2021-May/Jun - SSV Medicine by Sierra Sacramento Valley Medical Society

Sierra Sacramento Valley Serving the counties of El Dorado, Sacramento and Yolo

May/June 2021

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Sierra Sacramento Valley

MEDICINE 4

Bad Behavior Can Be a Sign of Burnout

Katrina Pasao, MS IV; Han "Cindy" Lam, MS IV; Sean Deane, MD

Faith Fitzgerald, MD

PRESIDENT’S MESSAGE

Carol Kimball, MD

EXECUTIVE DIRECTOR’S MESSAGE

Together at Last

Aileen Wetzel, Executive Director

OPINION

Unlocking the Love Inside of Us Caroline Giroux, MD

PHOTOS

Notes From a Pandemic

Medical Podcasts Offer Great Stories and Challenge Listeners Michelle Ann Wan, MS III

Crusin’ for a Diagnosis

POETRY

Prometheus

Eric Williams, MD

New SSVMS Members

BOOK REVIEW

100 Voices, 100 Journeys To Find Joy in Health Care

Board Briefs

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.

A Very Good Girl Tim Grennan, MD

Gerald Rogan, MD

2021 SSVMS Honors Medicine

Visit Our Medical History Museum 5380 Elvas Ave. Sacramento Temporarily closed due to the pandemic. Visit our website at ssvms.org/museum for updates and virtual events.

VOLUME 72/NUMBER 3 Cover photo: Artist David Garibaldi finishes his painting of a frontline worker at the virtual Honors Medicine gala.

Photo courtesy David Garibaldi

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

May/June 2021

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.

2021 Officers & Board of Directors

Carol Kimball, MD, President Paul Reynolds, MD, President-Elect John Wiesenfarth, 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 Shideh Chinichian, MD

District 5 Christina Bilyeu, MD Sean Deane, MD Kristin Gates, MD Farzam Gorouhi, MD Roderick Vitangcol, MD District 6 Marcia Gollober, MD

2021 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 Gordon Garcia, MD Ann Gerhardt, MD Farzam Gorouhi, 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 Angela Crans Yoon, MD Lucy Douglass, MD Rachel Ekaireb, MD Karen Hopp, MD Arthur Jey, MD

Steven Kmucha, MD Sam Lam, MD Taylor Nichols, MD Ashley Rubin, DO Alex Schmalz, MD Ashley Sens, MD

CMA Trustees, District XI Adam Dougherty, MD Robert Oldham, 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 Karen Poirier-Brode, MD Gerald Rogan, MD

Glennah Trochet, MD Kayla Umemoto, MS I Michelle Ann Wan, MS III Lee Welter, MD Eric Williams, MD James Zhou, MS I

Executive Director Managing Editor Webmaster

Aileen Wetzel Ken Smith Melissa Darling

Sierra Sacramento Valley Medicine

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. ©2021 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 |

Carol Kimball, MD

Caroline Giroux, MD

Michelle Ann Wan, MS III

Burnout is a serious issue among physicians and it's difficult for those around an affected colleague to know what to do. Dr. Kimball offers some advice from the perspective of the one who needed help.

Sometimes life gives you a sign. For Dr. Giroux, it just happened to be a digital one along the highway. It got her thinking about the nature of love and why loving yourself is the key to loving others.

Podcasts are exploding and there are several with medical themes that are worth spending time with your ear buds. From fascinating stories to challenging diagnoses, Michelle highlights her favorites.

Gerald Rogan, MD

Faith T. Fitzgerald, MD

Eric Williams, MD

Dr. Rogan reviews Joy in Medicine? What 100 Healthcare Professionals Have to Say about Job Satisfaction, Dissatisfaction, Burnout, and Joy, a new book in which health professionals tell their stories.

Faith recalls her days as a chief resident at Mission Emergency in San Francisco and the nightly arrival of the "Boozer Cruiser." She describes a memorable case when the division chief made an unexpected call.

Dr. Williams returns with a new and gripping poem dedicated to the frontline workers who have worked tirelessly through the pandemic and stood with patients through their last moments.

Katrina Pasao, MS IV

Han "Cindy" Lam, MS IV

carol.md.mba@gmail.com

jerryroganmd@sbcglobal.net

katpasao@gmail.com

cgiroux@ucdavis.edu

ftfitzgerald@ucdavis.edu

han.lam6241@cnsu.edu

Katrina and Cindy join Dr. Sean Deane in reflecting back on what it was like to learn and teach as the pandemic upended the routines of medical school. Students faced uncertainty about their training and teachers and hospitals had to scramble to bring training that had traditionally been based on laying of hands into a virtual world. Along the way, they write, there were successes but some limitations also became clear.

mwan@ucdavis.edu

imango@att.net

Tim Grennan, MD

tim.grennan@cnsu.edu

The patient under discussion was unexpectedly in the classroom. She'd even wander with big puppy eyes from student to student to say hello. The patient was Maggie Grennan, MD—as in "medical dog."

May/June 2021

| PRESIDENT’S MESSAGE |

Bad Behavior Can Be a Sign of Burnout By Carol Kimball, MD carol.md.mba@gmail.com

heard a voice yelling into the phone at an insurance representative who did not give the desired answer. Down the hall there was a patient engagement consultant who was quietly explaining how the organization should show kindness and empathy to patients. Clearly the insurance agent on the phone was not getting any empathy that day. I fully supported the consultant and believed what he was saying. It struck me that he heard the yelling, and as the call ended I was embarrassed. Because it was my voice. I was so frustrated and angry in my job that my empathy capacity was drained, and the unfortunate insurance agent had to pay for it. Later I was told that the world was trying to tell me something but that I wasn’t listening. It was, in fact, telling me using my own voice. How had I gotten to this point? I see myself as a thoughtful, kind person who shows respect to everyone. I see the big picture and can describe it to others. The other physicians around me seemed to think I was doing a fine job, but I felt I was ineffective in getting them support. I was becoming isolated and life at home just added to the stress. I was exhausted and felt trapped because no one else wanted to take over my position. On the outside, what people were seeing was a shorttempered woman who was quick to explain exactly how they had let her down. There was low morale among the physicians and the APPs because of an increasing paperwork burden and not enough staff to overcome it. Changes were also happening at work, shifting the way people thought of the structure of our clinic, and an administrator wanted to have all the answers even when there weren’t any good ones. I was frustrated in this environment, felt trapped and could not see how to improve the situation. And several people were done dealing with me, too. Burnout is defined as the presence of emotional and physical exhaustion, depersonalization and detachment, 4

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and loss of effectiveness and accomplishment. So, looking at the situation above: Emotional exhaustion—demonstrated in my rage— check. Depersonalization and detachment—insurance agent treated poorly, as well as several of the managers at work—check. Loss of accomplishment—not being able to effectively change how the providers were supported, and I could not see the accomplishments I had made—check. That’s three for three. Symptoms you may see in colleagues with burnout can include increased substance use, anxiety, agitation, changing sleep patterns, feeling trapped, hopelessness, withdrawal, rage, acting recklessly, and mood changes. While burnout is not considered depression, there seems to be a fair bit of overlap and an increased risk of suicide. Still, should we allow people to act as the worst versions of themselves? No, it should not be tolerated but it also shouldn’t be ignored or left unaddressed. Poor behavior is a chance to intervene and force physicians to take care of themselves. I know because, honestly, this was me. I acted this way, and if I become as tired, bored, trapped and isolated as I was then, I would unfortunately probably act in a similar way again. My goal is to not ever be in that situation again. But what is the road to healing? The antidote for burnout is multifold. It needs social support, connections with others, personal resilience and, ultimately, finding meaning. At first, the social support didn’t exactly seem like social support. Many people recognized that I was no longer able to tolerate the normal stressors of my job before I did. I was told fairly sternly and with the threat of significant consequences that I was no longer welcome to act poorly at work. Never. If I transgressed, I would lose my job.

