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SAN ANTONIO 4 SAN ANTONIO MEDICINE • August 2022 TABLE OF CONTENTS
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6 SAN ANTONIO MEDICINE • August 2022 ELECTED OFFICERS rajeev Suri, Md, President Brent W. Sanderlin, do, Vice President Ezequiel “Zeke” Silva iii, Md, Treasurer Alice Gong, Md, Secretary John J. nava, Md, President-elect rodolfo “rudy’ Molina, Md, Immediate Past President DIRECTORS vincent Fonseca, Md, MpH, Member Woodson "Scott" Jones, Md, Member lubna naeem, Md, Member lyssa n ochoa, Md, Member Jennifer r rushton, Md, Member raul Santoscoy, do, Member John Shepherd, Md, Member Amar Sunkari, Md, Member lauren tarbox, Member Col. tim Switaj, Md, Military Representative Manuel M. Quinones Jr., Md, Board of Ethics Chair George F. “rick” Evans, General Counsel Jayesh B. Shah, Md, TMA Board of Trustees Melody newsom, CEO/Executive Director taylor Frantz, Alliance Representative ramon S. Cancino, Md, Medical School Representative lori Kels, Md, Medical School Representative ronald rodriguez, Md, phd, Medical School Representative Carlos Alberto rosende, Md, Medical School Representative BCMS SEnIOR STAFF Melody newsom, CEO/Executive Director Monica Jones, Chief Operating Officer Yvonne nino, Controller Mary nava, Chief Government Affairs Officer Brissa vela, Membership Director phil Hornbeak, Auto Program Director August trevino, Development Director Betty Fernandez, BCVI Director Al ortiz, Chief Information Officer PUBLICATIOnS COMMITTEE John Joseph Seidenfeld, Md, Chair Kristy Yvonne Kosub, Md, Member louis doucette, Consultant Alan preston, phd, Member rajam S. ramamurthy, Md, Member Adam v ratner, Md, Member david Schulz, Community Member Faraz Yousefian, do, Member neal Meritz, Md, Member Jaime pankowsky, Md, Member Moses Alfaro, Student Member Winona Gbedey, Student Member tue Felix nguyen, Student Member Cara J. Schachter, Student Member niva Shrestha, Student Member danielle Moody, Editor nancy Salas, Editor BCMS BOARD OF DIRECTORS
PRESIDENT’SMESSAGE 8 SAN ANTONIO MEDICINE • August 2022
Ulrich in 1984 demonstrated that patients recovered more quickly in rooms with views of nature than those that had brick walls. Several studies since then have shown similar effects of arts on healing, the challenge has consistently remained so to how to quantitively and qual itatively measure that impact.
The concepts of ‘art in medicine’ and ‘art as medicine’ are gaining interest in the medical and scientific community. Even if details of medical trends from the past may not be available, interpretation of art from specific times in history can enlighten us so that we don’t run the risk of repeating our mistakes. As we learn from the art in medicine, we can also heal ourselves and heal others by using art as a medicine. The benefits from art in medicine and art as medicine may be intangi ble, but they are real.
2. Ulrich RS. View through a window may influence recovery from surgery. Science 1984 224: 420-21
Rajeev Suri, MD, MBA, FACR is the 2022 President of the Bexar County Medical Society, Tenured Professor and Interim Chair of the De partment Radiology at UT Health San Antonio, and Chief of Staff at University Hospital San Antonio.
of the history of art in medicine is essential so that physicians maintain touch with realism and humanity, and do not treat patients as inanimate objects. Patients want their physicians to be knowledgeable but also have a good bedside manner. Having the med ical knowledge to succeed is ingrained in all physicians, but how do we ensure the best bedside manner? This can only be achieved by en suring training in bedside manners is at par with medical knowledge and by making our physicians more empathetic. More and more med ical schools are partnering with visual arts programs to teach students observational skills, broaden their vistas and be more wholistic in their approach to a patient. Medical schools are discovering that by teaching arts to medical students, they are improving thoughtfulness, encour aging open communication, thus making them more humane, com passionate and supportive.
Art as a medicine has been used as a form of therapy for ages. Ex pressing yourself through any art form is a wonderful way of overtly communicating your feelings, very similar to being exposed to art forms via any of our five senses. Visual arts have a central role in healing and symptom management, and are now an integral part of medical settings, be it as art and music therapy or featured visual art in hospitals.
