tzu knew that even in ancient times a goal of any conflict is to control your opponent by affecting their beliefs and abilities to resist. As he said, “All warfare is based on deception.” So we are at war, often against the truth, even if the reasons aren’t always clear. We’ve heard arguments over the safety and advantages of masking—this is easy, wear one—and partisans without medical training touting treatments such as hydroxychloroquine even though they are of unproven efficacy and hold potential risk. As an emergency room physician, I can tell you that trying to treat COVID-19 and prevent its spread is difficult enough without the judgments, baseless theories and truly awful advice that is running rampant on social media. Conspiracy theories still abound, even those that would somehow require the covert cooperation of dozens of countries and millions of people willing to condemn their own citizens and family members to
death in support of an agenda to hurt or help someone politically. The only agenda that should be at work is to find ways to treat and prevent this disease, and to offer comfort to those who have lost loved ones. To accomplish that, we have to work together as a country and world to look out for each other and not just ourselves. Unfortunately, it has also placed the additional burden on physicians to promote the truth and sometimes make it understood that while we don’t have all the answers to this disease yet, that doesn’t mean something nefarious is behind it. We may not know everything about COVID-19, but one thing we do know for sure is that the virus doesn’t discriminate between political parties, red state or blue county lines, or even those who accept science and those who think it’s a hoax (again, easy answer, it’s not). All we can do is continue to let our patients and the public know that if we want to beat this disease and re-open the economy, it’s going to take understanding on their part that they are the socially distanced, maskwearing first line of defense. Unfortunately, it’s far more likely that we will find a cure for COVID-19 before we will have one for the ignorance, selfishness and denial of science that has gotten us to where we are now.
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| EXEC UTIVE DIRECTOR’S MESSAGE |
Joy of Medicine: It’s Needed Now More Than Ever By Aileen Wetzel awetzel@ssvms.org
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ith the pandemic affecting every aspect of our professional and personal lives, SSVMS has been busy reaching out to member physicians to see how we can help. Our response to your needs has included providing nearly a million dollars worth of free PPE to individual physicians, practices and medical groups, and also by advocating for funding and supplies at the federal, state and local levels of government. You’ve also told us that the stress caused by the pandemic has been tremendous. That’s why we’ve enhanced our Joy of Medicine program with new, virtual sessions to help our members get through these difficult times. Traditionally, SSVMS’s annual Joy of Medicine Summit has been an opportunity for local physicians to gather on a Saturday morning in September for fellowship and hands-on educational sessions that work to build resilience and bring joy back to the practice of medicine. Due to the pandemic, we were forced to get creative with this year’s summit. Therefore, instead of one morning of fellowship, we have decided to offer an entire month of joy, free to any physician in the Sacramento region. Every Tuesday evening in September we will be holding live webinars with experts who can help you find balance and resilience. We will kick off the event on Tuesday, Sept. 1 with Lightning Grand Rounds (think TED Talks) featuring a multitude of your colleagues sharing the ways they find joy in life. Immediately following the Lightning Grand Rounds, Dr. Peter Yellowlees, Professor of Psychiatry and Chief Wellness Officer at UC Davis Health, will share strategies for coping with COVID. The next two Tuesday sessions feature Joy of Medicine Chair Dr. John Chuck leading you on a journey to find joy and meaning in your practice of medicine. Immediately following Dr. Chuck’s sessions, we invite you to unwind with guided Pilates and yoga.
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Dr. Lydia Wytrzes is back by popular demand to offer a two-part sleep science session on Sept. 22 and 29. You will also be treated on Sept. 22 to a live cooking demonstration of a plant-based meal by Dr. Rajiv Misquitta. Our Joy of Medicine month will close on Tuesday, Sept. 25 with a virtual social you won’t want to miss. We have several opportunities for small groups to connect throughout the month (these limited-size events require an additional RSVP when you register for Joy of Medicine Month). Joy of Medicine Psychologist Amy Ahlfeld will facilitate the Virtual Physician Lounge, a small group discussion that provides an excellent way to connect with colleagues from other medical groups,
Our annual Joy of Medicine event is going virtual and will be spread throughout September. each Thursday during the month. Our Virtual Paint and Sip is Wednesday, Sept. 16, but this popular event is only open to 30 physicians so reserve your spot now. Feeling isolated? Consider registering for an in-person (but socially distanced) walk with Joy of Medicine Life Coach Steve Seay. These walks will occur every Saturday in September and are limited to six physicians. Helping our physician members and friends navigate the effects of the pandemic is one of the biggest challenges we have ever faced as an organization. However, we are up to the task and will continue to find innovative ways to support you and your practice of medicine. Thank you for trusting us. Our Tuesday sessions are worth 4.5 CMEs and will surely bring some much-needed delight to your life! To register for Joy of Medicine Month, scan the QR code on the opposite page or visit https://tinyurl.com/ SSVMSWellnessMonth2020.
JOY OF MEDICINE
Wellness Month SEPTEMBER 2020
JOIN US FOR A VIRTUAL MONTH OF WELLNESS!
Every Tuesday, from 6-8 pm, live webinars with local wellness leaders *Pending 4.5 CME Credits Additional small group activities and sessions available throughout the month Free to any physician in the Greater Sacramento Region REGISTER NOW, SPACE LIMITED
TUESDAY SESSIONS - FEATURED SPEAKERS & TOPICS Coping with COVID
2 Part Series: Joy & Meaning in Medicine
Peter Yellowlees, MBBS, MD
John Chuck, MD
September 1 - 7:00PM
Chief Wellness Officer, UCD Health Alan Stoudemire Endowed Prof. of Psychiatry
2 Part Series: Sleep Science September 22 & 29 - 6:00PM
Lydia Wytrzes, MD Neurologist/Sleep Specialist Director, Sutter Sleep Center
September 8 & 15 - 6:00PM Principal, John Chuck Wellness Chair, Joy of Medicine
Nutrition Pearls: The Plant-Based Diet September 22 - 7:00PM Rajiv Misquitta, MD, FACP Internal Medicine Specialist Physician Wellness Leader
THURSDAY SESSIONS - SMALL GROUP MEETUPS Virtual Physician Lounge September 3, 10, 17 & 24 - 5:30PM Amy Ahlfeld, PsyD Joy of Medicine Provider and Licensed Clinical & Consulting Psychologist
Weekly Prizes!
ADDITIONALÂ SESSIONS:
Virtual Paint & Sip - Wednesday, September 16, 2020 from 6:00 - 8:00PM *$10 per/person In-Person, Hosted Walk - Saturdays, September 5, 12, 19 & 26, 2020 at 8:00AM Session for Physician's Significant Others - Wednesday, September 9, 2020 at 6:00PM
REGISTRATION REQUIRED!
