Sierra Sacramento Valley Serving the counties of El Dorado, Sacramento and Yolo
September/October 2021
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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.
MEDICINE 4
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Emotions, Compassion Clash When Treating Unvaccinated
My Pallbearer Buddies, The Fairfield Poker Group
PRESIDENT’S MESSAGE
Carol Burch, MD
BOOK EXCERPT
John Chuck, MD
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18
Make a Plan Now With Honoring Wishes
Karen Poirier-Brode, MD: The Artist In Residence
EXECUTIVE DIRECTOR’S MESSAGE
Aileen Wetzel, Executive Director
8
Turning the Pyramid Upside Down Caroline Giroux, MD
12
The Future of Medicine Is In the Good Hands of Gen Z
PROFILE
Ken Smith, Managing Editor
26
Board Briefs
27
New SSVMS Members
28
There Really Can Be Magic In Medicine Alan Chien, MS II
22
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.
Spreading the TRUTH
Ken Smith, Managing Editor
24
The Piano (and Poker) Man Faith Fitzgerald, MD
Lindsay Coate, Vice President, Strategic Operations
Visit Our Medical History Museum 5380 Elvas Ave. Sacramento The museum is gradually reopening. Visit our website at ssvms.org/museum for updates and virtual events.
VOLUME 72/NUMBER 5 Cover photo: A brown bear hunts for dinner in an Alaskan river.
Photo by Marvin H. Kamras, MD
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/October 2021
1
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 Burch, 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 John Coburn, MD Sean Deane, 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 Janine Bera, MD District 3 Alternate Toussaint Mears-Clark, MD District 4 Alternate Shideh Chinichian, MD 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 Carol Burch, MD Amber Chatwin, MD Angelina Crans Yoon, MD Mark Drabkin, MD Rachel Ekaireb, MD Gordon Garcia, MD Ann Gerhardt, MD Farzam Gorouhi, MD Richard Gray, MD Richard Jones, MD Steven Kmucha, 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 Brea Bondi-Boyd, MD Christine Braid, DO Lucy Douglass, MD Karen Hopp, MD Arthur Jey, MD
CMA Trustees, District XI
Adam Dougherty, MD
AMA Delegation Barbara Arnold, MD
Editorial Committee
Sam Lam, MD Derek Marsee, MD Taylor Nichols, MD Ashley Rubin, DO Alex Schmalz, MD Ashley Sens, MD Robert Oldham, MD 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 II Michelle Ann Wan, MS III Lee Welter, MD Eric Williams, MD James Zhou, MS II
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. ©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 Burch, MD
Caroline Giroux, MD
Patients who could have protected themselves with a COVID vaccine but chose not to, Dr. Burch says, make feeling compassion more difficult and add to physicians’ stress. That’s why you need a plan.
Dr. Giroux says food for the soul is as important as our daily meals toward a fulfilling life. She says that it may be time to turn the way we think about Maslow’s pyramid upside down.
John Chuck, MD
Faith T. Fitzgerald, MD
carol.md.mba@gmail.com
johnchuck1@gmail.com Dr. Chuck, chair of the SSVMS Joy of Medicine Advisory Committee, tells about his “pallbearer buddies” as he shares a chapter from his new book Pearls From the Practice of Life.
Ken Smith
ken@kdscommunications.com
cgiroux@ucdavis.edu
ftfitzgerald@ucdavis.edu
Faith recalls, from her days as resident, a memorable man with a talent for piano and poker who asked her an unexpected question. He received an even more unexpected answer for reasons he never knew.
Lindsay Coate
lcoate@ssvms.org
SSVMS’s Future of Medicine program introduces high school students to a variety of medical careers and hands-on study. Find out how you can help grow the next generation of physicians for our region.
Alan Chien, MS II
Alan.Chien6944@csnu.edu
Alan puts a little magic into his medicine. Literally. He explains how his talents as a skilled illusionist have brought joy to patients and became the gateway to his career in medicine.
Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ssvms.org.
After Karen Poirier-Brode, MD ended her career as an OB-GYN in 2011, she gave birth to a new one as an artist. That lead to being named the 2020 American Medical Women’s Association artist in residence.
September/October 2021
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| PRESIDENT’S MESSAGE |
Emotions, Compassion Clash When Treating Unvaccinated By Carol Burch, MD carol.md.mba@gmail.com
H
is eyes are half closed with fatigue, but open with fear. His chest is heaving with effort. He’s been sick for two days, and his wife and his daughter are ill at home. The question has to be asked, for the fifth time so far today: Were you vaccinated for COVID-19? His eyes fly open, and he yells, “You doctors are all the same, you keep pushing those vaccines that are useless—you are just trying to make money! COVID is a hoax! That’s what the real news says—it’s just a hoax! There is no way I’d get that poison shot!” It’s a story I have heard many times from my colleagues. They are physicians who have all been trained to save lives, to know what to do, and to educate our patients so that they can participate in the decisions surrounding their care. These dedicated professionals experience a rush of emotions: anger that they have been accused of cooperating in a hoax for profit, fear that they will bring COVID home to their own families, fear of failure because he is the sickest patient they will see today. At the same time, there is concern for the patient’s family, a desire to educate about science and the facts and—to be honest—just a bit of apathy along with a lot of fatigue. It is hard to have compassion for someone so thoroughly duped and so angry. It takes energy to hold space for his illness and his flaws when we are filled with our own fatigue and insecurities. It was glorious to have a month of no patients in the ICU and to feel hope that the vaccine would return us to normality. Instead, we are heading into another wave of COVID and there is significant concern about our capability as a system of individuals to handle it. In addition to the number of health care workers dying from COVID, there is an increase in suicide among physicians. It’s the damage from another battle that we’re facing before recovering from the last one. The frustration that comes from taking care of people who could have protected themselves, but now lay 4
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dying, is understandable. Being met with anger from the patient because they are sure you are part of an elaborate scheme and that there is no COVID, or that COVID is not deadly, is beyond logic. We are usually filled with compassion when treating someone who may die and have a desire to try to ease their suffering, but when a patient focuses anger on you as you try to save them it is harder to show compassion and the therapeutic alliance is harder to form. There is also anger on our side because their choice has put us and our families at risk. With breakthrough
There is also anger on our side because a patient’s choice to not be vaccinated puts us and our families at risk. cases, vaccinated physicians still risk bringing the virus home to children too young to receive the shot. To deal with this fear takes energy and constant vigilance. Even though it seems we can often maintain this energy almost to a superhuman level, it can’t be done indefinitely. This surge is all the more frightening because we know that we are close to the limits of our endurance. With the angry, frustrated, misinformed patients who could have prevented their illness on the one side, and our families and our own fears on the other, where do we find the space for compassion? Where do we find the energy? What do you do when you are overwhelmed? It is essential to have a strategy based on an honest self-evaluation of your needs and what is most important at this moment in time. That involves understanding that if you have not seen your family in a week but you are exhausted, you may have to focus on your own health first for everyone’s sake. Knowing how you react when you are angry or afraid can help you better understand how the stress you feel manifests itself in your personal and professional relationships and when it can cause harm.