Photo courtesy David Garibaldi

This may not seem like support, but it was a hard line that forced me to finally stop and listen. Rather than continue on a destructive path, I was given the chance to heal. As my favorite author Brené Brown says, “Clear is kind. Unclear is unkind.” They were (finally) very, very clear. I have a deep faith, but I was not attending to it. I took time to start meditating and praying daily. This experience makes me know that burnout is a mental health condition; in the meditation, I felt shifts and changes in my thought patterns back to normal ones. I felt my compassion returning. I also spent time with friends. During a stage in which I was still very angry, I asked a friend if she believed that I was so terrible at work. The best answer she could have given me was, in fact, the one she gave: she said she did not know because she was not at work with me. She did not let me off the hook. The last bit which really worried me was how to prevent myself from becoming burned out ever again. I listened to several talks about burnout. The Stanford WellMD Model states that there are three factors in provider wellness: the culture of wellness, the efficiency of practice and personal resilience. That is helpful from a leadership perspective, but from my point of view I felt I only had control over my resilience. In Brown’s book Daring to Lead, there is a list of values and guidance on how to discern your core values. For me, this was the nugget I needed. I went through the list and could easily identify respect as

Garibaldi Artwork Donated to SSVMS After an intense bidding war at the SSVMS Honors Medicine gala, David Garibaldi's stunning portrait of a frontline worker was purchased by SSVMS President Carol Kimball, MD—who promptly

donated it to SSVMS so that it can be on display for all our members to enjoy. We want to thank Carol for her generous donation and invite you to stop by and see our new artwork!

one of my core values; whenever I became angry, I realized that it was because either I was being disrespectful or felt that someone was being disrespectful to me. I really had to search for the other core value. I’m still not certain, but I believe it has to do with curiosity. I thrive on learning and teaching, asking questions and always being curious about whether there is a better way. When I was choosing my next job, I started by looking to see if my values would be supported. I made a great choice, and now when I am unhappy about something I am easily able to express it without anger or frustration. I am not afraid to be clear and set expectations, but it comes out differently than before. So here are some of the key takeaways for me that might help you or someone you know:

Clear is kind. Unclear is unkind. Clear expectations for behavior need to be expressed. Poor behavior is not always burnout. But when it is, you could save a life by speaking up. Social support, building resilience and the right work environment are crucial. To prevent future burnout, find meaning. Meaning comes when what you do supports your core values. That’s why it’s so important to take the time to figure out what they are. Please make sure to pay attention to yourself and to your colleagues. If you see the signs of burnout, point it out. If it’s you who is struggling, don’t be afraid to take time away and discern your values and needs. Make sure to get support and be brave enough to make the hard— but right—choice when it’s needed. May/June 2021

| EXEC UTIVE DIRECTOR’S MESSAGE |

Together at Last

SSVMS Delivers as Physicians Celebrate National Doctors' Day

eep down, everyone has their own favorite day of the year. For many it could be saying goodbye to the year—especially 2020—and celebrating a fresh start on New Year's Eve. For others, it may be getting the whole family onto a blanket not nearly big enough for everyone while gazing at a magical fireworks display in the summer sky, all while pretending mosquitos have ceased to exist for thirty wonderful minutes. It might be a birthday or anniversary, or when you enjoy letting your inner child out as you slip into your favorite Power Ranger costume (or maybe something more adult) on Halloween. (Some of our emergency physicians who are on their shifts might not share my affection for Halloween, however.) For me, National Doctors' Day is one of my favorites and a day worth celebrating. Most of us were brought into this world by a doctor, and you mended our broken arms when we fell from the jungle gym. You were the

Chiraag S. Patel, MD shows off the delivery of chocolate chip cookies he received on National Doctors' Day. 6

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By Aileen Wetzel awetzel@ssvms.org

first ones to deliver us amazing news, and you sat with us when our lives changed in unfortunate ways. You have always been there for us, and at SSVMS we want you to know we will always be there for you. Although it might not show up on your calendar, March 30th is National Doctors' Day. While we look forward to this day every year, this year was particularly special because we were able to mark the occasion by doing exactly what has been missing from our lives for 13 long months: looking each other directly in the eyes. And it was wonderful. We were thrilled to join UC Davis Health for a Doctors' Day celebration at the Medical Center. Even though it required being masked and drenched in hand sanitizer, we were able to be in the same room together—vaccinated and comfortable. Although it was decidedly different from our pre-COVID memories—kudos to the the custodial staff for their reassuringly uncompromising table cleaning—the social connections came rushing back. We could look you in the eyes, say good morning, and even crack a cheesy joke. I've missed that. We also coordinated a table of goodies at Sutter Medical Center in Sacramento and at 18 different sites for Mercy Medical Group. In all, we were able to reach more than 3,000 local physicians, including more than 200 independent physicians. It was great to distribute face masks, hand sanitizer and our very own “Crushing COVID—Got My Vaccine” buttons, but the most popular item was easily the cookies that we delivered over the course of the week. The truth is, it was difficult not to eat them ourselves while navigating the roads of our four-county region. This is why Doctors' Day resonated with our staff this year more than ever, because we able to see you in person and share the time together. For the first time in months, we could be there in person to thank you for your dedication and doing so much to get

patients—and each other—through the difficult times of the past year. The term “health care heroes” has been bandied about a lot, but it falls short of capturing your personalities, your humor, your spirit. In other words, all of the things that make SSVMS members so special. If we didn't see you on Doctors' Day this year, please remember that SSVMS is here to support you every day and we'll try to celebrate together next year. In the meantime, our communities are thankful for all you do to save lives and spirits. Let's all hope that the upcoming year gives us more opportunities to get together not just professionally, but also with family and friends. We're all ready for that new beginning—even if it starts on Doctors' Day rather than New Year's Eve.

Physicians at the Doctors' Day celebration at UC Davis Medical Center had a variety of snacks and goodies to choose from.

