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Learning Compassion in Patient Care

Be the change you wish to see in the world.

For years, this motto has served as my inspiration towards becoming a physician, and as the first year closes, I cannot help but reflect on all the training I’ve received that has prepared me for clinical rotations this upcoming October.

There it is! Working on my ultrasound skills in the new Clinical Simulation Center during my free time.

At UMMS, we’re given a wealth of opportunities and experiences, one of which is called Interprofessional Clinical Experience (ICE). The purpose of ICE is to expose us to clinics right from the start by giving students the opportunity to shadow every player in a clinical team on a monthly basis. It’s a way of understanding the role of each player and their contributions to the patient’s care. During M1, I learned about efficient patient flow through the emergency department and snuck a peek into clinical radiology. I got to see some cool stuff, like CT-guided abdominal biopsies and sonographic Murphy signs to check for cholecystitis.  Prior to ICE, these were just words on a PowerPoint, but they now manifested into real-life experiences.

As I walked down the hallway with the ultrasound technologist I was shadowing, I was excited to see what my last encounter of the semester had to offer. Entering the room, I saw a seemingly 60-year-old woman, readily lying down for her appointment. The patient was here on a referral to check a potential abscess that had been hanging around for a few years. Gliding the probe over the mass, the technologist produced an image on the screen via transmitted sound waves.  It was a round and defined circle… makes sense. But… it was also a hazy-white color… fluids should be black on an ultrasound machine, I recalled from my ultrasound elective. I whispered my concerns and subsequent justifications – the technologist responded with a simple nod. She quickly switched to the doppler color flow image mode to view blood flow. There it was: blood vessels running through the mass.

My heart started beating faster and my hands clenched as my mind scrambled to find the one word that could change this patient’s life forever: cancer. Discretely excusing ourselves, we went to share our findings with the radiologist.

What next? I was told that she would be sent home, and her primary care physician would call to convey the news. I understood that this responsibility was outside our scope, but my deep concern still precipitated into a pit in my stomach as I had to silently watch her happily return home unbeknownst of a likely diagnosis of metastatic cancer.

Medicine is a difficult field because of the intense strain on both the body and the mind. While we have the privilege to treat and even cure patients, we also have to see them through their darkest hours. I am grateful not only for the opportunities to develop clinical competency, but also for the continuous reminder to always be compassionate. My training continues to prepare me for the day when I will have to break bad news to a patient in a manner not so different from the aforementioned situation. Fortunately, with the guidance and support from Michigan Medicine, I am confident that we can be the change we wish to see in the world.

LEAD: Early Involvement and Lasting Relationships

Not many people would decide to hike Mount Everest for the first time without some support, be it from fellow climbers, guides, resources, or information from others who have gone along the journey already. The Leadership and Enrichment for Academic Diversity (L.E.A.D.) program at Michigan provided a few of us M0s an early start on our journey into medical school. We were exposed to the learning environment while meeting some classmates and building a support system that will help us navigate through the hills and valleys of medical school. We got to see the unique abilities, talents and stories of some of our classmates, all while getting close and building some early skills in the anatomy lab.

The early start put many of us at ease by providing insights into class materials as well as resources that other students in the program may have had coming in. Special lectures from faculty and administration at UMMS about leadership, health care inequalities and mentorship gave us tools to manage obstacles that may come up throughout medical school. We built upon our leadership skills, bolstered our professionalism, and built an understanding about what it means to combat health disparities throughout our careers. We are all inspired by the commitment the Office for Health Equity and Inclusion (OHEI) has towards combating inequity in the health care system.

I would not be where I am at today without the great mentors I have had throughout my life. My mentors have been football coaches, weightlifting coaches, an organic chemistry professor, and many more. L.E.A.D. paired each of us with an M1 who will be our mentor throughout medical school. I know and feel that I can reach out to him at any time with questions, concerns, or just to chat about Michigan football. In tandem with our student mentorship, we received educational mentorship thanks to the Office of Medical Student Education. We learned about the curriculum, study skills and resources, and support available to us as we work toward our medical degrees.

Many of us enjoyed going out with others from the program to get food, drinks, and play some IM soccer. It is nice to know that going into Launch we will all have some familiar faces and connections to other members of our class. We are all very grateful for the great program that the Office of Admissions and Office for Health Equity and Inclusion worked hard to put together. We look forward to paying it back throughout our years here. Thank you for reading and as always, Go Blue!

