The 2015 UMMC Common Reading project, co-sponsored by the School of Medicine and the Center for Bioethics and Medical Humanities will feature Men We Reaped by Mississippi author, Jessmyn Ward. This annual event, now in its fourth year, is intended to highlight the many dimensions of diversity and to remind us how good literature can help us explore complex human problems.
For this year we chose something hard, challenging, even controversial. A book that examines the deaths of five African-American men in the author’s life in a raw and unflinching way. This work was chosen in part because we, as the community of UMMC caregivers, have an obligation to take on hard or uncomfortable topics that cause us to reach for deep understandings of the individuals for whom we provide care, or whom we study, or whom we educate. Selecting this book is not without risk. If read superficially, this book can reinforce negative racial and cultural stereotypes, even perpetuate long-standing prejudice and bias. Read more closely however, this book is about loss and grief, the cyclic frustrations of poverty, mental illness, chronic health issues, and under investment in education. A thoughtful reading unmasks a story of Mississippi, of Mississippians, of the social, economic and cultural contexts in which we live, in which we become patients, and how these facts complicate our care, and contribute to variances and disparities in outcome.
Our challenge is to give this excellent but difficult book a close, reflective reading and use it both as a corrective lens through which to see others and a mirror in which to see ourselves. Please join us at noon on Wednesday, February 25 in Room R354 for an open discussion.
Biomedical illustrations are used in teaching and research to communicate information that even “being there” cannot always convey. A line slightly contoured, highlighted, weighted, or shadowed - neither the perfect line of a computer, nor the unimpeded “capture” possible with a handy smartphone – is able to elucidate and communicate information about anatomy and physiology in a manner rarely otherwise achieved. But to produce lines that can communicate requires an ability to look at something, visualize it, and put it on paper.
To create such lines, Mr. Michael Schenk of Biomedical Illustrations at UMMC pursued both a full premed curriculum and a course of studies in art as an undergraduate, followed by a Master’s program at Georgia Regents University in Augusta, one of six Biomedical Illustrations programs in the U.S. and Canada. His graduate studies included coursework in the initial two years of medical school alongside medical students, a series of summer internships that put him in such sites as surgical theaters and pathology labs, and extensive study of the communication of complex concepts through art.
“If you don’t know your anatomy,” he states, “you won’t know how to remove the extraneous, the liquid for instance, so as to render the illustration better.”
Schenk’s work at UMMC began with an interview with Dr. James Hardy among packed boxes; the pioneer surgeon’s work was in transition. This past summer, however, Schenk’s UMMC collections of biomedical drawings and sketches were unpacked, examined, and archived by two School of Medicine students, Lauren Williamson and Jedd Audry.
The immediate task undertaken by Williamson and Audry involved sorting the Schenk sketches and drawings by discipline – no small task for a collection of its size. The individual items that the students worked with included free sketches on tracing paper, copy paper, water colors, carbon dust, pen-and-ink, and layers produced to show surgical procedures. The students were tested in their medical knowledge, as they had to identify the subject of every drawing in order to catalogue and archive it.
Williamson and Audry described it this way: “There were representations of Schwanomas, craniotomies, even laporoscopic panoramas, one might say, of complicated surgeries, as well as surgical manuals to review and catalogue.” Their efforts permitted them to explore academic archives, the Hardy catalogues, earlier editions of Arthur Guyton’s textbook, and the many contributions of other physicians whose efforts greatly contributed to the medical center, to School of Medicine educational goals and standards, and to the continuous development of a philosophy for guiding health care education across disciplines.
However, when asked about the value of a detailed examination of items in the collection, Williamson and Audry did not dwell on the past. Without a moment’s hesitation they replied, “It was great for our future knowledge,” one chiming in as the other left off.