References 1. Hajar R. What has Art to do with Medicine? Heart Views 2018 19(1): 34-35
Art in Medicine and Art as Medicine –Helping the Healers Heal Better
By Rajeev Suri, MD, MBA, FACR, 2022 BCMS President
The COVID-19 pandemic reminded us that despite all the scientific and medical advances of the 21st century, we are still dangerously sus ceptible to communicable diseases. Albert Camus in his 1948 novel The Plague said, “There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise.” Maybe we now better understand the causative organisms of infectious dis eases, and don’t react with witch hunts as were seen during The Black Death, illustrated by Pieter Tanjé in 1743, which shows a Christian procession carrying a canopy and a statue of the Virgin Mary through a town. The challenge of disease and death and the mass hysteria that we recently saw is, however, very similar to what was seen during the yellow fever pandemic as illustrated by Jose Aparicio in 1804, The yel low fever epidemic in Valencia and the cholera outbreak in Paris as il lustrated by Alfred Rethel in 1850, Dance of Death: Death the Strangler. Those that fail to learn from history are doomed to repeat it – is sadly still very Appreciationtrue.
One of the most famous paintings in medicine is The Anatomy Les son of Dr. Nicolaes Tulp by Rembrandt in 1632, which shows anatomy lessons being conducted in public theaters, and also highlights a text book on anatomy, the 1543 De Humani Corporis Fabrica (Fabric of the human body), a treatise on anatomy written by Andrea Vesalius in 1543. Another famous painting of surgery in a medical amphitheater is The Agnew Clinic by Thomas Eakins, 1889, which shows an evolving understanding of surgical hygiene compared to an earlier painting by the same artist in 1875, The Gross Clinic. ‘Art in the history of medi cine’ can inform us of the medical trends, innovations and evolutions over time, if observed and interpreted correctly.
What has art to do with medicine? The concept of ‘art in medicine’ dates back to time immemorial. ‘Art in medicine’ can be used to un derstand the history of medicine and enhance the teaching and learn ing of medicine. ‘Art as medicine’ also similarly dates back to antiquity and can be used as a powerful healing tool for us and for our patients.
Nichole Henkes is an MS-4 at UT Health SA Long School of Medicine. She is a member of Bexar County Medical Society and BCMS Alliance. by Nichole Henkes
Cluttered
“Cluttered” is a watercolor and ink on paper. This is my desk. At first glance it seems a disordered confusion of study tools. But to me, it is my carefully orchestrated, con trolled sanctuary. This is my safe space. Space I can control and a space that I know will be waiting for me. Regardless of who we are, we are all united in the fact that we need our safe space to bring us comfort. Mine just happens to be cluttered.
10 SAN ANTONIO MEDICINE • August 2022 BCMS ALLIANCE
By Rajam Ramamurthy, MD A
Being a dancer trained in Indian classical dance and a lover of all gen era of music, I was a witness for over a 40-year period to the arts creeping into the sterile stark grey and green corridors of hospitals. Now, the pur chase of paintings is a line-item budget when a hospital is being built. True, but the arts becoming a part of medical education takes quite an other dimension.
In early 2000, Humanities departments were established in several medical schools. In reading about it, this sentence stuck in my mind, and I quote, “The main concern of medical humanities education is teaching professionalism; one important aspect that has emerged is the goal of nurturing emotion through reflexivity.” I spent several minutes the of of Arts in Medicine
Physician! Rise to
Rhythm: The Significance
soft voice singing in an unknown language distracted my at tention from documenting my day’s work on medical records. Drawn towards the voice, I stepped into an alcove of the Neonatal Intensive Care Unit where four babies were housed. The light was dim, something the nurses did to provide some calm. Shi roni, I recognized her instantly from her long straight black hair and beautiful golden skin, was seated by her baby’s incubator, one port slightly open. She was singing a native Indian lullaby. I glanced at the baby who was moving her hands and feet; did I notice a facial grimace? Instinctively I looked at the monitor, the baby’s heart rate, respiration, oxygen saturation and blood pressure were perfectly within normal lim its. I have heard many parents mention that their presence and talking or reading to the baby made the oxygen saturation remain stable. Think of the role a lullaby has played in our lives. These days the recorded voice of the parent and music is not an uncommon sound in the nurseries.
Heights
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In 2001, an article in the Journal of the American Medical Association (JAMA) said that looking at paintings and sculptures can improve med ical students' observational abilities. If a student can observe a patient mindfully, notice the patient’s body language, and listen to them with all their attention instead of looking at a screen and typing; with height ened observational skills there will be fewer errors in diagnosis, and fewer reasons to do blood tests and x-rays.
looking up the meaning of reflexivity − the fact of someone being able to examine their own feelings, reactions and motives (reasons for act ing), and how these influence what they do or think in a situation. Pro fessionalism, on the other hand, I thought I knew. During my prime in medical school, a role model for professionalism could be described as a male physician, in a stiff starched long white coat, buttoned, with a tie. He always examined the patient thoroughly. He would keep his gaze on the patient’s face, kept a firm hand on the patient’s shoulder and ex plained his findings in the patient’s language if he could, and his last question always was, “what would make you happy in the hospital.” The wide-eyed patient’s expression was one of having seen the divine. We medical students wanted to emulate this mentor. Today the power of observation and mindfulness when interacting with patients is redis covered. Would a painting or a sculpture fulfill the role of a mentor?