When I was pushed beyond my limit and I had not really thought about or practiced what to do, I would be quite curt and the anger was reflected on my face for all to see. This was not a winning strategy. When I got help, I was told to write down my triggers and make a plan on how to react. This was not simply an exercise in my head; I had to write it down and practice reacting differently. There are two big reasons why this step was important for me. First, it helped to dial down my own stress and, secondly, it helped me to not increase the stress level of everyone around me. By first realizing that you are under stress and then working on strategies to reduce it, you can do your part to de-escalate an inherently stressful environment. Find your strategy for successfully addressing your physical and emotional stress. It might involve meditation, stretching or yoga, or maybe just having someone listen to you without giving advice. When was the last time you went on vacation and did not open email or went on a date (yes, there are COVID-friendly date ideas out there)? And this is a harder one—explicitly tell yourself that you can’t always fix the challenges that your patients present, whether it’s their medical condition or their embrace of misinformation that could kill them. You don’t always have to prove you’re right, and you are
allowed to be afraid. I often remind myself when I visit my mother that I don’t have to be a great daughter—I just have to be me with the same old limitations I’ve always had. My brother used to run marathons but started getting too exhausted, even in the offseason. He got an app that measures his heart rate variability (HRV), a number that decreases as you are under more stress. Now, when his HRV goes down he reduces the intensity of his workout or even skips it. After a year or so of using the app, he has found himself in better shape with more energy. I love this—it is a quick, objective way to verify to myself that I’m stressed, rather than hiding under the white coat of invincibility. I benefit greatly from something outside myself telling me that my fatigue and my stress are real. America’s level of fear has increased over the last several decades. We do not like to admit we are afraid, and coping takes many forms. This could be one reason conspiracy theories take root—they are a way of coping with fear and loss of agency. I hope to encourage us to look at our own fears, decide on how we can cope, and recognize that others are afraid as well. This may help make the space for our compassion to return and, perhaps, lead to ways to empower others to take better care of themselves.
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September/October 2021
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| EXEC UTIVE DIRECTOR’S MESSAGE |
Make a Plan Now With Honoring Wishes Advance Directives Aren’t Just for Patients
F
ar too often, families are left scrambling to figure out what to do when a loved one is dying. As a physician, you’ve likely seen this happen too many times, where rifts form in families, feelings boil over, and accusations fly while the only person who truly knows the answer is unable to voice it. We know this is not something you’d want to see in your family. It can be easily avoided by having an advance care directive in place. Earlier this year, SSVMS introduced our Honoring Wishes program, made possible through the generous giving of the late Al Kahane, MD and Mildred “Millie” Kahane, RN, to help physicians facilitate meaningful end-of-life care conversations and planning with patients and their families.
SSVMS is encouraging you to complete your own advance care directive and assisting you through our Make a Plan campaign. We’re now adding a new focus to Honoring Wishes: encouraging and assisting you to complete your own advance care directive through our Make a Plan campaign. Completing this short document can save your family from painful decisions while also giving you experience to draw upon when speaking with patients. Medicare, Medi-Cal and many private insurance payers will reimburse you for discussing end-of-life care with your patients because it is an essential, but often overlooked, element of care. SSVMS is collaborating with several medical staffs in the region to bring the Make a Plan campaign to a hospital, clinic, or practice near you where we will be providing free, one-on-one appointments to assist you with documenting your wishes. At the conclusion of the appointment, we will provide you the document on a flash drive so you can share it with your personal 6
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By Aileen Wetzel awetzel@ssvms.org
Scan here to start your Five Wishes directive or to set an appointment for help.
physician and designated agent. If you prefer, you can download the directive on your own or receive an email that includes instructions. Just like the care you specify in your directive, it’s your choice. I want to note that these materials and conversations are yours and are confidential. SSVMS does not keep a copy of your plan, so it is essential to leave it in a secure place that is accessible to your family or appointed agent in case you are incapacitated. After an exhaustive search, Honoring Wishes chose the Five Wishes directive from Aging with Dignity. Five Wishes is America’s most popular living will and speaks to medical, personal, emotional needs. It has been distributed to over 40,000 organizations. You know how challenging and difficult end-of-life care conversations can be with patients and families. Deciding on an advance decision about your own care can be just as challenging—and just as necessary—and that’s why we’re here to help with the forms that will enable you to clearly state your preferences and by offering counseling to assist you in determining what is best for you and your family. To start your Five Wishes directive, scan the QR code. You can then determine how you would prefer to complete it, either by setting an appointment for assistance or downloading it and completing it on your own. If you have any questions or wish to learn more about Five Wishes or the Honoring Wishes program, please contact Marlee Turner at mturner@ssmvs.org.
CONNECT WITH COLLEAGUES
VIRTUAL JOY OF MEDICINE SUMMIT
Saturday, September 25, 2021 Zoom
8:30 - 12:00 PM
Emcee John Chuck, MD
Featured Topics 9:00 AM - Does Anyone Have a Case? The Balint Group Experience Would you like to improve your rapport with your patients? Explore how to enhance patient-physician relationships with peer-to-peer Balint groups. Facilitated by Rochelle Frank, MD and Marissa Pierce, MFT.
10:00 AM - Overcoming Toxic Stress: Biography of a Wounded Healer You are invited to discover the other side of Adverse Childhood Experiences (ACES) in physicians by reframing their impact from a resilience angle. Presented by Caroline
Prizes
Giroux, MD.
Exploring Gratitude
11:00 AM - The Psychology of Wellness
Lightning Rounds
Workshop
CME Available
In a world of many challenges, how can we overcome them? Discover methods to improve our relationships with ourselves and with others. Presented by Amy Ahlfeld, PsyD.