Registered participants receive exclusive access to presentations and activities available throughout the month of September. Register now and be entered to win a virtual swag bag (valued at over $350). Register at https://tinyurl.com/SSVMSWellnessMonth2020.
| OPINION |
Life, Reinvented Being Away From it All Brings Acuity To How Life has Changed in 2020
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Sierra Sacramento Valley Medicine
seems to derive profound pleasure in this kind of challenge. Just being at Mono Lake provided a very much needed “dépaysement,” or change of scenery, allowing us to discover new bird sounds, admire the sacred tufas rising as temples bathed in the morning light, and experience an awe from looking at my boys playing with their “pet bees” that invaded our site any time we would spill liquid. They would come to suck the water out of a soaked tea bag or my facial cloth drying on a clothesline, and at sunset they were gone, except for their buzzing sound from afar, almost like a hypnotic, unifying “om.” I felt like we were being one with nature. There was almost a feng-
shui-ness to my quieter mind. My boys are happiest when they can explore. They climbed piles of rocks towards a crater and waved at me once from the top because I decided to stay down to read a book (plus, my hiking boots of almost twenty years started to fall apart). I was able to go even deeper inward by getting away, reflecting on the landscape of my relationships affected by social distancing and how we somehow made the best out of it. I had learned to transcend the world of the form. The forest has become my kids’ school and playground. It is now a goddess temple for me, as I see the full moon rising magnificently, slow and irreversible as birth, its light shining
Photos by Caroline Giroux, MD
W
ho would have thought I would have been filled with jubilation at the perspective of spending a three-day weekend in the wilderness in the arid climate at the border of Nevada, my blood being sucked by sly, strange insects, sleeping on a mattress making chip bag sounds (or worse: sleeping next to someone squirming on a mattress making chip bag sounds), and sunburned, my legs scratched by sagebrush and weathered dwarf trees as I am trying to catch up with three kids overjoyed in their search for obsidian rocks and discovery of animal bones? But here I am, indulging in sleeping outside for the first time since the pandemic, just happy to finally have a mini-bag to pack, a place to go, a someplace else to dream about. I usually dread the tedious process of not-so-minimalist gearpacking just for the sake of sleeping in a tent. I appreciate running water and access to a bathroom. I like a table nicely set for meals. Removed from my usual kitchen cues, I tend to stand, paralyzed, at the thought of cooking anything that involves a prior encounter between a match and a micro-stove, boiling of water, de-dusting non-ergonomic dishes, while squatted down on gravel. Thankfully, my significant other
By Caroline Giroux, MD cgiroux@ucdavis.edu
The boys show off their treasure, a shed antler.
Mono Lake is known for its Tufa towers, limestone formations that were formed underwater and then became exposed when water was diverted from the lake starting in 1941. through our darkest moments. At mid-point of our trip, we drove by June Lake and the lovely tiny town, renouncing the takenfor-granted pleasure of buying an ice cream or getting a cappuccino. Based on the number of cars, we also gave up on the apparently toopopular idea of a hike. Instead, we found a stream to filter water, and I laughed as we were dancing from trying to avoid the cannibalism of mosquitoes, at the boys’ playfulness, their always synchronized need to pee, and my own envy at the ease of men to be able to do that. I still smile at the thought of my 10-year-old son’s outrage during a word game when I picked anatomy or body parts as a category. He complained of how unfair it was, too easy for the parents (“you both are doctors!”). The deity of midwifery in me
couldn’t help but find a deeply symbolic meaning to the sudden C-Section in the woods as the green hammock the brothers were stuck in together like peas in a pod cracked open transversally, ejecting my little one in dismay. A new birth for us all, among trees, in Obsidianland.
beautiful, golden hair (some like it very long), applying conditioner (“rince-crème”) and untangling it gently. I was brought back to our wholesome adventure visiting New Zealand just over a year ago. It almost felt like we were back on
I couldn’t help but find a deeply symbolic meaning to the sudden C-Section in the woods, as the green hammock the brothers were stuck in together like peas in a pod cracked open. Did I mention already that it was a full moon? Removed from the stress of work, this pre-burnout state that seems to have become a default mode, I finally rejoice in the motherly tasks that allow me to touch my boys who seem to be needing less and less of me as they are getting older: scrubbing dirty feet, rinsing their
those beautiful islands: discovering majestic nature, teasing each other, wearing the same clothes, writing in my journal, packing a midday snack, taking a ton of pictures. This time I didn’t use my phone but decided to go back to my digital camera, just to keep the incessant and dizzying messaging that is inescapable on my phone separate from
September/October 2020
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the art of admiring, capturing, and creating memories. Just like many others, my whole life had to be reinvented this year. Reconciling with my joys from the past meant that I saw them no longer as the incidental commas in a long sentence of trauma, but rather as the words themselves. Just like the beautiful surreal antler found by my husband (to our sons’ greatest delight), the blissful encounters in my life have not been “accidents” or appendages shed or dropped by divinity in the narrative thread of my existence, they were legitimate doors to one’s essence. Embracing them all has become my goal, because these joys lay the foundation for more bliss to come, such as sitting in a friend’s backyard, just so, reading, writing, filling up my bottle of water, exchanging smiles, recharging my batteries between the clinic and home. This Zen backyard provides a new transitional space I used to find at the public library, which is now closed indefinitely. I have had to Zoomify many activities, and to compensate for the social vacuum at some point I even found myself “conversing” with oak trees in my backyard as if they were my ancestors whose wisdom I sought. I thanked the rescued red gladiola, whose stem had been severed, for brightening up my kitchen. This year has been the reinvention of gentler frameworks to look at myself (who currently looks like an unusually old case of chickenpox), at the world, at my life. It has been an accelerated course on scuba diving of my soul, reaching depths and dreams I never knew I could explore.
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| RACISM AND MEDICINE |
Tears of a Black Family Physician By J. Bianca Roberts, MD J.Bianca.Roberts@dignityhealth.org
I
t’s May 8. The clock says 4:30 a.m. I wake just before my alarm goes off. I typically rise early to complete the previous day’s patient care items: I review labs, reply to patient messages, finish incomplete chart notes and respond to any administrative emails that require my attention. This routine helps me stay on top of my work so I can spend quality time with my kids after a long day’s work. Today, however, is different. I am distracted by the uncertainty in the Ahmaud Arbery case. He was killed on February 23, 2020 after two armed men stopped him in a Georgia neighborhood while out for a jog. The Black community heard about Arbery’s killing quickly, but now a horrific video leaked in April has brought it to the attention of the entire country nearly two months after the fact. I want to believe that one day the justice system will serve everyone equally regardless of the color of their skin. I want to believe that this can be achieved without outcry from the Black community. But I rise and see that today is still not that day. I sigh. I close my computer. I get ready for my day and weep quietly in the solitude. In the two months since Arbery was shot, no arrests
have been made. This cycle of violence towards unarmed Black individuals, who are deemed suspicious for no reason other than the color of their skin, is exhausting. Even as we perform routine day-to-day activities such as going to the grocery store or going for a run, they are viewed as suspicious. Most of these incidents are never captured on video and yet, for the violence that is captured, rarely does it come with consequences for the assailant. My heart sinks and my tears continue to fall as I head to my clinic. Immediately upon my arrival, I’m bombarded with questions and patient care requests. I always try my best to accommodate all my patients’ needs. My philosophy of care is to treat my patients just as I would want my family treated. My team and I start our day as we always do, reviewing my schedule. Today is different. Today I see a trend. More than half of my scheduled patients are Black. I think about Ahmaud again. My stomach turns. I take a deep breath and hope my tears can’t be seen. My first patient is a 55 year-old Black female who presents with a two-week history of worsening abdominal pain. I quickly rule out any acute pathologies and within minutes realize she needs me for more than a Continued on page 14
SSVMS Forms Health Equity in Medicine Advisory Committee SSVMS has formed a new Health Equity in Medicine Advisory Committee with the goal of encouraging a diverse workforce in medicine and promoting health equity. Chaired by Dr. J. Bianca Roberts, the committee will study individual, institutional and structural racism and seek effective ways to address these problems. The committee will work to educate the physician community about how access to care and health
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outcomes are affected by inequities in our health system. It will be responsible for developing substantive recommendations, building cooperation among physicians for positive action, and advocating for appropriate legislation. For more information about the Health Equity in Medicine Advisory Committee, contact Lindsay Coate at lcoate@ssvms.org.