Leonardo da Vinci dissected cadavers to understand the human anatomy. Medicine has used paintings, models and simulations in teach ing for decades. However, witnessing a group of medical students tour ing a museum is a novel endeavor. Dr. David Muller, Chairman of Medical Education at the Mount Sinai School of Medicine, mentions how important and underrated the art of looking is to the practice of medicine. He says, "To make a better doctor means to me − and I can't speak for everyone − one who sees the person and not just the patient… not just an organ system that is screwed up.”
Some schools like UT Health in San Antonio have established centers for Humanities and Ethics that bring prize-winning authors, poets, Nobel laureates and philosophers from the liberal arts into the world of medicine. Generally, in these programs students are not graded, and so it is hard to tell whether their art appreciation was improving their di agnostic skills. However, the students’ narratives indicate that their at tention to the patient has improved, and they perceive an emotional response to the patient’s condition. Reflexivity is perceived. By integrat ing Arts and Humanities throughout medical edu cation, trainees and physi cians can learn to be better observers and inter preters; build omywelfare,thepublishedsionalismtimeism.tenciesOneorpartedcialty,applicablegeneral(ACGME)uatetationworkcommunication,empathy,teamskillsandmore.In1999,theAccrediCouncilforGradMedicalEducationimplementedcompetencies,toeveryspethatneedtobeimduringresidencyfellowshiptraining.ofthesesixcompeisprofessionalAroundthesamein2002,theprofescharterwasthatincludedprimacyofpatientpatientautonandsocialjustice.
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ACGME through the initiative FRAHME (Fundamental Role of Arts and Humanities in Medical Education) provides resources to help medical educators start, develop and/or improve the use of arts and humanities in their teaching. A student entering medical school is perceived usually to have a heightened level of altruism, and the experiences of the four years in medical school seem to undermine that. Researchers have shown that medical students finishing medical school have more cynicism than nursing students finishing nursing school. Detaching oneself from the patient, loss of reflection and a turning to rote actions based on expec tations have been observed. The arts including painting, sculpture, per forming arts like dance and music as well as art appreciation should be encouraged. The practice of these is akin to meditation, keeping one’s attention on a singular endeavor. “Mindful of that particular moment” gives the needed respite to the mind, body and intellect complex that prevents burnout. In his farewell address as president of the Association of American Medical Colleges, Jordan Cohen, MD, made this statement: “The physician professional is defined not only by what he or she must know and do, but most importantly by a profound sense of what the physician must be.”
2. Epstein RM, and Hundert EM (2002). Defining and assessing pro fessional competence. J. Am. Med. Association (JAMA) 287(2):226235. Rajam Ramamurthy, MD is Professor Emeritus of Pedi atrics and Neonatology at UT Health San Antonio. Dr. Ra mamurthy is an active member of the BCMS Publications Committee.
continued from page 13
References 1. Progress integrating medical humanities into medical education: a global overview, Stefani Pfeiffer, Yuchia Chen, and Duujian Tsai. Curr Opin Psychiatry 2016, 29:298–301. www.co-psychiatry.com Volume 29 _ Number 5 _ September 2016.
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This love expanded beyond the Bengali Folk dancing realm and made its way into the world of Bollywood. I vividly remember my older sister, cousin and me re-watching Bollywood movies from the 1990s and 2000s multiple times. We would replay the dance numbers over and over, dancing along to the choreography in our living room until we had the routine memorized. As we got older, our nostalgia for the 1990s and 2000s Bollywood movies remained. We found ourselves dancing to these very songs at our family’s dance-filled celebrations. We recently decided to take our love for dance from live events to producing dance cover videos on YouTube. This introduced a whole different layer into our dance work. Beyond choreography, we were pushed to think about direction, set location, outfit selection and more.
To watch the full video, visit this YouTube www.youtube.com/watch?v=Mp41XRO-nxslink:
rowing up, my parents instilled in me an appreciation for Bengali culture that I have carried on to this day, and thus, my Bengali culture greatly shaped my identity. I was sent to Bangla School alongside elementary school in order to learn how to read and write Bangla as well as learn the art of Bengali Folk dancing. It was from then on, that my love for dance grew.
Sadia Mohaimin is a rising second-year medical student at the University of the Incarnate Word School of Osteopathic Medicine. Sadia’s scientific interests include focusing on reduc ing health disparities in underserved and disadvantaged communities through culturally-tailored methods. She is an aspiring physician who hopes to practice preventive care with a socially-informed perspective in primary care settings.