My Summer with the Medical School Garden

There is a three-by-eight-foot raised garden bed nestled between the Cardiovascular Center, the Cancer Center and Med Sci I. It is the Medical Campus Garden, and this year it is host to a crowd of tomato plants, lettuce, kale, basil, peppers, marigolds and chard. A plaque explains that it is maintained by medical students, but encourages passerbys to pick whatever is ripe or ready. At this point in the summer, the lettuce and chard are well picked. There are bunches of green cherry tomatoes that unfortunately won’t be ripe until after I’ve left Ann Arbor for our short summer break. The basil has had no problem outgrowing the aggressive reach of the tomatoes and makes the garden smell good with each watering.

The garden plot!

Here in Michigan, the garden is a project of late spring and summer. The winter – my first one in Michigan — was long this year with snow well into spring. To celebrate the change of seasons, the Medical Campus Garden, a hodgepodge of students who have gardened or like the idea of gardening (me), organized a spring planting event as part of the April Wellness Week. Students tilled, fertilized, and then planted seedlings while enjoying salami, cheeses and fresh fruit generously supplied by the Wellness Pillar in M-Home.

The author with Annie Minns M1.

It is quite shocking how different life is in Michigan in the summer versus the spring. Thunderstorms, humidity, evenings spent swatting mosquitoes on my patio have all certainly defined this summer for me. The weather and its milieu of activities – going on runs, walks (to the ice cream store), reading outside – certainly make school more manageable. Thunderstorms roll in in the afternoons and rain gives relief. A couple times a week I water the garden, pull weeds, and nibble on the one or two ripe tomatoes.

Brycin Riley M1 and Garden Club member enjoys snacks during Garden Club-hosted Wellness Week.

This week marks my 52nd of medical school. It’s been a year since my white coat ceremony and I’ve taken dozens of quizzes and tests at this point, streamed many, many hours of lectures, and spilled coffee on my white coat five or six times. It is a blur of a year, strung together by organ sequences and the change of weather. We planted the half-foot seedlings sometime in April – in the middle of our Neurology sequence when dementia, movement disorders, and locating lesions were of utmost importance. I made a Waldorf salad in mid-June with the lettuce from the garden. We were in Infectious Diseases then, perhaps learning about parasites or maybe fungi? Last week we finished Psychiatry, our last sequence before we begin our clinical education, and the tomatoes had just begun to ripen.

Rachel Bergman M1 and Maria Santos M1 examine the lettuce.

In September we’ll return as M2s and after a month-long bootcamp begin our clinical rotations. While I won’t be tending to it, the garden will grow on until it gets cold and the last of the tomatoes have been picked. Hopefully, we’ll find some M1s to retill and replant in April or May next year. I’ll be in my internal medicine rotation and perhaps stop by the garden on my way home after clinic. I hope volunteers from this year’s crop — from the seeds of fallen fruit, basil, milkweed and parsley — populate the garden and carry a little of this summer into next.

Learning the Art of Medicine

We’ve (almost) done it! Only 1 more week left in M1 year! Here I am reflecting back on what has been a challenging but amazing ride and looking forward to starting my first clerkship in October. I can honestly say that I am less terrified and more excited to see patients next year based on my experience in the Clinical Reasoning Elective or as we call it “CRE.” CRE is an elective offered to M1 students during the Winter Term that assigns pairs of students to physicians throughout the hospital to practice their skills in a clinical setting. This elective is limited to 90 students, with two students per physician. Students get the opportunity to practice taking histories from patients and function in a similar manner as a clinical student without being graded.

Striking a pose with Big Bird, a rite of passage when in Mott Children’s Hospital!

Throughout the fall semester we learned how to take a history and complete a focused physical exam through the Doctoring course. However, the only patients I had applied this knowledge to were standardized patients as part of the curriculum. I was excited to be accepted into CRE and practice my clinical skills in the Pediatric Emergency Department. I am no stranger to the Peds ED, as I spent the previous year before medical school working at Children’s National Medical Center as a Clinical Research Coordinator. Enrolling children and families into research studies was a great clinical experience for me, but I was nervous to take on the role of student doctor and put to use the new set of skills that I have learned thus far as an M1.