| RACISM AND MEDICINE |
Why We Fail to See the Racism Before Our Eyes By Jonathan Breslau, MD breslaj@sutterhealth.org
he killings of Ahmaud Arbery, George Floyd, Breonna Taylor, and others, in close succession, have led millions to join in the multitude of protests that have swept the country. For once, these events have seemed to have raised the collective consciousness of Americans, who now support the Black Lives Matter movement by a two-to-one rate. An unprecedented number of white Americans have joined the protests and give hope to a new and lasting focus on making changes in our society. The COVID-19 pandemic and the ongoing epidemic of murders of Black people by police show us two important views of a general problem: we do not live in a society that treats everyone equally, and disparate health outcomes and unequal justice still plague the
lives of Black Americans. According to a study published in Health Affairs using data from Sutter Health’s electronic health record, non-Hispanic African American patients with COVID-19 are 2.7 times more likely to be hospitalized compared with non-Hispanic white patients. New data obtained from the CDC and reported in the New York Times also showed that Latino and African American residents of the U.S. are three times more likely to be infected with COVID-19 and twice as likely to die from the virus. Racial disparities in some of the largest sources of morbidity and mortality—hypertension, Type 2 diabetes, and congestive heart failure—contribute to disparate Continued on page 16
A protestor kneels at the Sacamento White Coats Against Racism rally at the State Capitol on June 1.
September/October 2020
Photo by Ian Kim, MD
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Photo: REUTERS/Lucy Nicholson
Health care workers attend a vigil against systemic racism and police brutality, amid the COVID-19 outbreak, in Los Angeles on June 15, 2020.
Tears
From page 12
diagnosis. She cries as she shares her personal experiences of racism with me and as well as her sadness and frustration about the lack of justice in Arbery’s case. We cry together while I listen. I listen as she expresses her fears of not having access to a Black gastroenterologist who can further help diagnose the cause of her abdominal pain. She, like many other Black people, is very much aware of the injustices in health care our ancestors and relatives endured. Many were forced into involuntary studies and procedures dating back to the 18th century. She is most fearful of the involuntary sterilization of other Black women. The “Mississippi Appendectomies” are an example. This was a period of time extending over 60 years, starting in the early 1920s, during which involuntary sterilizations were performed on Black women. Elain Riddick was just 14 years-old when she was raped and impregnated. Immediately after delivering her baby, she underwent a hysterectomy to which she had not consented. To make the situation even worse, she was not made aware it had been done until a physical exam by a physician five years later revealed she no longer had a uterus. Her attempt to sue the Eugenics 14
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Board of North Carolina was unsuccessful and neither the physician nor the hospital faced any consequences. This isn’t something relegated just to history. Between 2006 and 2010, nearly 150 female inmates in California prisons were sterilized in California prisons, and many of these former inmates say the procedure was involuntary. Many of these women were Black. These serve as just a few examples of how the system I work within has created such disparities for my race that continue today. As I say goodbye to my first patient, I dry my tears and move immediately to my next. I walk into the exam room and am happy to see a new patient for the first time, a 15-year-old male in for his well-child check. His family is also happy because he has a Black physician to care for him and the rest of the family. We talk about academics, his hopes and dreams, his growth, and his safety amid the current social climate. His mom mentions his moodiness and asks that I discuss with him why she, as his Black mother, encourages him to remain safely at home even though his nonBlack friends continue with life as normal. She steps out of the exam room so I may have a private discussion with him. The same room that was just minutes ago filled with happiness is now full of despair.
| RACISM AND MEDICINE | He expresses his sadness and lack of understanding why no one has been charged with murder in the Arbery case. I listen. We talk. I explain to him the importance of listening to his elders because, as a Black child, there are circumstances he is yet to fully understand in which—if he is in the wrong place—there could be grave consequences. If only I could remove this reality from his world. If only I could encourage him to go out and play with his friends as I would another child. I have to prevent him from seeing my fear, so I distract myself by imploring him to listen to his mother. We talk about his future and the need our entire Black community has for him to live so he can grow up to fight against these injustices. His mom returns to the room, and the visit continues. I provide additional counseling and recommend that he receive the vaccinations for which he is due. His mother considers the counseling but declines the vaccines. She, like other Black parents, are untrusting of common recommendations because they are familiar with health care injustices against minorities. They are aware, for example, of the 1998 experimentation on New York City Black and Latino boys who were injected with the cardiotoxic substance fenfluramine at the New York State Psychiatric Institute. The “experiment,” based on racist assumptions of inherent traits, was an effort to prove that violent and criminal behavior could be predicted physiologically until it was shut down and deemed unethical. But the damage it caused could not be undone, furthering the distrust the Black community has of the health care system. My patient’s mother, like so many, has sound reasons for distrust. I think about the preventive care not received because of injustices such as this, and it tears at my heart. I continue throughout my day and see a few more patients while I also experience a mix of emotions. I laugh and cry with other patients. I listen, nod and provide sound medical guidance and recommendations for each ailment presented. I have noticed today, though, that despite their medical compliance, the stress of racism in its current climate is taking yet another toll on my Black patients, manifesting in physical form as elevated blood pressure. We discuss this at length. Some would By beJon willing Davids,to MDseek therapy for this stress, jdavids@shrinenet.org however, only with a Black therapist or psychiatrist who won’t dismiss their experiences as a Black person in America. A Black therapist in my area is needed now
more than ever, and a wave of sadness falls over me for the lack of access my Black patients have to the services they deserve. While walking into another patient’s room, I run into a colleague who tells me I look tired. I think to myself, “I’m exhausted.” I don’t need to be told I look tired. I need to be told, “I stand with you!” I need to be told, “I am sorry for what you and other Black individuals are going through.” I don’t say that though. Instead, I politely smile. My outlet is to reach out to my medical school friends whom I trust with my vulnerability. When I tell them, “I am not OK,” they respond with, “None of us are OK.” It is they who are allowed to see the tears of this Black physician that I normally hide. Instantly it hits me again. It’s been more than two months since the witnessed killing of Ahmaud Arbery and still no arrests have been made. It hits me like a freight train coming at full speed when I am idle. It’s exhausting. I am exhausted, but my day is not yet complete. I head home and do what I can to process my day. For Ahmaud, I bike two miles. I reflect on my experiences as a black physician and on all the lives lost by senseless acts of racism. I see my babies, my daughter and son, and can’t help but think about Tamir Rice, who was killed in the park when a police officer mistook his toy gun for a real one and shot him. He was 12. With every simple act throughout my day, I am drawn into remembering these acts of racism. Each task can evoke an experience of a Black life lost and for today, this has amounted to a lot. Too much. I know that all of these Black lives lost and their survivors need a Black advocate to continue to speak on their behalf. I must continue to acknowledge racism in medicine for my patients’ sake. Racism has plagued medicine and our justice system. Racism is a curable disease and a public health emergency. I go to bed thinking about what needs to be done tomorrow. I go to bed knowing that what is done today will have to be done all over again tomorrow. Perhaps tomorrow I will wake and the tears of this Black physician will in fact be tears of relief, knowing Ahmaud Arbery will get the justice he deserves. Editor’s Note: On June 24, Gregory McMichael, his son Travis McMichael, and William Bryan were indicted on felony murder, aggravated assault and other charges in the Ahmaud Arbery case. A trial is pending. September/October 2020