Register Now! tinyurl.com/JOMSummit2021
| OPINION |
Turning the Pyramid Upside Down
Don’t Let Anyone Stop You From Being Yourself
M
aslow got it all wrong. Abraham Maslow, a psychology professor, developed a theory of psychological health predicated on fulfilling innate human needs in priority. He developed a pyramid to illustrate the hierarchy of needs, and I always thought it made a lot of sense, especially during catastrophes and crisis situations. The bottom, or foundational, levels of the pyramid include the basic physiological needs of food and safety. It culminates with self-actualization, which includes creativity, problem solving and spontaneity. However, during these past several months I started to seriously challenge this paradigm. The restrictions from the pandemic and their impact have demonstrated that without aiming at the other levels of the pyramid on a daily basis, access to food and other physiological needs become futile. A perfect illustration of the limitations of the pyramid is in orphanages: some of the children do not grow or gain weight as expected. They have a condition known as failure to thrive. Despite being fed, having access to the “basics,” they do not develop optimally nor at a normal pace. What they need is bonding, love, an affectionate touch: the pillars of emotional security. The newborn has skin-to-skin contact with another human before being given the breast. During the pandemic, many people had enough to eat, but not enough social interactions, crucial to wellbeing. I myself felt like the girl buried under empty pizza boxes in the uplifting Extra Gum commercial who emerged from her stuporous state into wild celebration after receiving a text announcing confinement was over and people could finally see each other in person. Once one feels loved, one can feel safe and free to explore, or self-actualize. And, well, eat. The form self-actualization takes is specific to each one of us: it consists of reaching one’s own potential 8
Sierra Sacramento Valley Medicine
By Caroline Giroux, MD cgiroux@ucdavis.edu
through meaningful life experiences. For instance, some people self-actualize through gardening, coaching a team, volunteering at a homeless shelter, or mountain climbing, with joy, even love, attached to the experience. The common denominator is an impulse to grow outside of oneself. It is essence, or passion, in action. The outcome is often more beauty, understanding, or harmony on the canvas of humankind. Sadly, this is the type of response I usually get when I ask people how they spend their days—in other words, the units of their existence: “I clean up, I go to doctor’s appointments.” But these are not really goals to a life, they are part of its infrastructure. Having a clean house
The need that should be at the foundation, not the top, is self-actualization—or at least the desire to strive for it. Without this life energy that is so unique, existence becomes tasteless. or blood pressure within range is all fine, but what does it allow you to do? What is beyond that? Such an existence of self-maintenance is basically like doing CPR on the soul: it helps maintain life artificially, but this is no life well or fully lived. What makes you want to be alive, to open your eyes in the morning? Not the pile of dishes… Therefore, in my opinion, the need that should be at the foundation, not the top, is self-actualization—or at least the desire to strive for it. Without this life energy that is so unique, existence becomes tasteless. And this life energy is everyone’s own creative reserve and essence. Without it, we are robots, or slaves to our modern world. Nietzsche said that if at least two-thirds of the day doesn’t belong to us, we are slaves rather than free beings. Self-realization has freedom as a prerequisite.
Freedom to fully be our own unique, beautiful selves. The pandemic, its limitations and the effect on those around me, amplified the stresses in my life. My motivation for daily chores was absent, my appetite was gone and my EMR in-basket reached 50 notes from residents to co-sign (in the past, I started to panic and attack the situation after I reached 20). I ignored the obsequious email reminders. My patients’ disclosure of their mood symptoms started to trigger me. I wanted to avoid distressed people, I felt like I could no longer help anyone. There was no mental space left for their stories. I was losing weight, slowly disappearing as my appetite shrank. The only aspect of my life in 2020 that seemed to work or go smoothly was writing. There was always a river of words, a flow of emotions in me that needed a passage, an expression, to help me reclaim some power, transform adversity and despair. It was my drive for self-actualization through writing, rather than access to food, that kept me going. Many of us are confronted with barriers to their self-actualization. Gifts that should be celebrated can be perceived by others as threatening, resulting in shaming or bullying rather than being welcomed. After years of
being a writer and a poet in a clandestine way, in the interstices of time between patient visits or while there was deserted space in a life I no longer seemed to belong to (if I ever did), I realized that maybe the expression of my need for self-actualization was attacked because this was in fact an aspect of me others had no control over. Moreover, when I write, I do something absolutely scandalous in the eyes of some: I dare to be myself! The freedom of the pen and the subsequent outcome (its impact, the readership’s reactions, the dialogue that ensues) is something limitless, mysterious, secret, surprising at times, but often wonderful. I continue to write, with a fervor like that of the musicians on the Titanic. Jean Cocteau said, “Writing is an act of love.” Self-expression as self-actualization needs the nurturance and support of love, and love, in order to be healthy, needs to make room for each person’s own self-realization needs. This all takes time. We should all persist and realize that the certitude of love, and its offspring creativity, are our most important freedoms, our self-actualizing powers. As I have observed both personally through my own experiences and professionally with survivors of
September/October 2021
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trauma, writing can help us feel whole. A story written can be like the Japanese art of “golden joinery,” kintsugi, for a traumatized identity. It gathers the fragments of a dispersed life or shattered self and creates a cohesive, meaningful narrative. It helps reconnect with a sense of identity or develop a new one. Self-actualization is an exciting journey that starts from the inside. Some might find this explosion in their passion for music. Playing the drum or improvising on a piano can be a fulfilling way to translate emotional states into sounds. How more harmonious and more just would our world be if everyone could reclaim their voice and make it heard, in whichever form helps them express it loudly and triumphantly?
I continue to write, with a fervor like that of the musicians on the Titanic. But first, you must make sure you hear and listen to that voice. Use my “4S” formula to find it if you can’t yet hear it: seek space, stillness, solitude, silence. Sometimes it becomes loud in the midst of a boring chore or as you take a walk. This voice, the whisper of your soul, the murmur of your spirit, should be the only thing you want to obey. That is the life energy that feeds us as we work toward the realization of who we are and the potential we hold. As you listen to your own voice and care about it, you will be your whole self more and more. And so much of life will start to taste better.
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| THE NEXT GENERATION |
The Future of Medicine Is In the Good Hands of Gen Z SSVMS Program Introduces High School Students to Health Care Careers Through Preceptorship
A
Photo courstesy Eric Williams, MD
t what age did you decide you wanted to become a doctor? Did it seem like a far-fetched dream or your calling? Dr. Eric Williams, Chair of the Future of Medicine program, said he knew he wanted to be a doctor at 10 years old. While he waited at the bus stop to head home from school, a storefront radio was playing a story about the first heart transplant performed in 1967. Inspired, he would later become a successful vascular surgeon. Dr. Megan Babb, a young physician in family medicine, also knew from a very young age that she was meant to be a physician. She felt that her path in life would lead her to healing others.