May/June 2021

| OPINION |

Unlocking the Love Inside of Us

Realize the Potential to Love Yourself and Others

t has been over a year since we cut ourselves from most of our tangible world, and I have had plenty of opportunities to reflect on the impact of social distancing on our wellbeing, as well as the pain of yearnings and the mysteries of love. As I drove to work recently, one of the big electronic signs (which I usually hate, what an eyesore!) displayed a message that resonated with one of my core truths: “BE LOVE.” Like many people, I spent most of my life seeking love outside of me, thinking that a bidirectional flow was necessary for the survival of our soul. Useless to say, this created a lot of unnecessary suffering. We have all heard that social connections are essential to our mental health, but what if we have been misled all along into thinking that the trigger for the source of our wellbeing must be found outside oneself? Would understanding why these relationships are so crucial possibly help us bypass the effects of social deprivation? Could it be that the well-documented necessity of such bonds for our survival reflect that it is really a compensation from some form of childhood emotional neglect, which is way more frequent than we could imagine? Does our need to latch onto the glitter of love at first sight or to find the right mate come from holes in our soul that were not filled during critical periods of our childhood? That begs a life-changing question: What if we can start filling those holes ourselves? I believe love, this mysterious phenomenon, is actually a treasure that is inside all of us from birth on. For many, childhood trauma or neglect has prevented access to the love inside them. But good parents, as we are mirrored and are held by them, can be the compass pointing to a child’s worthiness. That is the key that unlocks the chest deep within us holding the child’s self-esteem and ability to love throughout his or her life. If that is the case (as more and more wise folks seem 8

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By Caroline Giroux, MD cgiroux@ucdavis.edu

to believe), if we already have what we need in us, then we have power to shift the trajectory of our lives. We are no longer at the mercy of external circumstances, including other people’s judgments of us. When you know you are responsible for your own flow of love towards you, that means you have the power to choose to no longer withhold that love. Why would you not love you? You have been your most loyal, supportive, reliable friend all along. Through the years, you learn to know you and develop a deeper attachment to who you are. You can even discover treasures in the closet of your shadow, which consists of the disavowed parts of each person that lie in the unconscious and is the source of magnificent potential. I wish I had figured this out years ago, that we are embodied love and that the world fools us by programming this weird co-dependency into us. But it is never too late to wake up to that truth. We cannot fully receive and give love if we do not unlock this flow of light first. We cannot find a mate who is deeply caring about our wellbeing if we do not care about our own. To paraphrase Dr. Sue Morter in her book The Energy Codes, which I read recently, “all of life is a story of love finding love.” Once you let yourself vibrate at the frequency of love, you will attract those who are in the same mental space, and the simultaneous vibration of your soul will create what we call true love. Sharing joy and being in harmonious love with someone means that your own embodied love is amplified. So where do you start? Just like if you were not taught a specific skill growing up (cooking, budgeting, dealing with loss, etc.), you can either take a class or hang out with role models. If you feel like your parents didn’t teach you to love everything about you (which led to the formation of the shadow), you can unlearn the criticism and judgment by identifying what you like or what you are proud of about yourself and expand on those.

Maybe you appreciate your openmindedness, your musical talent, your eccentricities, or the way you bake cookies. It can be something

kindness toward others, can be a wonderful tool. Get familiarized with the experience of universal love in your work, in nature, or

Why would you not love you? You have been your most loyal, supportive, reliable friend all along. simple or more complex. If nothing comes to mind, imagine you are a stranger who meets you for the first time and starts a lively discussion. What are the positives the stranger would notice in you? Do you know what your friends and family like and love about you? If you agree with them, have gratitude for your gifts. It will boost self-love. Self-compassion and self-care— which is essential, not selfish—are within reach and we must make them a priority. Metta meditation, which promotes loving and

wherever you might be. Reciting positive mantras can build on your feelings of love and self-worth. “I have value. I have a space in the universe. I am worthy, I am relevant. I am enough. I can do this. I trust the whisper of my heart. I will let peace guide me. I can find love because I am love. Everyone is love.” By telling yourself this over and over, it will begin to take hold. Psychotherapy and validating friendships can also help fill some holes. You and your therapist, or even good friends can help each other to unlock the chest of love

within each other. Loving yourself as you are can take the form of setting boundaries, prioritizing your needs to maintain balance, or having the courage of walking away from a toxic relationship even when you fear victim-blaming and uncertainty. I have found that practicing all this helps as I coach patients who have suffered attachment trauma. They teach and inspire as they gradually reclaim disavowed parts of themselves. I have witnessed their beautiful evolution, and they have inspired me to reconnect with beliefs and ideas I had left aside because they were frowned upon by people around me. But I painfully realized that loving myself and feeling whole won’t be possible if I abandon my truth, the fact that I believe love to be the answer and that I must trust my intuition and tap the elements suspended in my shadow.

May/June 2021

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Some of you might remember Mr. Rogers, who asked, “Who loved you into being?” during an acceptance speech for a lifetime achievement award. It was a powerfully meditative moment. If nobody comes to mind in the next ten seconds, if nobody showed you the way adequately enough, know that you can still love you into being. Your life has the potential to be transformed by this truth. Before discovering this thunderstriking truth, my conceptualizations of love went through various stages. As a teen and young adult, I blindly thought the recipient of my love would be the answer. Then, as a more mature (or so I thought) grownup, I candidly believed the chosen one would give me the answers. But ultimately, I came to understand that a true, pure, deep, healthy love would, with compassion, patience, silence and acceptance, give me the space and time to find my own answers. You are a conduit for love. Therefore, you are love, embodied. Most of us forget this at some point. Repeat after me: “I am love.” And if you are love, you can love and be loved. It is all within your hands and heart.

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2021 SSVMS

HONORS MEDICINE This year's Honors Medicine gala was a virtual affair, with members enjoying artist David Garibaldi and joining for a toast to their colleagues. 1) Chris Serdahl, MD; 2) Christine Carroll, MD; 3) John Chuck, MD; 4) Nancy Williams, MD, El Dorado County's public health officer, receives her award for "bold and courageous work" to keep our communities safe. Drs. Olivia Kasiyre of Sacramento County, Aimee Sisson of Yolo County and Rob Oldham of Placer County were also honored. 5) Sean Deane, MD does dad duty as he watches Dr. Kasirye receive her award; 6) David Garibaldi was the featured entertainment, painting this portrait in under 15 minutes; 7) Immediate Past President John Wiesenfarth, MD; 8) Irina Korman, MD; 9) Ruth Haskins, MD; 10) Drs. Anand and Leena Mehta.

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9 May/June 2021

| COVID-19 |

Notes From a Pandemic Recollections of How Teaching and Learning Were Upended in 2020

ditor’s note: Dr. Sean Deane and two of his fourth-year medical students, Katrina Pasao and Han “Cindy” Lam, recall how the start of the pandemic and its progression affected training and teaching—as well as everyday life in a practice where the waiting room was suddenly empty. As with most elements of life in 2020, teachers, students and patients had to adapt to a new way of doing things. While the students were continuing their training, the teachers and hospitals were learning largely on the fly how to provide that training using virtual platforms while still maintaining some degree of normalcy. These unique circumstances led to innovation in virtual training and care but also exposed some of its limitations. Katrina Pasao: “96.6F. You are good to go.” I proceeded to enter the hospital lobby after the COVID-19 symptom screening, which by now has become a familiar daily routine. The once bustling hospital lobby was now filled with a nervous silence. I let out an uneasy smile behind my surgical face mask as I made my way through the hallways toward the Medical ICU. It was March 2020 and news of COVID-19 in Sacramento was becoming more and more serious by the day. As I logged onto the computer to pre-round my patients, I started to instinctively count the numbers of COVID-19 positive patients on the census. It had been steadily increasing. I glanced toward the ICU rooms all occupied with patients. It was just like any other day on the ICU rotation. “Looks like the hospital is thinking of pulling out