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| RACISM AND MEDICINE |
Racism
From page 13
outcomes from COVID-19. But these comorbidities are also linked to structural racism created by longstanding laws and policies. These disparities aren’t limited to COVID-19 cases. A new study by George Mason University determined that Black newborns are more likely to survive childbirth if they are cared for by Black doctors, but three times more likely to die when looked after by white doctors. So how can we help bridge this divide as individual physicians, especially as white physicians, and as medical organizations? First of all, we need to acknowledge that our Black patients and colleagues have unique and different experiences in health care. As clinicians, we should be naturally empathetic, so considering that others may have a different experience than us shouldn’t be difficult. But we doctors, particularly white male doctors, have benefitted from a system within medical education and our career paths in general that propagates racial injustice. And our patient health outcomes have societally determined disparities that continue before our very eyes. In some cases medical teaching is designed to relieve us of responsibility. We absolve ourselves by attributing increased hypertension among African Americans to a predisposition to salt-retention passed down by those who survived the horrific “middle passage” during the slave trade. We also attribute reduced compliance with prescribed medications to distrust of doctors and hospitals. But we need to make an effort to understand and improve the situation by addressing the cause rather than the symptoms. Doing nothing to solve these problems is, simply put, racist. And that makes those of us, who do not act, racist even if we would never think of ourselves that way. The reality is that we need to do more than not be racists. We need to be antiracist. “The opposite of ‘racist’ isn’t not racist, it is antiracist,” Professor Ibram X. Kendi wrote in How to Be an Antiracist. “What’s the difference? One endorses either the idea of a racial hierarchy as a racist, or racial equality as an antiracist. One either allows racial inequities to persevere, as a racist, or confronts racial inequities, as an antiracist. There is no in-between safe space of not racist. The claim of ‘not racist’ neutrality is a mask for racism.” 16
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It is a difficult—and therefore unlikely—conversation for white physicians to have, to ask their Black colleagues about their experiences. But under the hashtag #BlackintheIvory, numerous Black health care professionals have bravely shared their experiences on Twitter. Their words are honest, raw, sad, and to white male physicians like me who have been in medicine for decades, frankly embarrassing. Kara Toles MD @kat04747 I vividly remember being asked by a panel of interviewers at a prominent West Coast institution if I considered being a social worker given my BA in Black Studies and passion about social justice. At a medical school interview. #BlackintheIvory
Camille A. Clare MD MPH @cclareMDMPH7 Being told in a medical society committee meeting how articulate I am or asked if I am a writer because I know how to speak, read, write and articulate. #BlackintheIvory #notacompliment
Abimbola Adegbola, MD @AAdegbolaMD Having a white male patient say “I would have been a doctor, but they didn’t accept me because they started handing out medical school admissions to black women instead” while your white male attending nods in agreement. #BlackInTheIvory
Add these insults to the pressure experienced generally during medical education and in pursuit of desired career paths, and one can’t escape the certainty that their experiences are not just different, they are painful. George Floyd’s murder by police officers in Minneapolis also affected Black physicians in a way that must also be acknowledged as different, more visceral, and more threatening. In a chilling episode of the physician-produced podcast, “The Nocturnists,” a number of Black health care workers recounted their immediate reactions to learning of George Floyd’s murder, especially when seeing the widely shared video. They may be doctors and nurses and mothers and fathers, but, unlike me, they all could see themselves in
| RACISM AND MEDICINE |
George Floyd. I listened to the whole podcast twice and cried both times. Demographic trends also illustrate the challenges. Black physicians are increasingly underrepresented relative to their makeup in the population at large. According to the American Association of Medical Colleges, the percentage of Black physicians in the workforce actually declined from 6.3% in 2008 to 5% in 2018, even though African-Americans represent about 13% of the overall U.S. population. Physicians follow a narrow path of achievement over a long educational track that requires financial support, educational opportunities, and active mentorship. What can we do to extend this supportive environment to future Black doctors and assure them that they will have long and fulfilling careers in medicine? In her book, Biased, Stanford Psychology Professor Jennifer Eberhardt explains that the goal of colorblindness as a way to achieve racial fairness has had the opposite effect and impeded the move towards equality. People have become uncomfortable discussing race, she writes, adding that when people focus on not seeing color they may also fail to see discrimination. Dr. Eberhardt’s work and understanding of structural racism suggests we should see people of color as distinct individuals, not group members. This idea is also at the core of antiracism. Addressing the racial disparity in the impact of COVID-19 and also addressing racism in our profession requires us to identify each person’s unique circumstances. Physician and activist Dr. Camara P. Jones has defined racism as “a system of structuring opportunity and assigning value based on the social interpretation of how one looks.” We need to apply the term without fear because it improves our vision. Considering racism as a system focuses attention on an entire group’s incentive to fix it, rather than wasting time deciding who is racist and who isn’t. We must sustain the current momentum in addressing racial disparities by urging our organizations to recognize the problem and then actively try to improve it. SSVMS, for example, has recently established a Health Equity in Medicine Advisory Committee. We need good information on COVID-19 outcomes with race and ethnicity data included to increase awareness of implicit bias, and an increased access among Black and Hispanic populations to primary care through stronger partner-
ships with community health clinics. It is also important to focus on diversity in hiring at all levels of health care organizations in a way that will build trust and support anti-racist practices. Public health disparities that are a part of structural racism can be addressed by working between organizations and local, state and federal government. These overall societal challenges require medical groups, health systems, charitable foundations, and governments to work both individually and together. But addressing structural racism and implicit bias in the practice of medicine and in how clinicians interact can start with each of us: we must listen first, with humility, and realize the white privilege that has supported us. We should ask questions of our Black colleagues, who are living with bias and discrimination, but only with the understanding that we want to feel empathy and learn, not to be excused for our sins. This kind of attitude adjustment is important but widening the pipeline of Black physicians entering our profession requires supporting mentorship programs that expose youth to medical professionals in high school, increasing outreach to college students, medical students, and students in allied health professions to welcome them to our profession. Targeted recruiting efforts that involve our Black colleagues will help us better understand what issues they and other students of color have faced on their road to a career in medicine. Then we can work to improve. This isn’t simple stuff. We have to challenge a system that disfavors Black people but in which most of us have been living happily, or at least in oblivion, throughout our careers. During this time of the pandemic, however, we have seen some changes effected at a blinding speed such as the implementation of video visits; ramping down, and then safely ramping up our clinical services; and the giant outpouring of support for Black Lives Matter. We have momentum. We need awareness, empathy, endurance, and courage. Writing in 1963, the civil rights author James Baldwin clearly explained in a way that was meant to create some discomfort among those who fail to recognize the racism before them: “But it is not permissible that the authors of devastation should also be innocent. It is the innocence which constitutes the crime.” Let’s take a deep breath and get to work.