By Lindsay Coate lcoate@ssvms.org
Some don’t have their career epiphanies until a life event occurs. Dr. Ravinder Khaira was a freshman at UC Davis in 1985 when his baby brother was diagnosed with non-Hodgkin lymphoma. He quit university to help his family with treatment, but the experience led him to return to school and study to become a pediatrician. Others find their calling through education. Dr. Ruenell Adams Jacobs, a family medicine physician, signed up for an anatomy class at the local college for fun while in her last year of high school. She aced the class and realized her career would be in medicine. Practicing medicine has been—and still can be—a fulfilling and meaningful career. Unfortunately, the effects of the pandemic have exposed major cracks in our health care system that can dramatically affect career satisfaction. Many health care workers are nearing retirement age, more than a few are seeking early retirement due to the stress of the pandemic, and some are just outright leaving their jobs. The field of medicine needs an influx of youth. But with so much uncertainty in the air right now, how do we get young people interested in a health care career, and furthermore, convince them to ultimately choose to practice medicine? To encourage local youth Eric Williams, MD and volunteers Lisa Taub (left), Bonnie Bacchi (blue jacket) and to pursue careers as physiJanelle McGuckin (second from right) welcomed students to the one of the first cians or in other health care preceptor programs in a picture from 2015. 12
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positions, the Medical Society has started a new program called “Future of Medicine.” The program aims to strengthen Sacramento’s health care workforce by facilitating summer The Future of Medicine summer program was an incredpreceptor programs to introduce high school ible experience for me. I was able to listen to many students to various careers in medicine. presentations that changed my perspective on the health A clear roadmap for a success already exists care field. As I listened to each thanks to the program’s chair, Eric Williams, presentation, I became more open MD, who started an initiative called the Vista minded, and I was even surprised Summer Preceptor Program in 2013 with with different kinds of medical the help of Connie Lemon, a history teacher careers. at Vista Del Lago High School in Folsom, This opportunity was someand his colleagues at Kaiser Permanente in thing I have never experienced Sacramento. Dr. Williams says a series of before. At school, we have had events inspired him to create the volunteerguest speakers in the medical field driven program that has given hundreds of come in and talk to our class, but students an up-close and personal view of the not nearly in the depth, detail, or various facets of medicine. variety of the speakers at the Future of Medicine summer It began when a hospital volunteer, who program. is now a paramedic, approached him with Through this program, I was able to learn more about specific questions regarding vascular surgery. health care inequality, which was undoubtedly my favorite That led the volunteer to ask Dr. Williams to be presentation. After the presentation, there was a specific his mentor, to which he eagerly agreed. That exercise where students were given scenarios of being same year, Dr. Williams was asked to speak treated unfairly based on the color of our skin or a at a high school career class on medicine. language barrier between the physician and the patient. When he asked the students what their career This activity gave me the ability to place myself in the choices were and why, the responses ranged shoes of many immigrants and other people of color, which from astrophysics to farming. helped me understand the struggles of health care inequal“I realized students selected career choices ity in today’s world. which were familiar to them and to which From that moment on, I knew that if I were to work in they were directly exposed,” Dr. Williams the medical field in the future, I would try my best to be said. “Their personal attributes, skill sets and equally empathetic and compassionate as possible to all dreams did not factor into their choices.” As a patients in order to reduce the problem of patient inequalresult, he explained, he designed the program ity in health care. I am forever grateful for the experiences to increase awareness of careers in medicine, that the Future of Medicine summer program has brought address the lack of diversity and representame and I would recommend this program for everybody, tion of minorities in medicine, and to address especially those who have an interest in health care. the rapidly emerging problem of talent short— Lana Ngo ages in all areas of health care. Many former students who participated students from underrepresented communities. in the first program are currently in medical High school students in their junior year are eligible school with one year left before residency. But after and are selected after a rigorous selection process eight successful years of building this program and his that includes statements of interest, letters of recomretirement as a practicing physician, Dr. Williams asked mendation, grade evaluations and interviews. The 2022 SSVMS to take charge of the program by collaborating summer program will consist of a four-week commitwith other health systems and incorporating more
"An Incredible Experience…"
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ment from the students during which they will receive high school credits from a mix of didactic and simulation learning. Each lecture day will be dedicated to a different career and will include volunteer instructors, panelists, and hands-on activities. There will also be days committed to leadership training, public health initiatives, and health care advocacy. Finally, students will spend one day per week job
“I deal with medicine on a deep and personal level every day. I have multiple chronic illnesses that impact me. Doctors, nurses, phlebotomists, physical therapists, and more play an integral role in helping me lead a ‘normal’ life and give me the strong interest in medicine I have today. The high level of care and empathy my care team has shown me has made me realize I want to emulate that for other people like me…”
Recollections of How Teaching and Learning Were Upended in 2020
“I will be the first generation in my family to graduate high school and am pretty proud of myself for that. I have always been interested in the medical field, ever since I was a little girl…” —J.S., High School Junior
the stresses and decision making in the life of a health care professional. To kick things off in 2021, SSVMS hosted a two-week virtual program for 50 high school students from a variety of high schools in the Sacramento region, with the majority from Pleasant Grove, Foothills, Rio Linda and Hiram Johnson high schools. The students who
Photos by Marlee Turner
shadowing, an experience that allows the student to develop a connection with their mentors, ask direct questions, observe interactions, and better appreciate
—D.K., High School Junior
Despite the pandemic, students were able to get hands-on experience in classes at SSVMS thanks to social distancing and safety protocols. 14
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applied to the program shared a variety of reasons for wanting to participate, with many citing a love of science and a passion to care for people. To spark their interests and hopefully guide them on their career paths, the students attended interactive Zoom sessions where they received a firsthand look at a day in the life of many different careers through talks by medical office staff, technicians, nurses, public health officials, pharmacists, psychologists, dentists, physical therapists, medical students and physicians from multiple specialties. The students also participated in courses regarding access to care, how to advocate for legislative action, what they can do to promote equity in health care, and how they can build confidence and enhance their leader ship skills. The program concluded with a live session at SSVMS where the students received a guided tour of the Museum of Medical History and participated in a heart health discussion and demonstration. The 2021 summer program would not Andrew Hudnut, MD helps a student study a heart during a Future have been possible without the 39 speakers of Medicine session. who shared their journeys about their career passions, achievements, and failures. The students were and that more local students will stay in the Sacramento given insight into new career ideas and the different region as they begin their health care careers. paths that they could take. As a practicing health career professional, you have “Caring for people has always been a passion of mine, and it has led me to become interested in pursuing a medical career. While my long-term goals would include going to medical school, there are still many questions and curiosities I have about health care and different careers in health care...” —A.G., High School Senior The Future of Medicine’s goal is to inspire the next generation to pursue meaningful careers in medicine. Many student participants in this year’s inaugural program have indicated that they plan to apply to medical school in the future! SSVMS will continue to engage with these students and expect that with continued local support, five years from now many will be attending their first year of medical school. SSVMS plans continuing support of this program and expects that it will increase the diversity in our health care workforce
the ability to influence and inspire an interested student of medicine, and they will reward you with questions you may not have considered while infusing you with their boundless energy and can-do spirit. If you would like to inspire Generation Z and the future of medicine, contact Marlee Turner at mturner@ssvms.org to learn more about the program’s volunteer opportunities. Lindsay Coate is vice president, strategic operations at SSVMS.