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students because of the pandemic!” my attending exclaimed as she sat down. I looked up in surprise. I was nearing the end of my Internal Medicine core rotation and my Surgery rotation was next. What does that mean for us students? Where will we go for clinical experience if the hospitals were closing their doors to students? I was left completely stunned at this unexpected development. Little did I know, it was only the beginning of the onslaught of changes that awaited us as the pandemic took off. The traditional clinical curriculum was discarded as medical schools scrambled to adapt to a virtual curriculum with online lectures, didactics, and simulated patient encounters through Aquifer, File X, and other resources to supplement learning as students are pulled off rotations. Sean Deane, MD: The quiet is unnerving. The allergy/immunology clinic I am used to is filled with the sounds of families in various stages of waiting to be seen, being seen, being discharged, children playing, children laughing, and sometimes, children being consoled. Ours is a joint practice of three allergists who enjoy each other’s company and that of our staff. We are friends as well as colleagues, interdependent on each other. Our young field often manages problems for which answers do not yet exist, disorders for which medical science does not yet have a name or a cause. In our tight-knit group we are used to sharing the

burden by popping in and out on each other, sharing thoughts on management, coming up with consensus solutions, often, sharing a laugh or concern. Usually, we are not alone. Among the things we share is a love of teaching, and we usually have students and residents with us, all crowded together in our small shared space, talking, teaching, laughing, arguing, like a flock of eternally jabbering white coated gulls. We love it. It is good for us. It is good for our patients, who receive the very best of care that comes from the synthesis of perspectives from multiple collaborative minds. Now, silence. The change is sudden. “The last medical student rotation has been canceled due to the COVID-19 pandemic and I am not sure when they will be reinstated,” reads the email. I am the only one in the office. My colleagues are working from home. There is no student, no resident, no fellow. There are no patients in the rooms. There are no patients on the allergy shot line. I half expect to look out the window to see Charlton Heston staring at the Statue of Liberty buried in the sand. A friend among the office staff recently gave me a disco ball as a gag gift. It is still under my desk. I balance it on my officemate’s chair, put my coat around it, and send him a picture with the caption: "It’s too lonely in here so I decided to create Disco Garcia to keep me company." I put on my white coat and open my exam room door to meet the waiting webcam that will come to define much of pandemic practice. Cindy Lam: Eventually, many rotations resumed clinical activities while only prohibiting students from coming into contact with potential COVID-19 patients. But the threat of rotations cancelling was imminent and only one COVID-19 surge away. Third- and fourth-year students found themselves By Jon Davids, MD facing an entirely different clinical experience than the jdavids@shrinenet.org years before them. Away rotations at outside facilities were discouraged and face-to-face patient encounters

were limited. Most clinical practices adopted the virtual platform in which patients would be seen via video call and in-person visits are reserved for procedures and follow-ups that require a physical examination. Katrina Pasao: One of the practices that adopted the virtual platform is the Kaiser South Sacramento Allergy clinic. Dr. Sean Deane, one of the clinic’s allergists, divides his time as an allergist, hospitalist, and clinical associate professor. A quick look at his schedule reveals back-to-back video consultations for the whole day. As we both log on to the next visit in our respective offices, we do not have to worry about wearing our face shields in front of the computer screen as exposure to infectious diseases are significantly limited with this mode of communication. Sean Deane, MD: The students are returning. We have adapted our practice to a telemedicine focus, we have sorted out the workflows on how to get patients in when they need to come in. Now we have to figure out how to teach somebody to independently care for their future patients without the benefit of having had the background experience of in-person medicine to know what can be done through a screen and what cannot. Some providers have them shadow the video visits and then do a didactic session, some providers have the students review the charts. In the pre-pandemic world, learners would see the patient independently, present them to us with their findings and their plan, and then we would go in and see the patient together and confirm the findings and discuss the plan and make any necessary changes. It struck me that I still put on my white coat and walked into the exam room to see the webcam when we changed over to virtual visits. So, I figured, why change? The students will see the patient, the students will come up with a plan, then I will see the patient, we will adjust the plan, and we will talk about the findings. It is just that now, they’ll be learning through the virtual exam. Katrina Pasao: The patient appeared on the screen and marveled at the convenience of the online visits. She was taking care of her young children at home and would not have been able to leave her home to attend this visit. This was a common occurrence among

May/June 2021

The traditional clinical curriculum was discarded as medical schools scrambled to adapt to a virtual curriculum with online lectures, didactics, and simulated patient encounters.

Cindy Lam: Although video visits are convenient for both health care providers and patients, there are limitations. One glaring disadvantage of the virtual platform is the inability to perform physical examinations. This limitation was clearly depicted in the unfortunate story of a young mother in her early 30s who reached out to her PCP via email for a change in her inhalers. She feared her asthma was not responding to the treatment as her lungs felt tighter by the day. She thought she was having an allergic reaction to her inhalers as her face and body began to swell. After a virtual evaluation, her PCP changed the inhaler in an effort to treat the working diagnosis of asthma. The woman was later seen in the emergency department and transferred to the ICU for decompensated congestive heart failure with a significantly reduced ejection fraction. It is crucial to note that despite the convenience, limited infectious disease exposure, and potential for certain cost savings with telemedicine, significant find-

Sierra Sacramento Valley Medicine

Photo by Cindy Lam

patients when they had other obligations that prevented them from conducting a visit with their physician without leaving the comfort of their home or without missing significant time from work. Appointments like these were the result of months of trial-and-error while hospitals worked to streamline the video platform, installing webcams, headsets, and ringlights in order to provide a seamless patient encounter. The video platform became an invaluable tool that enabled continuation of health maintenance care in the midst of the COVID-19 pandemic. If anything, the need for contactless patient encounters created by the pandemic has pushed institutions to develop a robust and widely accessible platform for telemedicine that will serve us well beyond the pandemic. The virtual visits will serve as an alternative method of patient care and allow for greater access to health care while reducing costs. Cindy Lam prepares for a video visit with a patient. While video is convenient for patients and providers, the pandemic also exposed its limitations. ings may remain undetected without proper evaluation. The system must remain vigilant and capable of addressing situations in which patients need to come in come in for in-person appointments. As the pandemic weighs on, there are many uncertainties and changes that lie ahead. From medical schools converting to a virtual learning environment to physicians adopting a video visit platform, innovative solutions have been implemented to address problems brought on by the pandemic. They are not without their own set of limitations. However, I am certain of the desire and ability of our education and health care systems to adapt in order to serve the ultimate purpose: to train the next generation of physicians and provide the best service and care to our patients.