September/October 2020
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#MaskUp and Stop the Plague Of Misinformation New SSVMS PSAs Spread Facts, Fight Conspiracy Theories on Social Media
By Lindsay Coate lcoate@ssvms.org
S
SVMS recently completed a new set of public service announcements encouraging every one to #MaskUp and help prevent the spread of COVID-19. The videos featured four local physicians and one medical student encouraging the public to put on their masks, wash their hands and socially distance to help achieve the goal of beating down the virus so businesses and schools can reopen as soon as it’s safe. The PSAs appeared on social media sites and quickly earned over a thousand “likes” and more than one hundred shares. However, this experience was also a distressing look at how social media can spread false information in a way that mirrors the spread of a viral epidemic. The comment section included many positive responses but also offered a stark reminder of how a vocal minority of people living in the Sacramento region have politicized this issue and spread propaganda. There is 18
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no need to reprint these troubling comments and memes, but many of the comments contained links to false data from conspiracy theory sites, hate speech and threats. COVID-19 has made us all more reliant on technology to stay connected with friends, family, patients and colleagues. That often includes the use of social media, and for all the benefits it offers there are certainly challenges. Those who dismiss science or put a political spin on masks are vocal and can pollute interactions with your social media contacts, but they are a minority that counts on a shock factor and personal attacks rather than offering a reasonable response or demonstrating widespread support. The best way to fight the spread of this false and potentially damaging information is for you to speak up and share your thoughts on your own social media pages. Your family, friends and patients know you and trust you for credible—and
critical—information. You are not some actor in a white coat, you are a physician (a scientist!) who takes care of patients. They need to hear from you about the precautions you are taking to protect your family and what your thoughts are on the scientific data available regarding COVID-19. There is no need to take a political stance or to engage in arguments with others. With that in Scan this code mind, please with your phone help overcome to see the PSAs. the noise by sharing our #MaskUp campaign on your Facebook and other social media pages by scanning the QR code with your phone and copying our YouTube link to your Facebook page or Twitter timeline. Lindsay Coate is director of programs at SSVMS.
From us to you, we say thank you! UC Davis School of Medicine students and Serotonin Surge Charities give a big thank you to our generous sponsors, donors, and volunteers who joined us at this year’s annual Wine Tasting Benefit and Auction to support safety net medical care.
| COVID-19 |
Suiting Up and Swabbing At the State Fair Medical Student Volunteers at Cal Expo COVID-19 Testing Site “
T
ing at Cal Expo. I signed up. We were trained to don and doff PPE and perform nasopharyngeal swabs. Once we had mastered those skills, we were sworn in as official disaster workers for the State of California. On my first day, it is 85 degrees outside and I am sweating under the plastic gown before we have even started. I breathe in and become acutely aware that my breath is tinged with the sharpness of the mustard and pickles on the ham and swiss sandwich I had for lunch. I regret not brushing my teeth.
Photo: Andrew Nixon/CapRadio
urn around,” Dr. Harris says to me. “Let me look at you.” She instructs me to adjust my mask strap. I take a deep breath in. My mask collapses inward. I have a good seal. I put on my hair bouffant, my face shield. I am ready to go in. UC Davis decided to pull thirdyear medical students from rotations as the COVID-19 pandemic was quickly spreading coast to coast. Sacramento had issued an order for shelter in place and the Sacramento County Public Health Department called for volunteers to help with their COVID-19 drive-through test-
Clark Shueh of the Folsom Community Emergency Response Team is ready to direct cars at the COVID-19 drive-through testing at Cal Expo. 20
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By Mara Ta Cao, MS IV mtacao@ucdavis.edu
Normally, the State Fair would be happening this time of year at Cal Expo. Instead of the thousands of people who usually come for the Ferris wheels, concerts, midway games and food only found on fairgrounds, the slow line of cars snaking through the parking lot holds local residents who are anxious about whether they have a virus that has killed tens of thousands nationwide. National Guard personnel in their army camouflage walk around the premises of the Cal Expo concrete warehouse that is our base of operations. They are members of the medic team practicing to set up mobile testing sites for COVID-19. I hear the chop-chop sound of news helicopters hovering above. Voices echo across the vast concrete warehouse while orders flow over out of walkie-talkies. I follow Cynthia, a public health nurse. She coaches me through the nasopharyngeal swabbing as traffic controllers direct cars toward the three lanes that have been set up for testing. There are cars of all types: gas guzzlers with rumbling motors spewing fumes to sleek shiny Teslas. We motion to the first SUV to come forward then hold out our hands to signal to the driver, a young woman wearing a Sac State
Photo: Andrew Nixon/CapRadio
Health care workers test a patient for COVID-19 at Cal Expo. Over 15,000 cases have been confirmed in Sacramento. sweatshirt, to stop and roll down her window. We proceed to confirm her identity. The young woman says she is scared, and the facemasks and PPE that make us look like we’re in a scene from the X-Files don’t help. She tells us she is frightened to get COVID-19 because she has a little daughter and an older mother living with her and she has heard from news reports that thousands of people are dying every day from this disease. As we prepare the swab, she asks us if the swab is going to go into her brain. Cynthia explains the procedure to her and assuages her anxiety. I stick the swab in. When I pull it out, the young woman exclaims, “That wasn’t so bad!” She thanks us and drives off. Cynthia and I peel off our outer gloves, rub sanitizer on the inner gloves, a second skin we wear on our hands, then pull on a new
pair of outer gloves. Our next patient is a middle aged African-American man. He asks us how it feels to get the swab up his nose. “Well, it is uncomfortable,” Cynthia replies. “It stings. It’s like having wasabi in your nose.” He laughs. leans his head back on his head rest, pulls his face mask down to just below his nose, looks straight ahead, and declares, “I’m ready.” I place the swab in his nostril and his face bunches up. As I remove the swab, he starts tearing up. “Yep, it does feel like what I would imagine wasabi up your nose would feel like,” he says. Most times, the procedure is straightforward and people accept the momentary discomfort of a swab deep in their nostril. But in a few cases, the driver gets confused and is shaking with fear. One woman was unable to state her name with-