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| BOOK EXCERPT |
My Pallbearer Buddies, The Fairfield Poker Group Friends With Differences Make for a More Interesting Journey
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n her book Friendfluence, Carlin Flora describes the many benefits of having friends, including learning how to get along with others, sharpening our minds, defining our priorities, setting goals, discovering where we fit in society, meeting our romantic interests, sharing life’s ups and downs, and being happier in general. But how do we choose and make friends? Do opposites attract or do birds of a feather flock together? In a Journal of Personality and Social Psychology article titled, “Similarity in Relationships as Niche Construction: Choice, Stability, and Influence Within Dyads in a Free Choice Environment,” Angela Bahns and Chris Crandall report that future friends or partners are already similar at the outset of their social connection. “You try to create a social world where you’re comfortable, where you succeed, where you have people you can trust and with whom you can cooperate to meet your goals,” Crandall said. “To create this, similarity is very useful, and people are attracted to it most of the time.” While there are advantages to clustering in likeminded circles of friends (add comfort, familiarity, and harmony to those listed above), the downside is that it leads to a smaller life with far fewer opportunities for fresh ideas, stimulating conversations, and new adventures. My personal experience with developing a group of close friends largely unlike myself is one of chance rather than intention. The “Fairfield Poker Group” was started 30 years ago when a small group of first-time Editor’s Note—This is an excerpt from the new book Pearls From the Practice of Life by John Chuck, MD, chair of the SSVMS Joy of Medicine Advisory Committee. Pearls is available in paperback on Amazon for $19.95.
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By John Chuck, MD johnchuck1@gmail.com
moms met one another through an infant play group. Their husbands, including me, started a monthly poker game. I was a family physician of Chinese descent, a registered Democrat and a flag waiver for liberal causes. The majority of the group were white Republican businessmen who believed in small government. But these differences made no difference during our gatherings. All of us were just glad to get out of the house to enjoy a few beers and win or lose a few bucks. Over many years, the group settled into a steady stable of eight regulars—Brad, Jamie, Dave, Gene, Rick, Pat, Dave, and me—and we added to our regular game an annual weekend away in the mountains or at the coast. We grew closer and attended many of one another’s important social events including weddings, baby parties, and birthday celebrations. At one point a few years ago, for no one particular reason that I can remember, I suggested to my wife Lesli that perhaps it was time for me to step away from the poker group. It was probably a combination of things that led to this change of heart: another political text string; a comment meant to be humorous but perceived by me as off-color; or maybe I had simply lost more money than usual the night before. Plus, I could never really keep up with our group’s alcohol consumption (many Asians lack the aldehyde dehydrogenase enzyme required to metabolize alcohol, resulting in the facial flushing known as “the Asian glow”) and my Honda Accord looked puny compared to their Hummers and Mercedes. Lesli listened to my tale of woe, paused, and then replied, “You might want to consider what you would lose by leaving the poker group.” My initial reaction was that she did not want my withdrawal from the group to interfere with her corresponding night out with her girlfriends.
But her opinion was rooted in concern about my welfare, not hers. She went on to share a piece of advice that I treasure to this day: “If you were only friends with people who were just like you, you would have no friends.” I immediately realized that Lesli was absolutely right about that. Even if I could find friends who were just like me, how incredibly dull would a meeting of such homogenous minds and bodies be? Answer: super dull, verging on deadly dull. It turns out that the differences between my poker friends and me have actually served to fill many of my gaps in perspective and experience. Here are some examples of how they have helped me lead a more comprehensive and informed life: 1. They have shown me that in addition to tax-funded social welfare programs, a substantial way to show love for our fellow citizens is to build strong businesses that provide people with jobs, good salaries, and benefits. This in turn allows those employees to provide for their families, support causes they believe in, and live out their personal and professional dreams. 2. They have shown me that people who support candidates and political parties I disagree with are not all stupid or evil. In fact, they want most of the same things I want for America and its people. In the end, they just believe in a different way to get there. 3. They have shown me that loyalty to country and a heart for helping others takes many shapes, many of which I am unfamiliar
The Fairfield Poker Group has led to lifelong friendships.
Photo courtesy John Chuck, MD
with, but eager to learn more about. 4. Thanks to them, I know a lot more about business, the stock market, sales careers, taking a company public, casinos, golf, boats, fishing, liquor, red wine and world travel. 5. They have shown me that friendship has the power to supersede differences of background and opinions. In the end, my poker group of mostly dissimilar friends has been a big plus in the ledger of my life. For many years now, I have called them my pallbearer buddies, meaning that when I die, I know that they will be there to look after my family and carry my casket or urn at my memorial service. That’s how close I feel to them after 30 years of playing cards, drinking beer, inhaling snack foods, and sharing many laughs, burps, and farts. An invitation I received from Jamie’s daughter, Jennifer, and her fiance, Martin, to officiate their wedding served as evidence of the depth of our friendships and its extension to our families. The ceremony was held in the courtyard of a beachfront resort in Santa Barbara. The Pacific Ocean served as the perfect backdrop for the couple’s nuptials and the weather was perfect—sunny with a slight breeze. As I led the couple through their marriage vows, I looked over to Jamie, who was seated in the front row box seats reserved for the father and mother of the bride. He was beaming with joy. His rugged good looks, dapper tuxedo, and love for his family and friends propelled him past George Clooney as the most handsome and content man in the world. In that moment, I knew for certain that my enduring friendship with the poker boys, my pallbearer buddies, was one of the greatest blessings of my life.
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| PROFILE |
The Artist In Residence
Karen Poirier-Brode, MD Expresses the Angst of a Pandemic in Projects for AMWA
From March of 2020 through March of this year, Karen Poirier-Brode, MD served as artist in residence for the American Medical Women’s Association. An OB-GYN who practiced in Stockton for 20 years and had subspecialties in pediatric and adolescent OB-GYN and psychosomatic OB-GYN, she embraced a new career as an artist following her retirement in 2011. She hadn’t anticipated the challenges COVID19 and an ill husband would present as she worked on projects for AMWA. Managing Editor Ken Smith talked with her about her experience over the past year and what's ahead.
see myself that way at all, but they started pointing things out to me. It was kind of funny because I hadn’t recognized that. It was after I had retired [in 2011] that I started taking classes. While book art was the principal focus of my main work as an artist in residence, I did get to explore some graphic design and illustration for AMWA. I also was able to work on my video skills in collaboration with AMWA’s Music and Medicine in illustrating their original musi-
What is the Artist in Residence award? It was set up in 2015 by the American Medical Women’s Association. It’s now called the Dr. Kathryn Ko Artist in Residence Award. Dr. Ko was the first artist in residence, and every year we put out a message for our members to apply for this. AMWA’s mission is to advance women in medicine, advocate for equity and ensure excellence in health care. AMWA encourages and promotes artistic expression among its members. You have to apply for AIR and send representations of your art and what you plan to do as a project. Since 2015, there have been, I think, eight artists and they range from fine arts to people who do dance and poetry and writing as well as visual arts. What did you do as the artist in residence? What was your medium? I see myself as a multimedia artist, probably because I like to dabble in all kinds of things. I think I got into art mainly because of my scrapbooking. I told my children I was taking some classes to learn some principles of art, and I said, “I think I’m pretty good at this.” My kids said, “But Mom, you’ve always been an artist!” I didn’t really
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"WASH" is made from paper towels with a die-cut "20" on each signature front page, inpired by the 20 seconds of recommended hand washing. Opposite: A lab coat featuring the words from a book by AMWA founder Bertha Van Hoosen, MD.