“There was a story in every picture.” “
“It was a great opportunity to kind of flesh out the story within the picture…”
Audry later described “an image which stood out (that) involved the trapping of the anterior inferior cerebellar artery before it could distribute blood to the cerebellum. This reminded me of a trigeminal neuralgia patient whom I saw in clinic. Although a different kind of entrapment (dealing with nerves), in looking at the AICA entrapment, it kind of hit me: This surgery had been done on a real person that had presented with real pain and discomfort. It was a life-saver to them, and it was interesting to see a clinical presentation that gave life to the medical artwork. Lauren and I were constantly reminded that the beauty of Michael Schenk’s work is in its ability to show students, surgeons, physicians, nurses, and others in the medical field not only the techniques and procedures in medicine, but also the intricacy of the human body.”
In closing his description, Audry quoted a poster in the Biomedical Illustration offices: “Draw what can’t be seen. Watch what’s never been done. And tell thousands about it without saying a word.”
Williamson similarly described the sleuthing that was part of the students’ summer. “One of the more difficult image series that we had to identify was found in the ENT box. The anatomy is very complex, and some of the drawings were finely detailed surgical images. One in particular involved a nine step operation that had no explanation or labeled anatomy. Luckily, Jedd had shadowed neurosurgeons throughout the summer and knew it was a craniotomy (for which a bone flap is temporarily removed from the skull to access the brain). But there are so many different approaches, such as frontotemporal, parietal, and suboccipital, that we needed additional information to fully identify all nine images. This involved searching the online library catalog and scanning the bookshelves for ENT surgical texts. I found one that did step-by-step instructions on craniotomies, from which I learned that we were working with a frontotemporal approach. It took us about two hours to identify just nine images, but it was well worth the effort. And we could not have done this without our recent neuroanatomy class, Jedd’s hands-on knowledge in the OR, and my knowledge of the library resources (Pubmed, Up-to-Date, and the catalog).”
“And now we have this collection of medical drawings that are very well annotated.”
“We hope it becomes a future resource for medical practitioners.”
There is every reason to expect that the students’ hope will be realized. As Schenk explains it, a well done pen-and-ink drawing, for example, can be scanned at high resolution, the resulting huge file transferred to a software program such as Illustrator, then streamlined, converted to vector, and sent around the world. When printed, it will look like a pen-and-ink drawing.
But to achieve that result, to avoid a stagnant pane, to realize instead an image’s communicative potential, the placement of each line is defining. The work of Williamson and Audry, and their excitement in brief moments and phrases describing it, confirms that a line well placed can both yield a biomedical landscape and its context – and invite its viewer to probe and discover each.
On October 16, 2014, the Center for Bioethics and Medical Humanities (CBMH) hosted the Mississippi Humanities Council’s (MHC) fall meeting at UMMC. The CBMH works regularly with the Council to employ humanities approaches to knowledge and its assessment and dissemination to help strengthen health care professionalism, research, advocacy, and patient outcomes.
The meeting included a tour of key sites on the UMMC campus that comprise architectural “archives” of our history as an institution. Some of the sites visited on the tour included the surgical room where Dr. James Hardy performed the first heart transplant, the Emergency Room where Civil Rights leader Medger Evers, transported by private car to UMMC because no ambulance would respond to the call, passed away after being shot, and the bank of nearly adjacent bathrooms and dining rooms that bear further witness to the demonstrable facts of segregation. The tour began at the original entrance to the hospital, and continued to the new adult hospital, symbolizing a move towards a healthier future for all Mississippians.
Details on our current CBMH-MHC collaborative effort, Food: for Thought, for Life, can be accessed from the home page of the CBMH website.
The most recent UMMC Poverty Simulation was held on Thursday, October 9, 2014 from 9 a.m. – 12 noon in the UMMC Student Union.
Our next Poverty Simulation will be held Wednesday, February 11, 2015 from 9 a.m.-12 noon.
The Poverty Simulation, developed by the Missouri Association for Community Action, is a tool designed to educate participants about the day to day realities of living with a shortage of resources and an abundance of stress.
Participants were each assigned a role to assume during the four 15-minute long “weeks” during which the simulation takes place. The participants’ challenge is to end the “month” having met all of their obligations – financial, familial and social. The simulation takes approximately three hours to complete.