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| RESOURCES |

Medical Podcasts Offer Great Stories and Challenge Listeners Top Choices Are Entertaining as Well as Insightful

ver the last several years, podcasts have become an incredibly popular media for both creators and consumers. Over half of all Americans over the age of 12—or about 144 million Americans—have listened to a podcast, and about a third of Americans listen to at least one podcast each month. SSVMS produces its own podcast, Joy of Medicine, with host Dr. Peter Yellowes talking to local physicians about what makes them happy, mostly outside of medicine. The episodes have been downloaded over 4,000 times and are available monthly. But Joy of Medicine is just one star in a universe of podcasts. Podcast Insights estimates that there were about 1.75 million different shows and 43 million episodes available in 2021 on a wide range of topics, including medicine. Many that I listen to are educational and entertaining supplements to my undergraduate medical education curriculum. Here are some medicine and medicine-related podcasts that I can recommend and think SSV Medicine readers will enjoy.

The Nocturnists The Nocturnists is a live storytelling event and podcast, modeled after the popular live show The Moth, that invites health care workers to share the moments of joy, inspiration and hardship that provide insight into what it means to work in health care. Each episode is a recording of a story told to a live audience followed by an interview between the storyteller and show creator Dr. Emily Silverman. The storytellers come from diverse occupations and specialty fields at all levels of training, from medical student to retired physician. They share about building relationships with patients, overcoming crises of confidence, and other moments of humanity when 18

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By Michelle Ann Wan, MS III mwan@ucdavis.edu

working in medicine. The Nocturnists team produced two special series in response to the crises of 2020. “Stories from a Pandemic” reveals the impact of working through the unknowns in the early days of the pandemic in audio clips submitted by health care workers from across the country in real time from March to May of 2020. In “Black Voices in Health Care,” created after the murder of George Floyd, Black colleagues tell of their experiences of racism in health care as well as experiences of joy, finding identity, and celebrating Black voices. Comparing the very different podcasts on this list is difficult, but The Nocturnists is my favorite. I love good storytelling; it builds empathy and community. For every emotion I have felt in my medical training, there is a corresponding story from a colleague sharing their own feelings of shame, inadequacy, and burnout, but also of catharsis, hope, and acceptance. These stories inspire me and make me excited to be joining the medical community. The Nocturnists is available on Apple Podcasts, Spotify, Stitcher, and at www.thenocturnists.com.

Bedside Rounds This monthly podcast provides the historical context they don’t teach in medical school. Each episode is an insightful and fascinating history lesson that attempts to make sense of medical practices of the present. Presenter Dr. Adam Rodman is a fan of history and how events in history continue to shape how we think about and treat disease in modern medicine. Dr. Rodman says he was inspired to start his own narrative podcast about medicine after not finding one out there already, and he modeled it on podcast classics By Eric Williams, MD such as Radiolab and 99% Invisible. imango@att.net

Core IM This is one of several medical education podcasts that focus on case-based discussions of chief complaints and clinical pearls in internal medicine that can be taken to the bedside. Core IM offers five different series. Hoofbeats challenges listeners to solve diagnostically difficult cases in real time along with experienced clinicians. 5 Pearls offers clinical pearls on specific topics immediately applicable to patient care, while At the Bedside focuses on topics in medical ethics. The Interprofessional Education Series episodes offer insightful interviews with interprofessional colleagues about their roles in the health care system, and Mind the Gap discusses the evidence—or lack of evidence—for practices in internal medicine. I found Mind the Gap especially helpful in the transition from pre-clinical to clinical undergraduate medical education for reviewing diagnostic schemas and sharpening clinical reasoning skills. Detailed show notes on the podcast website summarize the key takeaways of each episode. The material is appropriate for trainees and practitioners at all levels. ACP members can earn CME credits from listening.

Photo: bedside-rounds.org

Bedside Rounds subjects have included the 20thcentury pellagra epidemic in the southern United States, tuberculosis and the creation of sanatoriums, a threepart series on how the causal link between smoking and lung cancer was established, and the deification of William Osler. Dr. Rodman does extensive research to prepare for each episode. He draws on dozens of contemporary medical and historical journal articles in addition to primary sources when they are available to put together a cohesive summary of the historical context of events and provides a brief analysis of why they continue to matter to medicine today. All of his sources are listed in the show notes for listeners to reference independently. Through a partnership with the American College of Physicians, ACP members can earn CME credits by listening. Bedside Rounds is available on Apple Podcasts, Spotify, and at www.bedside-rounds.org.

Dr. Adam Rodman is the host and creator of Bedside Rounds, a must-listen for fans of medical history. Core IM podcasts can be streamed through Apple Podcasts, Spotify, and at www.coreimpodcast.com. For additional internal medicine podcasts on clinical reasoning and practice knowledge, also check out Curbsiders and Clinical Problem Solvers, both of which are available on Apple and Spotify.

Dr. Death, Season 1 This is a narrative podcast from the podcast production company Wondery about cases of medical malpractice. The first season focuses on the crimes of Christopher Duntsch, a former neurosurgeon in Texas who seriously injured 31 patients and killed two before his medical license was revoked. He was convicted of first-degree felony injury of an elderly person, for which he is serving a life sentence in prison. The series is reported by a health and science journalist, Laura Beil, and is intended for a broad general audience. It is a captivating production of narrative journalism that demonstrates why investigative narrative series have become so popular among podcast listeners. We hear the voices of Duntsch’s former patients, victims, and the physicians who raised warnings about his incompetence and helped get his license revoked. The writing and narration are suspenseful. While Duntsch’s trial in 2017 was covered by local May/June 2021

Photo: thenocturnists.com

Dallas and Texas media, this podcast brought his crimes and victims' stories to national attention. It also raises questions about the systemslevel flaws that allowed a dangerous and incompetent physician to continue practicing. You can listen to Dr. Death through Apple Podcasts, Amazon Music, Spotify, and at wondery.com/shows/dr-death.

Curious Clinicians

Emily Silverman, MD, the founder and host of The Nocturnists, is a doctor at Zuckerberg San Francisco General Hospital and an assistant professor of medicine at UC San Francisco.

In each episode of Curious Clinicians, hosts Drs. Hannah Abrams, Tony Breu and Avraham Cooper explain the “why” behind commonly encountered clinical presentations, mechanisms of disease, and pathophysiology. They ask questions such as why fingernail clubbing presents in so many different diseases, why acet-

aminophen toxicity causes metabolic acidosis, and why transmural myocardial infarctions lead to ST segment elevations on EKGs. These were all questions that I once had in a lecture hall but quickly filed away in favor of learning the material on the next lecture slide. Curious Clinicians finally helps me find the answers I was looking for. The 20-minute episodes are short, digestible and excellent complements to the practice knowledge podcasts such as Core IM and Curbsiders. Learning the “whys” has helped me retain the information more effectively than simply memorizing the facts, and this podcast provides explanations that are fun and succinct. Curious Clinicians is available on Apple Podcasts, Spotify, Stitcher, and at www.curiousclinicians.com.

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.