out pulling out her drivers license to look at it. Another older woman with frizzy hair jerked away with the swab in her nose, screaming, “I can’t! I can’t! I can’t!” She calmed down after a minute and let me pull the swab out for her. By the end of the morning shift, we had collected more than 70 specimens. We took them to be inventoried and placed them in foam coolers which were labeled with red stickers emblazoned with a warning: Caution! Biohazard Contaminants. At the end of the day, my colleagues watch me remove my PPE to ensure I do it properly. I start with a pump of sanitizer. I remove my shoe coverings. Pump of sanitizer. I pull my gown away from me and remove my gloves in one motion so that they all roll off into the bin. Pump of sanitizer. I tilt forward slightly over the waste bin and lift the back band of my face shield, letting it fall into the bin. Pump of sanitizer. I lift the back bands of my surgical mask and remove it. I can breathe with ease again. Pump of sanitizer. I remove the bouffant, loosening first from the nape. It was the last piece. My face is sore from the pressure of the mask and the back of my scrubs are drenched with sweat. Dr. Harris holds up her phone camera so I can see the red indentations the mask left on my face. She nods encouragingly. I watch Cynthia doff her PPE and we all applaud each other. I am exhausted and hungry. I decide tonight I will treat myself to a delicious hamburger and fries and a cold strawberry milk shake. September/October 2020
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| PUBLIC HEALTH |
Wasted Opportunities Wholesome Food That Could Feed Millions Fills Landfills and Hastens Climate Change
M
ore than 215,000 people in the Sacramento area, including 65% of all Sacramento County children, experience food insecurity. The USDA considers someone “food insecure” when they lack consistent access to enough food for an active, healthy life. Meanwhile, between 30% and 40% of the food produced in the United States each year goes to waste. That adds up to 133 billion pounds, or the equivalent of 1,249 calories per person per day—about 60 percent of the recommended daily caloric intake for an adult. The financial impact is just as significant. The amount of uneaten food in the U.S. equates to $161 billion each year, or about $1,500 for the average family of four. A large part of the reason Americans waste so much is that we tend to favor visually perfect food. Not only does food go unsold as a result, but perfectly edible produce, for example, is pulled from the supply to stores because it is unlikely to sell. An astounding 612 pounds of food for each person in the U.S. goes to waste annually and constitutes over 20% of what goes into landfills for disposal. France, in contrast, passed a widely supported law in 2016 that bans grocery stores from throwing away edible food and the amount of waste per person (233 pounds) is well less than half what Americans waste. Under the French law, stores can be fined up to $4,500 for each infraction and supermarkets with a footprint of more than 400 square meters (4,305 sq ft) have to sign donation contracts with charities or face a penalty. A study by the National Resources Defense Council found that reducing food losses by just 15 percent would save enough food to feed more than 25 million Americans every year. That’s over half the number of people in this country who are food insecure. There is another bonus from reducing food waste. The World Wildlife Fund estimates that about 11% of all the greenhouse gas emissions that come from the food system could be reduced if we stop wasting food. 22
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By George Meyer, MD geowmeyer@icloud.com
In the US alone, the production of lost or wasted food generates the equivalent of 37 million cars worth of greenhouse gas emissions. In 2015, California began to require commercial generators of excess food that can’t be consumed to have it composted or transformed to energy via anaerobic digestion. The renewable natural gas created through the process not only supplies energy needs for companies such as UPS, which announced last year that it is committed to buying 170 million gallons of biogas by 2026, but it also reduces carbon emissions.
Sacramento Food Bank Leads the Way
In our area, Sacramento Food Bank & Family Services is the administrative coordinator for 220 partner agencies in the area that work with local grocery stores. The soon-to-be outdated food recovered by these organizations, supplemented by additional purchased food, helps provide food for 150,000 people each month. In 2017-18, SFBFS’s Partner Agencies had 1,087,719 visits and distributed over 19.5 million pounds of fresh groceries to the community. While donations from grocery outlets is an important part of the supply to food banks and other organizations targeting food insecurity, the majority of food provided does not come from retail sources. The Sacramento Food Bank & Family Services belongs to the California Association of Food Banks, a group of 41 food banks that have banded together for cooperative buying. Together, they source food from wholesalers, manufacturers, food drives and from farms, where they may purchase a whole farm’s output at pennies on the dollar. The food they obtain is perfectly edible but may have blemishes or can’t be sold for another reason. One impediment to distributing otherwise wholesome food that may be blemished or beyond its expiration date has been the threat of litigation. As a result, California and the federal government have enacted
An estimated 30%-40% of the food produced in the U.S. each year goes to waste. That’s the equivalent of over 1,200 calories per person per day, or about 60% of the recommended caloric intake for adults. laws that protect anyone donating what appears to be wholesome food from civil or criminal liability unless gross negligence is involved. Gleaning, or gathering produce left after a harvest or that would otherwise go uncollected, is getting a renewed focus in California. Although the best known group, the volunteer organization Senior Gleaners, merged with the Sacramento Food Bank in 2016 due to financial concerns, other efforts persist. Rancho Cordova’s Soil Born Farms helped to develop Harvest Sacramento, which harvests underutilized fruit and vegetables from backyards and small orchards and then donates it to local food assistance agencies. The city of Chico is currently looking at allowing a nonprofit organization to collect fruit from over 200 trees growing on city right-of-ways, and it offers free citrus and apple trees to
residents under a greenhouse gas reduction grant. Food insecurity has also become a bigger problem among college students. Sacramento State just recently began to implement practices such as the Epicure Extras app that notifies students when catered events have leftover food, and they partner with dining services to send unsold pre-packaged meals to their food pantry for use by students.
You Can Make a Difference
California is making progress, but too much food still goes to waste. In American Wasteland, author Jonathan Bloom notes that households throw out an estimated 25% or more of the food they buy, often because it spoils before use. By tweaking our lifestyles just a little bit in the way we buy and consume food, we could help make a serious dent in eliminating food waste.
On his blog site Wasted Food (wastedfood.com), Bloom offers some suggestions on easy ways to reduce food waste in your household: • Plan meals before you shop, and keep to your list when you go to the grocery store; • Serve reasonably sized portions to reduce waste (and maybe your waistline); • Save leftovers, and then eat those leftovers. Food insecurity, which affects one in six Americans, is a significant public health problem despite enough food being produced each year to feed everyone. By putting nutritious food that would otherwise go to waste to good use, millions of Americans could have a healthier diet available to them, which in turn can help avoid or limit chronic conditions that lead to expensive care and shorter lives.