My CRE partner and I had the pleasure of being matched with Dr. Marie Lozon, our guide into this new clinical world who also happens to be a real-life superhero. Dr. Lozon is the Associate Chief of Staff for Michigan Medicine, which she balances with her many other roles in the hospital system and her clinical shifts in the Pediatric ED. While our preclinical year, referred to as the Scientific Trunk, taught us the science and pathophysiology of the human body, Dr. Lozon focused on the “Art of Medicine.” In addition to helping us learn how to apply the textbook knowledge that we had studied for hours on end, she sought to teach us clinical pearls of wisdom you cannot find in lectures, study guides or books. Specifically, she sought to teach us how to appreciate and be part of the art of delivering care. She explained to us how there is art in many aspects of medicine, such as “the art of sensing other people’s pain or anxiety, the art of listening to their story, and the art of working with a team to take care of the patient.” With Dr. Lozon we learned that without the art of medicine, the science of it cannot flourish.

And so, we started our journey. Despite Dr. Lozon’s busy schedule she always made time to help us learn and see patients, even when this meant going to the ED for 2 hours between meetings to teach us. My partner, Enze Xing, and I regularly planned shifts to work with Dr. Lozon and were incorporated into the clinical team to care for patients. Often we were among the first people to obtain patient histories and perform physical exams. Throughout this experience I have learned a lot about myself and grown as a person, but no experience has been more important than getting comfortable with being uncomfortable. Although I was nervous to dive into seeing patients, I found that embracing where I was and being confident in the ways that I could be helpful enabled me to positively impact the care of families in the ED, which made this experience so much more valuable. I know many more challenges await in my journey to becoming a physician, but I look forward to the road ahead and mastering the art of medicine.

Learning from Imperfection

I first heard about the University of Michigan’s Ceramics Club from my classmate Sylvia. We’d been in the depths of M1 year for several months at that point, and I was looking for some kind of creative outlet so it sounded perfect.

When I entered the studio up in North Campus for the first time, I was amazed. The studio had everything: bins of clay rolls, dozens of different glazes, multiple kilns, and all the tools and wisdom we’d ever need. The room’s walls and racks were filled with incredible works of art like blocks with faces expertly carved out of them, huge colorful vases, and something that looked vaguely like a didgeridoo.

Being surrounded by this much talent with the realization that the last time I had even touched clay was in elementary school art class, I was immediately struck with a feeling of worry and inadequacy. However, my feelings quickly dissipated as I met the other members of the club, like Hazel, a member of the Ann Arbor community who’d been doing ceramics longer than I’d been alive and taught me how to make my first bowl on the wheel. I also became friends with Avery, an UM alum who happily answered my endless questions and guided me through the art of glazing. I was amazed by how supportive everyone in the club was and how willing they were to share their skills and help anyone who asked.

With Avery on the last day of ceramics

After doing ceramics for several months now and absolutely loving it, I still find it difficult. Ceramics is very different from any art media I’ve ever tried before. Making something on the wheel relies just as much on how the piece looks as on how it feels in your hands. It’s a very physical art form; it surprised me how much force I had to use just to get the clay centered on the wheel, and some days I’d leave the studio with my forearms aching. I don’t think a single piece I’ve made has turned out 100 percent the way I intended, but I’ve learned to see the beauty in my happy accidents. For example, a bowl that I’ve trimmed too far with a hole in the bottom becomes a flower pot. When a vase I make gets too lopsided, I’ll just fold in the edges and give it a frilled edge.

Having an open environment in the studio to learn without consequences is a very enriching experience that has helped me learn not to get too bogged down in the mistakes. In the studio I’m able to play with the clay and explore different ways of working it, without the pressure of needing to have a perfect finished product at the end of the day. In fact, the club members encourage and celebrate mistakes. There are days where all my attempts on the wheel end up in the bin, but it’s okay, because I know that I can just come back the next day and try again, and whatever I accomplish is purely for the sake of enjoyment and learning.

While in medicine we can’t just come back and try again, I can still see some value in learning in such an open and fearless place. In a world full of pressures, this environment of unrestricted learning is one that I’ll strive to find more of, not just as I get better at making symmetrical pots but also as I learn to become a physician.

One of my favorite pieces from this year, before it was glazed!

Groundcover News: The Street Newspaper of Washtenaw County

In September of 2010, Shelley Deneve was 2 months behind on her rent. Shelley’s landlord told her that if she couldn’t pay rent by the end of the month, he would have to evict her.