Ariella C. Emunah, MD, P, Turning Point Community Programs Efrem H. Gebremedhin, MD, END, Mercy Medical Group Okeanos Z. Gerell, MD, NPM, Sutter Medical Group Zahid Iqbal, MD, HO, Sutter Medical Group Amanda A. Kamali, MD, ID, California Dept. of Public Health

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John H. Lee, MD, GS, Sutter Medical Group Stanley W. Leff, MD, FP, Sutter Medical Group Robert B. Lurvey, MD, JD, U, NorthBay Healthcare Group Brett L. Mathieson, MD, AN, Sutter Davis Hospital Erika M. Roshanravan, MD, FP, Hansen Family Health Center (Communicare)

Victoria Belle Y. Shin, DO, UC, Sutter Medical Group Jeffrey N. Stoneberg, DO, PLM, Sutter Medical Group Lauren P. Strickland, DO, GS, Sutter Medical Group Stephen Tseng, MD, IM, Calif Correctional Health Care Svcs Yelena V. Usmanova, MD, N, Mercy Medical Group

|BOOK REVIEW|

100 Voices, 100 Journeys To Find Joy in Health Care New Book Uses Health Care Professionals' Own Words to Describe How They Sought Joy in Medicine

ashington D.C. based medical writer Eve Shapiro is keenly interested in relationships within health care and in the stories people tell about themselves and their experiences. That interest is evident in her new book, Joy in Medicine? What 100 Healthcare Professionals Have to Say about Job Satisfaction, Dissatisfaction, Burnout, and Joy (Routledge, $136.24 hardcover, $29.95 paperback on Amazon). The book’s stories, told in these professionals’ own words, explain what promotes, diminishes, and destroys joy in medical work. Curiously, the same circumstance can affect individuals differently. For example, some professionals relish jobs that give them autonomy and control; others seek jobs that allow them to work in the multiple roles of clinician, researcher, writer, and teacher. Some like to own and manage a business. Others prefer to be an employee with less business responsibility and financial risk. Each story is divided into several sections including the choices and motivations that led these health care providers to a career in medicine, their subsequent professional journeys, factors that bring and diminish joy, finding balance in life, and financial issues. Recognizing what factors are important to each individual can help one choose a specialty, practice setting, and institution that is more likely to be a good match. Some people focus on their passion for patient care, leadership, or teaching. Others describe journeys that led to multiple careers within the greater medical industry. Electronic medical records are a burden for some, while for others they are a blessing. The stories include experiences with solo practice, employment within a large group, and how one balances family and

By Gerald Rogan, MD jerryroganmd@sbcglobal.net

professional commitments. The stories include orthopedic surgeon Harlan Z., who explains his three motivators: autonomy, mastery, and purpose. Alan F. tells of his evolution from a sculptor to an anesthesiologist, then to start and run a company that coaches medical groups to improve the joy and quality of their internal culture. Ruth N. talks about her entry into nursing at age 59, while Eliot D. describes his work in South Africa and at a U.S. public inner-city hospital. Anthony F. discusses his professional career as an internist, professor, and integrated health system medical director, and Derek V. recounts his path from being an OB-GYN physician to becoming a medical director for Humana. Of all those she talked to, Shapiro found only one person—a neurosurgery resident—who chose a specialty for the money. Others, especially more experienced docs, said money should not be a factor in choosing a specialty because all will provide enough money to pay back student loans and support a family with a reasonable lifestyle. Some believe income is not important, but others want freedom from financial uncertainty. For those who wish to understand various causes of physician burnout, the book offers many stories describing what led physicians to change careers, including, for some, abandoning patient care. Folks who wish to understand corporate psychology will find helpful words, particularly now that medicine is rapidly changing into integrated health care delivery systems. Joy of Medicine? would be a beneficial reference for high school, college, and medical school libraries to help students clarify career options in the field of medicine. It can also be an enlightening resource for current practitioners who are considering new career options and can learn from the choices others have made.

May/June 2021

| ESSAY |

Crusin’ for a Diagnosis One Physician’s Memorable Admission From the Heart

any years ago, the City of San Francisco had a program where ambulances (then unkindly called the “boozer cruisers”) would set out at night to pick up people on the street, mostly alcoholics, found collapsed on the sidewalk, huddled in doorways, staggering into traffic, or otherwise clearly unable to care for themselves. They would then bring them to the emergency room (Mission Emergency) at San Francisco General Hospital. There they were triaged by the ER medical resident, deloused if necessary (dipped into the Cuprex bathtub) and given cots in the men’s area. Each was hooked up to a “yellow bottle” to supply vitamins B and C intravenously. By tradition, the yellow bottle (so colored by the vitamin B) once yearly turned into a “green bottle” when a house staff wit added drops of methylene blue to the yellow IV fluid on St. Patrick’s Day. Those men found in life-threatening withdrawal (delirium tremens), injury or other illnesses were admitted to the wards. Those judged to be safely manageable in the ER, and fit enough for probable discharge the next morning, were held in the ER’s overnight ward. Their clothes were taken away to be laundered. They slept on clean, white sheets, and in the morning delivered to them were several large trays of hot buttered toast, oranges and coffee. Those well enough to return to the streets were dressed in their now clean clothes and discharged, but not until they ate the toast and oranges, drank the coffee, and in most cases, had their hair combed by the nurses and ancillary staff. Before any discharges, however, the chief of internal medicine and the chief residents (of whom I was one) would make early morning rounds with the ER house staff on all the patients under their care. Most of the patients were ready to go, and many thanked us for the cot, the caring, and the food. They were given Alcoholics Anonymous contact information, and, almost to a man, 22

Sierra Sacramento Valley Medicine

By Faith Fitzgerald, MD ftfitzgerald@ucdavis.edu

praised future abstinence from alcohol, as they had promised many times before. Some presaged this with a a wave and a smile at us, saying: “See ya later.” One old man, however, was still on his cot when we rounded. He was very, very thin, ribs protruding, scaphoid abdomen, wasted arms and legs, and breathing shallowly with his eyes closed. He was, however, easily arousable. When the division chief asked him how he as doing, the old man said repeatedly, and in a whisper, little other than: “I am so tired.” He had been found down in a gutter by the Boozer Cruiser team, reeking of alcohol and vomitus. His physical exam, other than cachexia and mild hypothermia was, the ER resident had declared, unremarkable. His CBC and chemistries were within normal limits. My division chief listened to his heart and lungs, palpated his abdomen, and checked his reflexes. All were normal. The division chief then nodded, turned to the ER resident and said, “Admit him.” The ER resident was both surprised and very, very unhappy. It was, during that era in medicine, that the ER physician was proud to be a “rock,” admitting as few patients to the medical wards as possible, either by discharge or cunning triage to another specialty. His umbrage, as they say, was quite palpable. The resident began to argue with the chief, who repeated, with set jaw and steel in his voice, “Admit him. Now!” The ER resident challenged the chief again. “With what diagnosis? What do I tell the ward resident is the reason for admission?” The chief looked straight at the resident as he gave him his answer. “Compassion.”