September/October 2020
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| ESSAY |
Photos By Ian Kim, MD
It’s Against the Law to Die of Old Age A
bout 30 years ago, a 98-year old woman was brought from her home in Sacramento to the Internal Medicine Clinic at my hospital by her very caring neighbors. They had not seen her outside for two days, which was unusual for her. Since she did not respond to their knocking at the door, they had used the key that she had given them long ago to get in. They found her in bed where, she told them in a whisper, she had been unable to get up since the day before and her telephone was out of reach. She asked to be taken to our clinic as, fortuitously it seemed, she had a late day “check up” appointment on that very afternoon. The clinic was close—two streets away—so her neighbor wrapped her in a clean blanket while her husband phoned the clinic to tell them what was happening. He then carried her to the car and the wife held her upright in the back seat. After driving the five-minute distance, the man carried her (she was very light, he said) into the clinic. The clinic attending, with his resident, was waiting at the front desk to meet her and took her to an examination room. The neighbors told them what had happened, that she had no kin, and, to their knowledge, no will and testament. As she was having her vital signs and weight checked followed by a quick cardiac, pulmonary, abdominal and neurological examinations, the old woman fell asleep and could not be awakened. She was taken by wheelchair to the ER (which was then very close to the clinic) and following a quick re-examination, EKG, chest film and STAT blood for labs, an IV was started with normal saline and she was admitted to the ward on East 8. When I first saw her, after the ward resident and intern had already done so, she was awake but periodically somnolent. She told me in a soft voice after my exam, “I am so very tired.”
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By Faith T. Fitzgerald, MD ftfitzgerald@ucdavis.edu
I talked to the resident and intern who said that the ER studies provided no help in diagnosis, as they were largely normal but they would get further studies such as a urinalysis and blood cultures. I was still in the hospital when it became dark outside two hours later, so I went to see her again. She seemed to be sleeping but, as I watched her, she made no movements. Her eyes were half shut; she was not breathing at all and had no heart sounds. She was dead!
She seemed to be sleeping but, as I watched her, she made no movements. I told the head nurse on the ward and, after seeing the patient herself, she went right to work calling the Office of Decedent Affairs. I was shortly given a paper to fill out, including the cause (or causes) of her death. I wrote in: Old Age. A second form was quickly given to me early the next morning and I was surprised to learn that, in our country, one could not die of old age. I went to the Office of Decedent Affairs to explain my diagnosis. The agent there, very kind and knowledgeable, gave me some help (this was my first death certificate). She asked how I knew the patient was dead. I answered that her heart had stopped beating, she had stopped breathing and she had been in her late 90’s. “So,” she said, “fill out the form for the cause of death as follows: 1) Heart failure 2) Pulmonary failure. “Leave out the ‘old age’ part on the death certificate. Nobody is alowed, by law, to die in our country of old age.” “Oh? So what’s the penalty for them if they do?”
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Subscription Services, Inc www.buymags.com/cma
Confidential Physician Wellness Resources 24-hour confidential assistance hotline is free and will not result in any disciplinary action. Additional Physician wellbeing resources also available through SSVMS’ Joy of Medicine.
Physicians’ Confidential Line (650) 756-7787 www.cmadocs.org/confidential-line www.joyofmedicine.org
Medical Waste Management Save up to 30% on medical waste management and regulatory compliance services.
EnviroMerica www.enviromerica.com
Office supplies, facility, technology, furniture, custom printing and more… Save up to 80%
StaplesAdvantage
Physician Laboratory Accreditation 15% off lab accreditation programs and services Members only coupon code required
COLA (800) 981-9883
Security Prescription Products RxSecurity Members receive 15% off tamper-resistant security subscription pads. www.rxsecurity.com/cma-order
SSVMS Vetted Vendor Partners Maloof Law Group Nicholas Maloof, Esq. Estate planning, business transactions. Physician members receive a 10% discount on all services. Cooperative of American Physicians (CAP) Medical professional liability protection to over 12,000 of California’s finest physicians. NORCAL Group Medical professional liability insurance, risk management solutions and provider wellness resources.
Sotheby’s International Realty Mela Fratarcangeli is consistently ranked in the top 5% of all real estate agents in the Sacramento Valley serving the buyers and sellers at all levels in the Sacramento Region.
Crumley & Associates Drawing on more than 120 years of experience, Crumley & Associates emphasizes sound financial planning, along with a variety of personal financial services.
The Mortgage Company The Mortgage Company brings a wealth of experience to every purchase and refinance loan, and exceptional concierge level service.
Bank Card USA By eliminating the middleman, Bank Card USA is able to offer special pricing for our members.
www.ssvms.org/physician-resources/vendor-partners. Questions: dbrooks@ssvms.org
September/October 2020
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| BOARD BRIEFS AND NEW MEMBERS |
Board Briefs July 13, 2020 THE BOARD: Received a report from guest Steve Ferraiuolo, President, Vitalant, West Division (formerly BloodSource) regarding blood services and the impact of Covid-19 on the regional blood supply. Received a report from Director J. Bianca Roberts, MD addressing racism and bias in medicine. President John Wiesenfarth, MD has appointed Dr. Roberts to chair the newly created Health Equity in Medicine Advisory Committee. The committee is charged with studying and developing programs, services and resources to address racism and bias in medicine. Accepted the resignation of Angie Yu, MD from the Board of Directors and approved the appointment of Kristin Gates, MD to the Board to fill the vacancy representing District 5 (TPMG), Office 11. Approved the 2019 Audit Report. Approved changes and appointments to the SSVMS Delegation to the California Medical Association. Approved the 1st Quarter 2020 Financial Statements, Investment Reports and Recommendations.
APPROVED THE FOLLOWING MEMBERSHIP REPORTS June 23, 2020 For Active Membership — Ritka K. Aulakh, DO; Nicole M. Bautista, MD; David A. Cain, MD; Kalyani Chandra, MD; Caroline J. Currie, MD; Khalilah C. Dann, MD; Gagan Preet Garcha,
26
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To see the list of 264 UC Davis residents whose memberships were approved in the July 13 Membership Report, visit https://tinyurl.com/WelcomeUCD-Residents-Fellows or scan the QR code. MD; Gurkaran Singh Garcha, MD; Diane T. Pap, MD; Suneet Verma, MD. For Reinstatement to Active Membership — Richard Bermudes, MD; Rochelle Frank, MD; Oana Galicki, MD; Kevin Rosi, MD. For Change in Membership from Active to Probationary — Stacey A. Nakano, MD For Termination of Membership — Peter Edward Droubay, MD July 13, 2020 For Active Membership — Dylan A. Alegria, MD; Francisco L. Garcia, MD; Namrita Gogia, MD; Tanya Maagdenberg, MD; Thomas E. Melchione, MD; Sukhjinder Sandhu, MD; Smit Singla, MD. For Government Active Membership — Charity A. Dean, MD For Retired Membership — Bhaskara G. Reddy, MD For Transfer of Membership — Bahman Sayyar Roudsari, MD (to Stanislaus); Gerardo Guerra Bonilla, MD (to Placer-Nevada); Matthew Thomas Pena, MD (to Stanislaus); Jonathan James Liu, MD (to FresnoMadera)
New SSVMS Members
The following applications have been approved by the Sierra Sacramento Valley Medical Society. Information pertinent to consideration of any applicant for membership should be communicated to the Society. — J. Bianca Roberts, MD, Secretary.
New Active Members
*Physician specialty abbreviated following name.