With this in mind, Shelley visited a local food bank where she came across a woman named Rissa Haynes. Rissa was selling a newspaper called Groundcover News, a street newspaper that community members were starting to sell in Washtenaw County to earn money. Rissa asked Shelley if she would be interested in buying a copy. When Shelley responded saying that she didn’t have the $1 to spend, Rissa replied, “If you don’t have a dollar to spare, you should be selling for Groundcover News.” Shelley was trained as a vendor (Groundcover News vendors sell the newspapers out in the community) and soon thereafter began to sell newspapers out in the community. 

Groundcover News is a monthly street newspaper written and distributed by community members of Washtenaw County, including those facing poverty and homelessness. Built on the idea of microenterprise, vendors buy the newspaper for 50 cents and sell them to community members across Washtenaw County for $2. In this way, vendors are able to save money and earn or supplement their income. Founded in early 2010, Groundcover News has been sold throughout Washtenaw County by over 450 vendors for the past 8 years. Shelley is vendor #22.

Susan Beckett, Groundcover News’ founder, says she initially had the idea for the newspaper after visiting her daughter in Seattle where she saw a street newspaper named Real Change. She was impressed by the idea, and after working many years as a volunteer lobbyist on issues of hunger and poverty, Susan was ready to execute this idea at home in Ann Arbor. Initially, however, Susan’s idea was met with skepticism. While the idea worked in Seattle, many doubted that a street newspaper would be successful in the much smaller city of Ann Arbor. Months later, after the recession hit, The Religious Coalition for the Homeless convened to discuss how to best support the homeless population of Washtenaw County. Here, Susan pitched her idea of the newspaper again. This time the idea stuck, and with the help of volunteers, the first issue was published in July 2010. A few months later, Shelley began to sell the new newspaper along Main Street and East Liberty.

While the paper was initially hard to sell, a few standout vendors started to spread the word. With each month, more community members around Ann Arbor had heard about the newspaper, and by the time the recession started to abate in 2014, the paper exploded. Many new vendors joined Groundcover News as a way to supplement their income and to become involved in a new community. In this excitement, Susan says she found great joy. “The most rewarding part of the process,” she recalls, “is the transformation the paper has had on people’s lives.” The initial amount of money saved is often what vendors need to pay off tickets and bills, get their chauffeur’s licenses, save, and get the tools and supplies to get a job. Shelley agrees, and recalls when she first started to sell papers, she was shy and found it hard to get people’s attention. With time, she notes, she was able to step outside of her comfort zone, become confident in professional settings, and even wrote articles for the paper.

As Susan, who will be retiring from her position at the paper this year, transitions the leadership of Groundcover News to a new editor, she states that the biggest lesson she has learned is the importance of direct giving. “There are many organizations that act as a middle party to distribute care to populations in need, but the act of direct giving is so personal.” With this, she encourages all to both give directly and to learn about vendor stories.

For me, this advice has held especially true. As an undergraduate student here at UofM, I often passed vendors selling Groundcover News on my way to class, and in an effort to make it to my classes on time, I found myself staring straight ahead hoping to not have to make contact. Only after I was introduced to Groundcover News by a friend (a medical student at the time) did I start to pay attention to the people calling themselves vendors and the newspapers in their hands. With time, I started to buy copies and encouraged my friends to buy them as well. I stopped to have conversations with vendors and read each newspaper completely, embarrassed to think of times when I had ignored vendors in the past. Now, as I end my 6th year of living in Ann Arbor (my second as a medical student), I feel lucky to contribute to the paper as a writer and am thankful that I live in a city like Ann Arbor that allows the paper to thrive. Although finding the time to write is challenging – especially during this past clinical year – writing for the paper and taking part in the Groundcover News community has allowed me to take a much needed break from the hospital complex and my shelf study books. Through writing, attending meetings, and speaking with staff members and vendors, I’ve learned so much about a community outside of my own, and I have even started to think about how writing could be a part of my career in medicine.

And as for Shelley? Thanks in part to Groundcover News, Shelley lives in the same apartment that she almost was evicted from 8 years ago. In addition, she works two part-time jobs and supplements her income by selling Groundcover News to three local churches.  

If you would like to buy a newspaper from a Groundcover News vendor, look for them at the Kerrytown Farmers Market Wednesday and Saturday as well as in front of the People’s Food Co-op all day Wednesday. In addition, there are almost always vendors on the corner of East Liberty and Main St. during the day as well as in front of the Ann Arbor Library. All vendors selling Groundcover News have certified vendor badges.

 

Susan Beckett (left) and Shelley Deneve (right) pose with newspapers in the Groundcover News office.