The Center for Bioethics and Medical Humanities brings the Poverty Simulation to the University of Mississippi Medical Center to sensitize our students – future practitioners – to the challenges that some of their patients may experience in addition to being in ill health. It is our hope that the simulation will serve to inform and shape the way the future healthcare providers of Mississippi deliver care. The simulation is also open to UMMC faculty and staff, our stakeholders, and interested members of the community. Please email Amani Bailey (firstname.lastname@example.org) with any questions you may have.
Our fifth Summer Bioethics Fellowship came to a close Aug. 1, 2014. We reluctantly said good-bye to our six fellows who had been with us since June 30. This fellowship, a collaboration between the CBMH, Millsaps College and the Department of Philosophy and Religion at the University of Mississippi, began in 2009, and is a five-week immersion experience exposing students to many ethical, social and cultural issues associated with modern health care and bioscience research.
In addition to being the largest fellowship class yet, several new events were added to this year’s program content . New to the fellowship this year was a visit with Dr. Gloria Perry, Chief Medical Officer of the MS Department of Corrections who shared information on the topic of dual loyalty in correctional medicine. This theme was continued by another new addition, Dr. Leslie McKenzie, Associate Professor of Emergency Medicine at UMMC and an active-duty officer in the Mississippi Army National Guard. Another new experience for our students was a tour of the SIM Center conducted by its medical director, Dr. Anna Lerant.
Also added as a discussant this year was Dr. Peyton McElroy, Affiliated Scholar at Millsaps College and affiliate faculty for the CBMH who met with students to discuss the philosophy of film. This discussion provided an excellent base for viewing films assigned over the course of the fellowship. Dr. McElroy holds degrees in Philosophy from Stanford University as well as a Masters in Philosophy of Religion from Yale Divinity School and is also experienced in theater having served as theater director for plays in Boston and New York. Other new topics added this year included a medical anthropology discussion, led by Caroline Compretta, PhD, QEP Post-Doctoral Fellow at the CBMH and a discussion of war and health facilitated by Dr. Libby Spence, Professor in UMMC’s School of Health Related Professions.
In total, the students met with 44 expert docents and discussants, completed and reviewed 56 readings, and viewed and analyzed 13 films. They successfully distilled their experiences and observations into essays on a focused bioethics topic. This year’s group was bright, engaged and at times challenging. In other words, exactly what one wants developing scholars to be. A perfect example is Anya Kremer, a rising senior in the Honors College at the University of Mississippi who introduced a new film documentary to the group and led a discussion about contextualizing a patient’s illness. The film, “Tanaquil LeClercq - Afternoon of a Faun,” is based on the life of a ballet dancer who was stricken with polio at the height of her career. Anya, herself a dancer, amplified this discussion with her own artwork as well as exceptional insight.
Our Summer Bioethics students were included, for the first time, as participants in the summer session of the CBMH Poverty Simulation. This simulation experience, is a collaboration with Entergy Corp. and is designed to educate participants about the day-to-day realities of living with a shortage of resources and an abundance of stress. It has proven to have a profound effect on all who take part.
As these students return to school to resume their traditional studies, we are certain that their summer experiences will change the way they approach their studies, their careers, and the world. It was a pleasure to have had them this year. We at the Center for Bioethics and Medical Humanities wish each of them much success in the years to come.
On June 30, the Center for Bioethics welcomed members of the 2014 Summer Bioethics Fellowship. The fellowship, now in its fifth year, is a five-week immersion experience exposing students to many ethical, social and cultural issues associated with modern health care. This year’s fellowship of six is the Center’s largest to date.They are Joseph Maxwell, Anya Kremer and Anna Grace Stout from the University of Mississippi, Merrilee Bufkin and Charles Stevens from Millsaps, and Amir Khadivi from the University of Chicago.
During this fellowship experience the students will attend sessions conducted by 44 discussants and docents, visit various clinics and attend Weekly Fetal Conference. In addition, they are assigned selected readings from biomedical literature and view films that serve as the basis for weekly discussions.