Photos courtesy Karen Poirier-Brode, MD
cal compositions and performances. Those videos and my AIR presentation at the AMWA national meeting in March 2021 can be found on my YouTube channel. The final project of my residency was three books. The first, Six Feet Apart, is an accordion-style bound book of clear polymer pages. The primary color is black with a small amount of each of the primary colors. I designed a decal of a masked woman physician with arms outstretched applied to each page. She is above a yellow circle reminiscent of the areas seen in queues with footprints and a reminder of 6 feet/2 meters of separation. The impressions on my spots are of high heels. The second book is called WASH. It’s white with a simple bookcloth cover bound with French-link, and kettle stitching with waxed linen thread. However, Ingres paper’s accordion pleats are used with the kettle stitch for stability as the book’s pages are formed from Bounty paper towels. Applied to each signature front page is a die-cut number 20. That and the 20 signatures are inspired by the 20 seconds of recommended hand washing. However, I like the implied reference to the year 2020, too. The third book, Hx and RX, is in gray. It’s bound with a two-shade braided Coptic stitch. The pages of Reeves BFK paper are letter-pressed with repeating images of a masked woman physician’s face alternating with drawings of a COVID-19 vaccine vial and syringes. Pages between the pictures feature quotes from women physicians and institutions that I chose to illustrate the pandemic’s history, leaving the final page blank as it has not yet ended. It was an odd year, and you have other challenges beyond the pandemic. How do you stay focused, how do you deal with that? You know what? It’s really hard. I had this commitment and I’m good with deadlines. If I’m committed to something I’ll
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putting it on Tyvek, which is a kind of plastic paper, as another form of book art, making a lab coat of that and creating the white coat “Bertha.” The coat is done, but it needs buttons. I have a mannequin with an AMWA mask and an AMWA scarf and a neat black dress. I’m going to do some high-top sneakers with fabric—I’ve already designed it—with images of [pioneering female physician] Elizabeth Blackwell’s face studded on the fabric covering for the shoes.
A page from Six Feet Apart. follow through, so that always helps. Just kind of saying, “Well, just do art” is sometimes a little difficult. Although I’ve been working on some projects, it’s a lot easier when you have that focus. But yeah, my husband has early Alzheimer’s and advanced cancer and it’s very, very difficult, as well as COVID restrictions and everything else. So it’s been a tough year. Does your art help you get through some tough times? That’s my happy place, to be doing things like scrapbooking or art. Putting my mind to some kind of creativity, I find that very helpful through stress. When I’m feeling really stressed I might just sit down quickly, design a few pictures and do a quick scrapbook page because that doesn’t take any time. I do that on phone apps, too, and I do digital art as well as paper art. What’s your next project? Bertha Van Hoosen, the founder of the American Medical Women’s Association, wrote a book in the 1950s that was just reprinted by a museum dedicated to her in Rochester, Minnesota, a place I’ve visited. Studio AMWA often has a “white coat” project, and we paint or put digital images or words on the back of a white coat to express ideas about some theme in medicine. I thought of this idea of taking Van Hoosen’s book and 20
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You’re from Manitoba, Canada, and went to school in Montreal. Did you have an interest in art then? I lived in a tiny city about 23 miles from the big city of Winnipeg on the Red River called Selkirk. For some reason, probably for the combined science and medicine program, so one less year of tuition, I decided to go to McGill in Montreal for college. They accepted me and I got some scholarships. So I said, OK, I’m off to McGill. I just took off there without visiting the school or anything, because that, too, costs money. I’m on the plane chatting with people. I’m young and naive, I don’t know if I was 17 or what, and I’m off to college. I told this lady I’m heading to McGill. She said she’s a buyer for a major department store and calls to some guy down at the end of the plane. She says, “Aren’t you staying at the Holiday Inn that’s right by Royal Victoria College? Give this girl a ride in your car.” His car was a limousine. This poor girl with her paste-board suitcase who knows nothing. He drops me off in front of the college. Three girls came up to me on the sidewalk and said, “Oh, are you new here?” I said who I was, and one girl said, “I’ve been writing you all summer!” She took part in the “big sister” program to welcome newcomers, and just by chance I met the only person I remotely knew in that part of Canada. [Montreal] was a fabulous city, an amazing place. Talk about art—I used to go down Sherbrooke Street, just a little west of the college, and the museum was there. There were also all these wonderful art galleries along the street. I wandered in, and I could look at art and appreciate art. That was kind of my escape during medical school, to enjoy myself, just taking in all the art. It was so much fun to be in that environment. On the sidewalk in Montreal were a Henry Moore sculpture and Rodin’s The Thinker—it was a marvelous place to be. To see more of Dr. Poirier-Brode’s work, visit artofkarenpoirierbrode.blogspot.com.
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 and after the pandemic. 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 OnCall documents and valuable information for physicians and their staff at no cost. 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. 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.