Gagan P. Garcha, MD, HOS, Mercy Medical Group
Cheng Nguyen-Xiong, MD, FP, Dignity Health Methodist Hospital of Sacramento Program
Dylan A. Alegria, MD, N, Mercy Medical Group
Gurkaran S. Garcha, MD, HOS, Mercy Medical Group
Diane T. Pap, MD, NM, The Permanente Medical Group
Francisco L. Garcia, MD, FP, River Bend Medical Associates
Rakhal M. Reddy, MD, PD, Adventist Health
Ritika K. Aulakh, DO, FP, The Permanente Medical Group Nicole M. Bautista, MD, IM, The Permanente Medical Group
Namrita Gogia, MD, IM, Mercy Medical Group
Savitha K. Reddy, MD, FP, The Permanente Medical Group
Lorianne C. Burns, MD, PD, The Permanente Medical Group
Erin E. Gonzales, MD, PD, The Permanente Medical Group
Sukhjinder K. Sandhu, MD, FM, Mercy Medical Group
David A. Cain, MD, AN, The Permanente Medical Group
Withman H. Haro, MD, PD, The Permanente Medical Group
Smit Singla, MD, SO, Mercy Medical Group
Kalyani Chandra, MD, IM, The Permanente Medical Group
Matthew P. Herrick, MD, EM, Sutter Medical Center - Sacramento
Shravan Cheruku, MD, AN, Mercy General Hospital
Ron E. James, MD, ORS, Northern California Orthopaedic Assoc
Melody L. Chin, MD, IM, Mercy Medical Group
Elizabeth J. Kailath, MD, MPH, ID, Sierra Infectious Disease
Caroline J. Currie, MD, PD, The Permanente Medical Group Xi Z. Damrell, MD, MS, EM, Mercy San Juan Med Ctr
Steven T. Kmucha, MD, OTO, California Department of Health Care Services
Manjit S. Sran, MD, P , Woodland Memorial Hospital Paramjit S. Takhar, MD, FP, Takhar Urgent Care and Family Medicine Rajinder K. Trewn, MD, IM, Mercy Medical Group Enkhee Tuvshintogs, MD, FP, Mercy Medical Group
Tanya Maagdenberg, MD, OBG, Capital OB/GYN
Suneet Verma, MD, IM, The Permanente Medical Group
Khalilah C. Dann, MD, FP, The Permanente Medical Group
Thomas E. Melchione, MD, OBG, Capital OB/ GYN
David P. Whalen, MD, AN, Mercy General Hospital
Charity A. Dean, MD, MPH, IM, California Department of Public Health
Pritam Neupane, MD, PUD, Mercy Medical Group
September/October 2020
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| OBITUARY |
Ray F. Fitch, MD Colonel, USAF (Retired)
July 11, 1923 – May 27, 2020
R
ay Foote Fitch, MD, a 46-year member of SSVMS and a prominent internist and rheumatologist, passed away in Sacramento on May 27 at the age of 96. “I admired him for his greatness, dedication, caring and very courteous attitude,” said Christine Fernando, MD, who met Dr. Fitch when she joined Kaiser Permanente in 1979. “His patients loved him. His clinics on most days would go until 7:30 p.m., and sometimes until 8 p.m., and then he would bike home. His wife, Betty Jo, would always wait to have dinner with him.” Dr. Fitch led a dedicated and memorable life. Born in New York City, he was hospitalized with scarlet fever. After his father completed his doctorate in psychology, the family moved to Muncie, Indiana where Ray attended grade school and high school. He was 10 years old when he made the decision to become a doctor because of some good experiences he had with physicians. Dr. Fitch joined the Naval Reserve after studying at Ball State University, and after being accepted at Northwestern University Medical School the Navy sent him instead to Loyola University in Chicago for his first two years of medical school. He left the Navy in 1945 and married Betty Jo Millspaugh, whom he had met while at Ball State. They remained married until her death in 2015. Returning to Muncie, in 1949, Dr. Fitch started a general medical practice that offered medical care for $1.50 for an office visit and about $3 for a house call. Comprehensive care for pregnancy was $75. Dr. Fitch returned to military service in 1951 when he joined the Air Force. He completed his internal medicine residency at Walter Reed Medical Center and was stationed in several locations in the U.S. and England. He retired from the Air Force in 1972 as a colonel and 28
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joined the Permanente Medical Group in Sacramento. He was one of the founders of the Sacramento Rheumatology Journal Club, the director of voluntary clinical faculty at UC Davis, and the recipient of the Arthritis Foundation Humanitarian Award. He supported improving doctor to doctor relationships, was known for his positive outlook on life and had a daily routine of commuting to the office by bicycle, rain or shine. In 1989, after 17 years, he retired from Kaiser Permanente. He continued his medical career for another 15 years by volunteering as a Professor of Medicine at UC Davis Medical School. Dr. Fitch was also an active member of SSVMS. He served on the Scholarship and Awards Committee for over 30 years. “He was a kind, gentle man, respected by all who knew him,” said Dr. Richard Bauer, who worked with Dr. Fitch at Kaiser Permanente Sacramento Medical Center. He retired from medicine at the age of 80 to enjoy family and friends, who were of great importance to him, in addition to church fellowship, golf, gardening, and bridge. He was a regular attendee at Internal Medicine Grand Rounds at UCD, often parking some distance away from the entrance for the exercise. “He was a gentleman to the core, very professional, and a caring, dedicated physician who went beyond his call of duty,” Dr. Fernando said. “He was admired by his colleagues, well-respected by everyone who came across him and always available for advice.” Dr. Fitch is survived by five of his six children, six grandchildren, one great-granddaughter, and numerous nieces and nephews. If you wish to make a memorial gift, the Fitch Family suggests a donation to Westminster Presbyterian Church, UC Davis Medical School, Ball State University, Northwestern University Medical School, or your favorite nonprofit organization whose mission is to help the underserved. His ashes will be buried at Arlington National Cemetery.
Telehealth Services Joy of Medicine Resiliency Consultations
P syc ho log i sts
Daniel Rockers, PhD (916) 273-1740 daniel.rockers@gmail.com
Amy Ahlfeld, PsyD (916) 799-3866 drahlfeld@gmail.com
Lori Roberto, PhD (916) 206-1741 drlori@drloriroberto.com
Patricia L. Bach, PsyD, RN (916) 662-0767 pbachpsd@gmail.com
Confidential Convenient Competent Katherine Kilgore, PhD (916) 458-5505 dr.katherinekilgore@gmail.com
Cost-Free
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Angela Trapp (305) 962-1936 3coaching.cc@gmail.com
With increasing stress and pressure physicians are facing, SSVMS is committed to providing all physicians a place to turn during these difficult times. SSVMS will sponsors up to six wellness sessions with vetted psychologists and/or life coaches for physicians in Sacramento, El Dorado, Yolo, and Placer Counties. Members and non-members may utilize this service. To schedule a virtual appointment, contact a Vetted Provider directly, ask what virtual platform they support, and mention that you are accessing the SSVMS Joy of Medicine Program.
Steve Seay (916) 715-9252 stevendseay@gmail.com
JoyofMedicine.org