To date, the students have toured the Animal Lab Facilities as well as the Simulation Center, have seen the Dialysis Unit at the Jackson Medical Mall, attended Mortality/Morbidity Conference and met with the Director of the Institutional Review Board. Additional experiences included a visit to the Tissue Bank, and accompanying rounds in the Pediatric Palliative Care unit at Batson. A trip to the MS State Hospital at Whitfield was the highlight of their second week of the fellowship.
Sessions during the fellowship cover a broad spectrum of topics for the students: religion and spirituality, literature and medicine, allocation of scarce medical resources, organ transplantation, confidentiality, dual loyalty in both military and correctional medicine, public health policy, genetics, medical anthropology and cosmetic procedures, to name a few.
Many other exciting events are scheduled before the fellowship concludes Aug. 1. The students will meet with Dr. Gloria Perry, Chief Medical Officer, MS Department of Corrections, participate in the UMMC Poverty Simulation, visit the UMMC Center for Telehealth and view several films of Dr. James Hardy’s surgeries performed at UMMC.
It is the ultimate goal of this fellowship to produce a population of humanities scholars versed in the human aspects of medical care and bioscience research. Our hope is that these scholars can bring the skills of their respective disciplines to a better understanding of how people experience health, injury and illness.
Selection of the prize winners was done by four reviewers, each with experience in health care education, a love of literature, and a current or former engagement with literary scholarship, poetics, essays, and/or reviews. Two further readers from the Center for Bioethics and Medical Humanities served as “tie breakers” – or tried to! First place was awarded to Will Berlin for Before, a poem that moves its reader through the strengths and fragilities encountered in initial clinical experiences and “the fierce magic it takes to live.” The unbreakable tie for second place went to Leslie Davis for her reflective poem Where You Are and to Andrea McLaughlin for her good-humored, light verse rendition of This Chaos they Call, “Nursing School. Third place went to Allison Pace for her reflective essay, A Year of Firsts.
The book prize, a copy of William Carlos Williams’ The Doctor Stories, was selected for its literary quality and eye witness documentation of the health care assumptions, practices, and relationships prevailing over the course of Williams’ lifetime (1883-1963). His Paterson, New Jersey medical practice is portrayed in these studies and poems through clinics, hospitals and house calls, but most importantly through vignettes – not always flattering and some outright objectionable – of William’s interactions with those who sought care. All local, some would arrive through world wars, the Great Migration, revolutions; all 20th century, many would be affected by the Great Depression, or benefit by the advent of discoveries that would lead to astonishing changes in our approach to illness, health and health care, changes that continue to unfold. Robert Coles (b 1929), who introduces this volume and the Williams who observed to a medical student “There’s nothing like a difficult patient to show us ourselves,” finds in Williams professional renderings the following caution:
Coles goes on to state that, "Presumptuousness and self-importance are the wounds this life imposes upon those privy to the wounds of others. The busy capable doctor, well aware of all the burdens he must carry, and not in the least inclined to shirk his duties, may stumble badly in those small moral moments that constantly press upon him or her – the nature of a hello or good-bye, the tone of voice as a question is asked or answered, the private thoughts one has, and the effect they have on our face, our hands as they do their work, our posture, our gait. (xiii)"
These words apply to health care providers in every discipline, and the submissions to Writes … of spring showed that our students try diligently to heed them.
Finally, the awards were made only a few hours after word of the passing of Maya Angelou (1928-2014). In honor of her contributions within American letters and art, and in recognition of her immense influence on literary forms by which to examine the histories we live, the Book Awards began with a reading of the first stanzas of Maya Angelou’s Still I Rise, followed by an excerpt from Theories of Time and Space by Mississippi and U.S. poet laureate Natasha Tretheway.
The Center for Bioethics and Medical Humanities would again like to congratulate each student who participated in the 2014 launch of Writes … of spring for picking up the mandate of Williams, Coles, Angelou, Tretheway, and uncountable others to intervene on behalf of healing through the reflective exercise of their profession. We look forward to reading more work by all of these students – and you?!