Educational Programs Free CMEs, webinars and in-person seminars. Discounts For insurance services, office supplies, magazines, security prescriptions and more. Partners in Medicine Vetted vendors that provide SSVMS members with exclusive services and discounts. These partners have gone through an application process and provided multiple physician references. They are dedicated to offering special services or discounts to SSVMS members on various products and services designed to accommodate the business and personal needs of physicians. 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
| VACCINE HESITANCY |
Spreading the TRUTH SSVMS Partners with UC Davis Health to Use a New, Highly Targeted Approach to Reach Vaccine-Uncertain Populations
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series of highly targeted public service announcements that address the key concerns of vaccinehesitant demographics will soon be available to SSVMS members and physicians across the region. The project is backed by UC Davis Health’s Targeted Reach Using Tailored Health messages (TRUTH) Project, which hired SeeBoundless, a video producer who had implemented a similar campaign for the North Carolina Department of Health and Human Services. SeeBoundless interviews members of demographic groups that have
shown a high level of vaccine uncertainty to listen to their concerns, and then works to produce hyperfocused, personalized PSAs that offer persuasive information. Although UC Davis Health and Digital CoLab, its digital health innovation hub, brought SeeBoundless to California after learning about them at a conference, the health system offered SSVMS the opportunity to record PSAs and expand exposure of the vital messages they will contain. UC Davis is also partnering with SeeBoundless and SSVMS to develop a toolkit under an
Emergency room physician John Wiesenfarth, MD had a message for the vaccine hesitant about the unnecessary tragedies he has seen as a result of COVID-19. Above, pulmonologist Vanessa Walker, DO, talked to “young invincibles.” 22
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open innovation model. “They approached us about doing targeted messaging but then they said they wanted to make it ’open source’ so that not just their team could use it, but other doctors in the area could use it,” said Brooke Van Dam, director of partnerships and education for SeeBoundless. “So that’s when we reached out to the Society.” Four physicians recorded interviews with personalized messages aimed squarely at key demographics. Vanessa Walker, DO shared heartbreaking stories of the young and seemingly healthy individuals she has seen experience the horrors of COVID-19 in an outreach to “young invincibles.” John Wiesenfarth, MD spoke directly to Evangelicals and
Photos by Ken Smith
similar populations, recognizing that he understands why individual choice is an important part of the decision process for them but that the vaccine is something that works toward the greater good. Catherine Malmsten, MD spoke to those in the Black community who have been uncertain because of a lack of equity within health systems. She noted, however, that the best way to avoid becoming a victim of health equity problems is to take the vaccine and nearly eliminate the chance of needing to go to the hospital because of COVID. Finally, Jose Cueto, MD responded to concerns in the Latino community, including whether there is any risk to those without legal status and how to find access to the vaccine. “Every single time we do an outreach and a push of PSAs, there’s an uptick in searches on [the state vaccine] website, which leads to an uptick in vaccinations,” said Steve Johnson, a former journalist and University of Florida professor who
founded SeeBoundless. He added that there is usually a two-week period between the rise in website visits and the bump in vaccinations. The goal is to get members of the targeted demographics to look to physicians, whom they trust, as their primary source of information rather than sorting through the raft of disinformation online. Johnson said they’ve discovered common denominators among those who are
Catherine Malmsten, MD spoke to concerns held in the Black community while Jose Cueto, MD (above) addressed the Latino community.
hesitant to get the vaccine. “First, they want it to be in a medical setting, not a mass vaccination site. The idea of cars lined up at sports arenas is a no-go,” Johnson said. “The second is that they trust physicians. They don’t want politicians, they don’t want celebrities. They want a white coat telling them why this is safe for them.” "This partnership between Digital CoLab and SSVMS is missionaligned to provide a more personalized, engaging message for our community and patients," said Dr. Ashish Atreja, CIO and chief digital health officer at UC Davis Health. SSVMS plans to use the PSAs, which can be quickly and repeatedly recut to reflect the need to change messages in order to stay focused on the concerns of the moment among targeted groups, on Facebook and other social media, as well as potentially on cable channels. SSVMS will be reaching out to members with more information about content created for the TRUTH Project and how to use it to reach the communities you serve. —Ken Smith September/October 2021
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| ESSAY |
The Piano (and Poker) Man
This Player Was Dealt a Tough Hand
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was a second year internal medicine resident assigned to the coronary care unit at UC San Francisco’s Moffitt Hospital when a man in his late 50s was admitted with chest pain. The nurses were familiar with him as he had been in the CCU several times before. His EKG strongly suggested ischemia, the chest pains he described were classical angina, and he was being treated with sublingual nitroglycerin and rest. The CCU nurses liked him as he was graceful in his speech and behavior and they were sad to know that he was back in the unit, as they feared for his life. On each admission he would comply with his nurse’s
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By Faith Fitzgerald, MD ftfitzgerald@ucdavis.edu
medical therapy, rest and diet, and he improved as he followed their instructions. As he got better, he would tell them (and me) wonderful stories. He had come to America from Europe by boat just before the First World War, carried by his widowed mother as a babe in arms. Landing in New York at Ellis Island, she somehow managed to cross America and wound up in San Francisco where she worked for very low wages as a maid. Mother and son slept in a tiny room near her workplace and they were fed largely by leftovers kindly given to them by the family that had hired her. Her son also worked as a newspaper boy, a street sweeper, dog walker and a number of other odd jobs. He never went to school but taught himself, with his mother’s help, to read both in English and in Hebrew. As he got older he also got work cleaning up the many bars in the Tenderloin area of San Francisco. There he became entranced by playing honkytonk pianos and began—through tips—to earn some significant amounts of money doing so. He was asked, when he got older, to periodically sit in on card games in the bars during breaks from the piano and, as he had a knack for it, he often won. One day when he came home from the Tenderloin to the room he shared with his mother, he was surprised to find her still in bed as she was generally an early riser. He took her hand and it was very cold. She was dead. Crying, he quickly went to tell the rabbi what had happened. Following the funeral, he went back to the room in which they had both lived for decades. He continued to work in the Tenderloin, but he would get a ride, now and again, to periodically go to Nevada where he was very good at winning poker games. Because he was losing his hearing, bilaterally, he gave up honkytonk and
When the last of my patients left the clinic, he rose from his chair where he had been waiting and asked me to marry him. I shook my head no. "Why not?" he asked. I have money and you would get it when I die." became a successful card player. Then, over the next few years, he found himself having chest pain—from the thrill of winning, he thought. But it got worse over time, so for the first time in his life he went to see a doctor and wound up in the Moffitt Emergency Room at the UCSF hospital. His EKG showed marked ischemia so he was promptly admitted to the Coronary Care Unit. Over that first week he got better and was discharged home, but he had to be readmitted several times for severe angina before I met him and got to know him. A few months after his most recent discharge he appeared in the General Medicine Clinic where I was seeing my patients. When the last of them left the clinic, he rose from his chair where he had been waiting and asked me to marry him. I was dumbfounded. He was in his late 50’s and I was in my mid-twenties. I was close to six feet tall and he stood no more than five and a half feet in height. I shook my head, “No.” “Why not?” he asked, “I have money and you would get it when I die.” I got a piece of paper and wrote on it as his hearing was very bad. The note read, “I am married already.” He looked chagrined. “Oh,” he said. “I did not know this.” And I did not tell him that it was medicine that I was married to.
Then he asked, “Will you come to my funeral and read Kaddish for me when I die?” “I will if I can,” I answered. (Kaddish is a mourner’s Jewish prayer.) Several months later he died in the CCU and was buried next to his mother in a San Francisco Jewish
cemetery. I read Kaddish for him there and for the next 11 months in the Jewish tradition. I visited his grave to say goodbye when I was recruited away from San Francisco to the University of Michigan in Ann Arbor. He was, and remains to me, a memorable man.
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| BOARD BRIEFS |
Board Briefs July 12, 2021 THE BOARD: Received an update from Glennah Trochet, MD, Chair of the Public & Environmental Health Committee regarding the committee’s activities during the past year.
For Retired to Active Membership — Thomas Atkins, MD; William Au, MD.
Received a report from director Ravi Khaira, MD, who along with Marvin Kamras, MD represent SSVMS on the Sacramento County Health Authority Commission. The purpose of the commission is to serve the public interest of Medi-Cal beneficiaries in the county and strive to improve health care quality to better integrate the services of Medi-Cal managed care plans.