Serotonin Surge Charities extends a heartfelt thank you to the generous sponsors, donors, performers, and event guests who supported our 2021 Great Adaptations Serotonin Surge Charities extends a heartfelt thank you to the online fundraiser for safety net medical care in the Greater Sacramento region.

generous sponsors, donors, performers, and event guests who supported our 2021 Great Adaptations online fundraiser for safeCOVID-19 Terminators: Dr. &care Mrs. Thomas & ty net medical in the Greater Sacramento region. Elizabeth Atkins, Dr. & Mrs. Dave & Sue Cosca, Mr. & Mrs. Bill & JoAnn McGowan, Mr. & Mrs. Jeff & Mary Nicholson, Vanguard Charitable (as recommended by Drs. Alan Anzai and Shing Chung). Vaccine Warriors: Mr. & Mrs. Rex & Janet Berry, California Northstate University, Dr. Yvonne Otani & Mr. Gasem Sahit, Drs. Ginger Joyce & Oliver Stanton. Physical Distancers: Mr. & Mrs. Mike Hughes & Dawn Casteel, Mr. & Mrs. Ron & Rebecca Cole, Ms. Julie Kuo & Dr. Mark Eaton, Mr. & Mrs. Tim & Kim Lien, Drs. Joanne Low & Martin Hikido, Dr. & Mrs. Roderick & Liza Vitangcol. Face Maskers: Dr. & Mrs. Hilary & Maureen Brodie, Mr. & Mrs. Greg & Traci Fung, Ms. & Mr. Tracy & Stuart Kaplan, Mr. & Mrs. Chuck & Lori Krouse, Mr. & Mrs. Bill & Nanc Roe, Dr. Rosemary Wu. Hand Washers: Ms. Beth Abad & Mr. Kevin Duggan, Mr. Paul Chuck & Ms. Liane Wong, Ms. Kathleen Doty, Ms. Julia Estrella, Eye Site Sacramento Medical Group, Inc. (Drs. Chris Serdahl & Richard Jones), Mrs. Winifred Fung, Mr. & Mrs. Allan & Kathy Goulding, Mr. & Mrs. William & Barbara Greene, Ms. Kelly Guenther, Dr. & Mrs. Chris & Carol Jensen, Dr. & Mrs. Ray & Jennie Jing, Mr. & Mrs. Michael & Heloisa Kinder, Mr. & Mrs. Rich & Amy Seropian, Mr. Mike Wiethorn.

Thank you Mrs. Sue Stiling for a special gift in memory of the late Dr. Jim Stiling, a long time friend of the Chuck family and Serotonin Surge Charities.

serotoninsurge.org

| POETRY |

PROMETHEUS By Eric Williams, MD imango@att.net The box of Pandora lay open and Heroes rise. They stand ...with you ...working tirelessly ...with equanimity under duress— to hold back the surging tide of impending death. Using science when possible empathy and human kindness when not. Heroes stand strong in families’ stead and of loved ones who could not. Heroes bear witness to final words from loved ones to patients. They stand vigil when there is naught else that could be done. And when there was no fight to be fought they hold a hand ...then hold a moment more till death has passed their way ...and hold a moment more as families do for in that moment they are you. For while science drives us our humanity defines us. Heroes hold a hand and whisper a solemn prayer. At days end in their cars heroes sit ...inhale deeply and recall that though they are fit, at the end their patient could not ...inhale deeply ...breath deeply and exhale the odor and the taste of the long worn mask ...breath deeply in the safety of their ‘alone’. Tears threatening, they too—now alone—breathe deeply ...as their patient could not

Sierra Sacramento Valley Medicine

Heavy-hearted heroes drive home mindlessly knowing the way. Hopelessly numbed by the events of the day Their rearview mirror filled with ghosts; the soul of a loved one with others left to grieve. The heroes who clean and scrub and prepare the room could hear the echoes of death, Of lives lost in this battle and they wonder what more they too could do. Housekeepers and environmental specialists now clean and scrub and clean and scrub and clean much too often now. Now home, these heroes disrobe, changing clothing to protect their own. They shower and wipe to rid themselves of an enemy which they cannot see. They wash their faces with water and soap. Some even rinse their eyes to redness. Appetites lost and still wondering, they hug their loved ones ...to satisfy the deep need for skin against skin ...to share a breath among others ...to hear clear voices and unmuffled laughter. Heroes close their eyes for elusive sleep and a moment without ‘rapid response’ and ‘code blues’ ...without death ...a few hours to fill the gaping ragged hole left in their hearts. They close their eyes and move on to another day. Pandora rages... Prometheus rises... Heroes arrive at Mount Caucasus... This day... Like yesterday, and Day upon Day upon Day...

May/June 2021

| BOARD BRIEFS |

Board Briefs

For Government Active Membership — Amanda A. Kamali, MD; Stephen Tseng, MD.

March 8, 2021

For Reinstatement to Active Regular Membership — Okeanos Z. Gerell, MD; Robert Lurvey, MD.

THE BOARD:

For Resident Physician Active — Chisom Ofodire, MD

Received an update from Director Vanessa Walker, DO, chair of the SSVMS Honoring Wishes Program. In the fall of 2020, SSVMS launched the End-of-Life Program and soon thereafter the name was changed to the Honoring Wishes Program. A steering committee was established comprised of physicians from different specialties practicing in a variety of health care settings including critical care, emergency care, hospice, geriatric, and family medicine. Under the guidance of the committee, SSVMS is developing tools and resources to educate physicians and to help physicians educate patients and families on the importance of advance care planning.

For Retired Membership — Cecelia N. Berg, MD; Michael J. Bicocca, MD; John M. Chuck, MD; Janice A. GranzellaRogers, MD; David P. Kissinger, MD; Jane O. Koenig, MD; Kim Wang, MD; Andrew W. Wertz, MD.

Received an update from Aileen Wetzel, CEO and Lindsay Coate, Vice President of Strategy and Operations regarding the Joy of Medicine Physician Well-Being Survey Results, and approved recommendations based on responses from physicians participating in the survey. Approved the January 2021 Financial Statements. Approved the 4th Quarter 2020 Financial Statements, Investment Reports and Recommendations. Approved the Following Changes to the SSVMS Delegation: Angelina Crans Yoon, MD to Delegate; Steven Kmucha, MD to Delegate; Janine Bera, MD to Alternate-Delegate; Mohammed Khan, MD Resigned. Approved the following Membership Reports: March 8, 2021

For Resignation (left area) — Khurram Abbass, MD; Earl T. Abel, MD; Zaida L. Albarracin, MD; Rawaa M. Almukhtar, MD; Ghazaleh Bahrami, MD; Macario Camacho, MD; Thomas J. Curran, MD; Nicholas A. Currlin, MD; Oana Galicki, MD; Devon E. Ganter, MD; Carolyn A. Geanacou, MD; Thomas O. Gifford, MD; Christopher M. Johnson, MD; Monica C.Q. Kieu, DO; Scott B. McCusker, MD; Purvi Y. Parikh, MD; Vivek-Sagar M. Patel, MD; Gary W. Roach, MD; Iliana I. Rodriguez, MD; Jonier R. Rodriguez, MD; Homayoon Shahidi, MD; Afshin Samet, MD; Armen Serebrakian, MD; Tiffany W. Shiau, MD; Anna X. Tsai, MD; Kenneth K.C. Vu, MD; Megan J. Wolf, MD. For Membership Termination (license expired) — Chong-Xian Pan, MD; Dania G. Malik, MD; Timothy J. McDonald, MD; Shelby McLaughlin-Patel, MD; Pooja Prasad, MD; Jean M. Struthers, MD; Eric J. Wevers, MD. January 25, 2021 For Active Membership — Samira Kirmiz, MD; Eric D. M, Kuo, MD; Akilesh Palanisamy, MD; Michael J. Sasevich, MD; Peter Valenzuela, MD. For Change in Status from Active to Active 65/20 — Lydia Wytrzes, MD.