The Center for Bioethics and Medical Humanities is pleased to introduce Dr. Caroline Compretta, our Quality Enhancement Plan (QEP) Post-doctoral Fellow. A graduate of Millsaps College, Dr. Compretta received her master’s and doctoral degrees in Cultural Anthropology at the University of Kentucky, Lexington, where she investigated the complex and contested relationships between service providers and recipients in faith-based social service programming.
Her doctoral research examined the contradictions and commonalities in providers’ conceptualizations and implementations of services and the lived realities of participating children and families. In view of agency struggles to meet the needs of children and families, her research showed that giving voice to service populations, especially children who are rarely considered in the creation and provision of services, helped to identify areas for service development and collaboration. Her work advocates listening to clients’ voices so service professionals can construct more responsive programs given their knowledge about the everyday issues clients face. In addition to her research interests, Dr. Compretta brings to CBMH an expertise in qualitative methodologies. As an anthropologist, she conducts structured analyses using techniques such as interviewing, focus groups, surveys, and “participant observation,” a method that allows a researcher to immerse herself in the participant community to gain first-hand knowledge about research issues. The analyzed data generated from these and other qualitative methods helps to create a holistic understanding of social dynamics in order to affect social change. Dr. Compretta’s work at CBMH will focus on issues of engagement as a means to work toward the improvement of patient outcomes. She plans to investigate engagement as it relates to the communicative dynamics within interdisciplinary healthcare teams, between patients/families and practitioners, in patients’ cultural and spiritual practices that affect health, and between practitioners and the wider community. Dr. Compretta will apply her knowledge and skills to examine how people within healthcare communities can create more effective responses to patients’ medical and sociocultural needs through communication and understanding. In so doing, her work will help to improve the quality of care at UMMC.
Topics important to national health care education and policy discussions on both physician retention and the declining interest in rural and primary care practices provided the focus for original investigations by Therese L. Sison (M3) and Khang Dang (M2), respectively, of the UMMC School of Medicine. The students, who have worked with the Center for Bioethics and Medical Humanities since their M1 year, continue to evaluate and interpret data on physician management of professional grief (Sison) and on election to practice in Mississippi (Dang).
Coping patterns for professional encounters with grief comprise an important skill set for physicians and other clinical caregivers. To examine these patterns among resident UMMC physicians, Sison modified a survey instrument jointly designed by Kenneth J. Doka, professor of gerontology at the College of New Rochelle (NY), as well as a senior consultant to the Hospice Foundation of America, and Terry L. Martin, associate professor of Psychology and Thanatology at Hood College (MD). Their metric delineates grief patterns into "instrumental'" (modulation through problem solving), "intuitive" (modulation through demonstration), and "blended" approaches.
Sison piloted her modified metric in a survey of 281 residents from a range of UMMC specialties to identify the patterns most frequently used to manage professional grief. A blended grief pattern was seen for most of the residents surveyed. However, statistically significant differences were observed in a number of areas. Among the most interesting for further investigation, one comparison showed that respondents in primary care specialties had significantly higher instrumental scores (p ≤ 0.001) than their colleagues in non-primary care specialties. Policy discussions about the election to practice in a Mississippi practice after completing UMMC medical training helped prompt Dang's interest in medical graduate specialty selection and practice locale. This pilot retrospective study was conducted as the initial segment of an effort to develop useful models for predicting both election to practice in the state and specialty selection among graduating UMMC School of Medicine Students. For this work, Dang examined demographic data for 1,056 students and for 1,599 residents at UMMC to identify patterns and policies that positively correlated with the election to practice in Mississippi between 2002 and 2012. Dang's study results showed that the election to practice in Mississippi was positively correlated with primary care residencies (more female than male physicians), a Mississippi origin and/or family in Mississippi, a dedication to primary care medicine, and a Mississippi undergraduate education. Sison and Dang hope that their work will contribute to policy and education efforts that will ultimately help improve physician satisfaction and retention, and thereby improve standard of care for patients throughout Mississippi.
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