For Resident Physician Active Membership — Michael J. Baggett, MD; Michael L. Cardenas, MD; Erik A. Carpio, MD; David S. Chen, MD; Kristopher J. De Ga, MD; Ryan T. Di Geronimo, MD; Amanda J. Ferguson, MD; Kaitlin M. Ford, MD; Jena K. Fujimoto, MD; Zachary B. Jenner, MD; Satinderpal S. Khera, MD; Benjamin A. Kipper, MD; Manav Kumar, MD; Jennifer R. Laroy, MD; Ana S. Mitchell, MD; Quinn K. Ng, MD; Dylan A. Noblett, MD; David V. Pham, MD; Jonathan S. Phuong, MD; Michael V. Ramirez, MD; Anthony J. Ronco, MD; Steffan K. Soosman, MD; Matthew L. Stegman, MD; Oana M. Stroie, MD; Stephen Vong, MD; Samuel P. Yap, MD.
Received an update from Lindsay Coate, SSVMS Vice President of Strategic Operations, regarding the Future of Medicine Program and its recent summer education program for high school students interested in a health care career. Accepted the resignation of Kristin Gates, MD as director representing District 5, Office 11 (TPMG). Approved the appointment of John Coburn, MD as director representing District 5, Office 11 (TPMG). Approved the appointment of Shideh Chinichian, MD to Alternate-Delegate, District 4, Office 4 and Rachel Ekaireb, MD from Alternate-Delegate Office 23 to Delegate Office 34. Approved the Financial Statements ending May 31, 2021.
For Active to Probationary Membership — Kalpana A. Phadnis, MD.
For Retired Membership — Marion Leff, MD. For Resignation of Resident Membership — Jessica A. Fortin, MD (moved out of state); Katherine S. Wilkowski, MD (left area). For Termination of Membership Due to Expired License — Yasmine Gharbaoui, MD; John T. Hosoume, MD. July 12, 2021
Approved the following Membership Reports:
For Active Membership — Vivian T. Bui, MD; Laura E. Watters, MD.
June 28, 2021
For Retired Membership — Frank A. Apgar, MD; William R. Auch, MD; Stephen K. Parkinson, MD; Margaret Portwood, MD; William R. Vetter, MD.
For Active Membership — Naomi Hauser, MD; Taylor S. Nichols, MD; Anuradha Shanmugham, MD; Andy Y. Zhu, MD. For Reinstatement to Active Membership — Keith M. Jones, MD.
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Sierra Sacramento Valley Medicine
| NEW MEMBERS |
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.
Felipe O. Arredondo, MD, IM, Mercy Medical Group Ramesis J. Bacolod, MD, FP, The Permanente Medical Group Vivian T. Bui, MD, HOS, Mercy General Hospital Robert J. Debruin, MD,FACP, IM, Robert DeBruin M.D. Spencer M. George, MD, ORS, Mercy Medical Group Pantea Hashemi, MD, D, University Skin Institute Naomi Hauser, MD, MPH, ID, UC Davis Health
Keith M. Jones, MD, VS, Mercy Medical Group Michael T. Massaro, MD, GE, Mercy Medical Group Taylor S. Nichols, MD, EM, Mercy San Juan Medical Center Neil G. Parikh, MD, AI, Mercy Medical Group Arlene E. Reyna, MD, HOS, Mercy Medical Group Lakhbir Sandhu, MD, SO, The Permanente Medical Group Gurjeet K. Sanghera, DO, FP, Woodland Clinic Medical Group
Anuradha Shanmugham, MD, IM, Marshall Medical Center Laura E. Watters, MD, OBG, Mercy Medical Group George Wong, DO, HOS, Mercy General Hospital Sijia M. Wu, MD, FP, Woodland Clinic Medical Group Andy Y. Zhu, MD, FP, Woodland Clinic Medical Group
September/October 2021
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| THE LAST WORD |
There Really Can Be Magic In Medicine
The Joy it Brings to Patients Isn’t an Illusion
A
nurse pointed me towards the door of a 35-year-old patient named Michael at Ronald Reagan UCLA Medical Center. He had recently received a course of chemotherapy treatment and was too tired to leave his room. I asked Michael to play a little game with a simple objective: tell me which of my hands held a hidden cotton ball. Michael’s father, a surgeon, also attempted to solve the puzzle. Curiously, Michael magically intuited the correct hand time after time while his father could not, which added to his delight. Michael repeatedly said spending time with me was one of the highlights of his hospital experience. Perhaps, it was because I added a few moments of joy into his life, which his cancer diagnosis had drastically altered. (It’s possible that my invitation to the world-famous Magic Castle, redeemable after treatment, also excited him.) Each week during my undergraduate years at UCLA, I walked through the bustling college town of Westwood to the hospital with pockets full of props like squeakers from dog toys, a seven-foot-long straw, and fake thumbs. Once I surprised a bright-eyed 26-year-old leukemia patient with a vanishing cupcake on her birthday. When patients were especially anxious about treatment, the nurses would send me over to calm their nerves. Another time, I made a wilted bouquet vanish from a patient’s room and pulled a fresh one from thin air. At first, I felt out of place performing magic in a hospital, but I soon found my place on a medical team,
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Sierra Sacramento Valley Medicine
By Alan Chien, MS II Alan.Chien6944@cnsu.edu
bringing joy to patients and encouragement to succeed in their treatments. A pivotal moment in my career as the hospital magician occurred when I was asked to be the closing speaker at a celebration of life for patients on the hematology-oncology ward. I shared a story with patients, their family members, physicians, and the staff about a recent performance I had given at the Magic Castle. On that particular night, Michael and I stood sideby-side running through our magic act, one we had practiced many times in the hematology-oncology ward. But instead of other patients, we performed that night before for an enthusiastic Hollywood crowd. Magic, my childhood hobby, became my gateway to committing to a lifelong Photo by Alan Chien career in medicine. An illusion or two can provide patients with at least a brief relief from their pain. But performing magic in a hospital and getting to know the patients led me to realize that I wanted to deliver longer-term solutions. I know that hiding a second cotton ball between my fingers so the patient is always right will bring them some happiness. But I also know, as a second-year medical student considering a career in oncology, that the healing I can provide won’t be an illusion. I will be able to change lives in tangible, awesome ways. And that, to me, is truly the magic in medicine. Alan Chien will present on magic and medicine at the 2021 Joy of Medicine Summit.
Closer to home + enhanced referrals = easier access to world-class care Pediatric neurosurgeon Marike Zwienenberg, M.D., FAANS, is an endoscopy expert and part of our fetal surgery team.
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: Robert Musso | 916-878-7310 | rpmusso@ucdavis.edu
referrals.ucdavis.edu