For Active Regular Membership — Zahid Iqbal, MD; Yelena V. Usmanova, MD.

For Retired Membership — William R. Vetter, MD.

For Resignation — Pin-Chieh Chiang, DO (left area).

For Resignation — Khuram Arif, MD; Richard D. Carvolth, MD; Lisa M. Cookingham, MD; Jenny N. Du, DO; Alexander R. Facque, MD; Samuel E. Galle, MD; Jesse A. Reinking, MD.

For Termination of Membership — Stanley W. Leff, MD (license expired). February 8, 2021 For Active Regular Membership — Airella C. Emunah, MD; Efrem Gebremedhin, MD; John H. Lee, MD; Rett L. Mathieson, MD; Erika M. Roshanravan, MD; Victoria Belle Y. Shin, MD; Jeffrey N. Stoneberg, DO; Lauren Strickland, MD. 26

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For Retired Membership — John A. Schafer, MD.

For Transfer of Membership — Alison G. Chang, MD; Priya Duggal, MD; Gary Lin, MD; Andrew J. Meyers, MD; Jeremiah W. Ray, MD; Kyle C. Smith, MD; Arata F. Zowghi, DO. For Membership Termination (license expired) — Lloyd K. Ito, MD.

Member Benefits & Resources

The Sierra Sacramento Valley Medical Society (SSVMS) offers many resources and services exclusively for our over 6,000 physician members. Members receive specialized one-on-one assistance designed to keep your independent practice healthy and viable. Join us today by contacting dbrooks@ssvms.org or by visiting www.ssvms.org.

COVID-19 Advocacy Access up-to-date members-only resources, including financial and practice management tools that will ensure your medical practice is prepared to survive and thrive during the pandemic.

Practice Resources For practices of all sizes, and including HIPAA compliance toolkits, practice management guides, patient forms, resources for starting, closing, or expanding your practice and more.

COVID-19 Vaccine Clinic for independent physicians and office staff. SSVMS provided exclusive access to the vaccine to ensure the safety of you and your employees.

Joy of Medicine No-cost sessions with psychologists and life coaches, CME wellness education, physician interest groups and more. Visit www.JoyofMedicine.org to learn more.

PPE Relief No cost boxes of PPE, worth $4,800, available to keep physicians, staff, and patients safe.

Educational Programs Free CME’s, webinars and in-person seminars.

Economic Advocacy Access to highly trained economic advocates with expertise in physician reimbursement are available to provide one-on-one help with payor issues and contracting at no cost. Statewide, more than $30 million has been recouped over 12 years. Legal Resources Over 5,400 pages of On-Call documents and valuable information for physicians and their staff at no cost.

Discounts For insurance services, office supplies, magazines, security prescriptions and more. News and Information Stay informed about public health, practice management, and other breaking healthcare news. Leadership Opportunities Serve on the SSVMS Board of Directors, Delegation, or a Council or Committee. Connect with Peers Meet colleagues through virtual networking opportunities.

www.ssvms.org

| APPRECIATION |

A Very Good Girl

Remembering Maggie the Medical Dog

73-year-old female of Scot tish ancestry was noted by a colleague to have lost weight. Further history indicated that she had become less active and experienced a loss of appetite along with dark, tarry stools, but no apparent abdominal pain. So began the case about a patient with iron deficiency anemia and the wrap up to a discussion about this common malady with a multiplicity of possible etiologies. As with many case discussions, clues to the case were revealed layer by layer until the etiology of the iron deficiency was discovered to be an adenocarcinoma of the duodenum. The first year students in class at California Northstate University College of Medicine were completing a segment in their hematology course dealing with anemia, but little did they know that the “patient” was in the room for the discussion. She wandered from student to student, saying “Hi” in her own unique way: sniffing them, putting her nose on their lap, and gazing into their eyes with her own soulful eyes as if to say, “How are you doing today?” The patient was Maggie Grennan, MD. That’s “MD” as in “Medical Dog.” Maggie was a golden retriever who worked as a visiting dog for Pet Partners, working almost exclusively with medical students. For over half of her life, she visited medical students and residents from UC Davis who were rotating on their internal medicine rotation at Kaiser Permanente, Sacramento, and at UC Davis

Sierra Sacramento Valley Medicine

By Tim Grennan, MD tim.grennan@cnsu.edu

with students during their third year “Doctoring Three” course. For the past three to four years, Maggie had been an integral part of College 10 and now College 7 at CNU. Maggie had the remarkable gift of empathy that goldens are famous for—kind, caring, intuitive about reading people, and always comforting. Students from all over Cal Northstate would flock to her when she was on campus. Maggie often created a traffic jam between classes, but she always dispensed her love and attention on whoever needed it. Maggie was known to be a “diva” and a “drama queen” as she was always in the middle of a crowd of students and always loving the attention. Although Maggie’s adenocarcinoma of the duodenum was successfully treated with surgery at the UC Davis Veterinary Hospital, further problems with cancer were ahead for her. Unfortunately, Maggie also developed two types of non-Hodgkin’s lymphoma, an indolent type and an aggressive type (along with her successfully treated adenocarcinoma of the duodenum). While undergoing chemotherapy treatment for her aggressive lymphoma at UC Davis Veterinary Hospital, where she received world class care, Maggie improved and had a good quality of life for several months. However, like many oncology patients, and like many golden retrievers, Maggie died from her disease in February 2021 at the age of 10, leaving many students and family members the better for having known her.

Closer to home + enhanced referrals = easier access to world-class care Chief of Cardiothoracic Surgery Bob Kiaii, B.Sc., M.D., F.R.C.S.C., F.A.C.S., is currently president-elect of the International Society for Minimally Invasive Cardiothoracic Surgery, and widely known for several surgical firsts and advancements in the field. He performed Northern California’s first robotic mitral valve repair last year after coming to UC Davis Health.

UC Davis Health offers nationally ranked medical specialties and prominent innovators — now with added convenience for our referring providers From the most delicate robotic and catheter procedures to the latest precision therapeutics, we’re proud to offer up-to-the-minute diagnostic and treatment options for both adult and pediatric referring providers across Northern California and the Central Valley.

Our liaisons can also help to:

Your referred patients benefit from shorter drives, less traffic gridlock, affordable lodging, and more support from local family and friends. We also offer robust telehealth and telemedicine options, for both initial consultations and follow up care.

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Referring your patients to UC Davis Health specialty and subspecialty care is now easier than ever. Our physician referral liaison team is here to serve as direct lines of communication — helping to navigate and expedite referrals, obtain information, resolve process questions, and more.

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Facilitate access to our secure EMR system, PhysicianConnect Arrange meetings and/or webinars with our clinicians Assist with UC Davis Health clinical trials and telemedicine Keep you abreast of new services, providers and research programs Share information about CME and events such as tumor boards, grand rounds, lunch-and-learns and symposiums

We welcome you to reach out to your local UC Davis Health Physician Referral Liaison today: Tracy Bayne | 916-281-8734 | thbayne@ucdavis.edu

referrals.ucdavis.edu