Dance to “Chamma Chamma”
By Sadia Mohaimin
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This piece, “Chamma Chamma” was one of the latest pieces my sister, cousin and I produced. It is a dance cover to a classic Bollywood song from the 1998 Indian film, “China Gate.” The song was sung by Alka Yagnik and performed on screen by actress Urmila Matondkar. The ac tress noted that she wore over 30 lbs. of jewelry for this song! In our rendition, we took pieces of the original choreography while adding in our own flare. We wore lehengas and oxidized jewelry to match the original Banjaran look the actress had on for the dance –although our jewelry was not anywhere near 30 lbs! I hope to con tinue creating dance covers and re-picturize classic Bengali and Bol lywood songs.
By John J. Seidenfeld, MD
Art in
D
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octors, nurses and pharmacists as well as many other med ical professionals interact in and outside of healthcare fa cilities on a regular basis. Most of these interactions are focused on patient care and many are stressful and provoke anxiety. In terprofessional education is aimed at interactions guided by respect, kindness, recognition of the importance of multiple intelligences, team work, shared observation and shared decision-making. To train for these interactions and to build this environment, the UIWSOM has partnered with the McNay Art Museum. We work with our partners to engage in the discovery and enjoyment Medicine*; Interprofessional Education (IPE) at University of the Incarnate Word, School of Osteopathic Medicine (UIWSOM)
is shown in part below with a COVID-19 focus from a work of a previous pandemic.
At the McNay Art Museum, learners can make connections with other health professions in the UIW Community. As individuals freed of professional role expectations learners make observations with the familiar and unfamiliar and practice communication skills. After in troductions, learners progress through several activities.
“Since Mrs. McNay’s original bequest in 1950, the museum’s collec tion has expanded to more than 22,000 works including: Medieval and Renaissance art, 19th- through 21st- century European and American paintings, sculptures and photographs, one of the finest collections of prints and drawings in the Southwest, the exceptional Tobin Collection of Theatre Arts, the Jeanne and Irving Mathews Collection of Art Glass, and the Art of New Mexico.” (https://www.mcnayart.org/)
To conclude, learners are asked to write a one-word critique of the experience. The group shows all their words and discusses the experi ence. Our UIWSOM learners write a one-page reflection on their in teractions which is reviewed by the members of the Community Engagement Partnership committee. During the COVID-19 pandemic these experiences continued in the virtual format. The McNay Art Museum staff facilitated our Inter professional educational experience, like the in-person event. Learners from the various UIW health professions schools teamed in virtual breakout rooms to analyze artwork and perform group activities, cul tivating a strong emphasis on teamwork and networking. One-hour virtual sessions were scheduled throughout the academic year.
In “Creative Connections,” learners are divided into small groups and select a work of art. A picture card guides imagination of the work of art as one of the familiar objects and describes its use, sound and oper ation. Ideas are shared with the small group and then the larger group.
*(For those who wish to experience the transcendent experience of medicine and art the author suggests the following link:) https://rx museum.org/reflections/the-masque Anexampleofthesiteofferings
Visit us at www.bcms.org 17 of visual arts to experience a transformation where all participants in teract to share observations, listen to one another, and gain collegial interactions in a less stressful environment aimed at advancing interac tive skills, diversity, equity and inclusion. The McNay Museum set in a landscaped architectural haven is a San Antonio gem described as;
In “Gallery Observations,” learners engage in close observation of a single object, employ visual thinking strategies in conjunction with discovery-based questioning strategies, draft a list of questions for the subject or artist and discuss ideas with peers. Learners also observe an other object nearby and make visual content comparisons between the two objects.
“Demuth’s Masque of the Red Death performs a number of transla tions. First, an epidemiological phenomenon is transformed into Poe’s allegorical work of literature; then, nearly a century later, that work of literature becomes a painting. Perhaps furthering this process, a con temporary viewer will doubtlessly translate the painting to their own experience, recognizing its parallel to the current COVID-19 pan demic. The Masque of the Red Death is a visual representation of the ways in which a plague, even if it may appear to not touch certain cir cles initially, can be an unpredictable equalizer of all human beings. It infiltrates. It spreads, like watercolor across canvas. Similarly, COVID19, which has been taken more lightly by some than others, may ulti mately come to affect all of us with as much force and devastation, before it ends. How can representations of pestilence such as The Masque of the Red Death convey the universality of the pandemic ex perience, no matter how different the context and demographics of those portrayals may be?”
Demuth similarly visualizes the differential impact of pandemics, and the crises of empathy they can engender. How can compassion mo tivate us to uphold the social contract and support others?”
John J. Seidenfeld, MD is the Chair of the BCMS Publications Committee. Image, facing page: Charles Demuth, The Masque of the Red Death, c. 1918. (Courtesy of Barnes Foundation)
“Throughout the COVID-19 pandemic, people have been impacted to varying degrees, with certain groups more vulnerable than others (e.g., the poor, the elderly and those without access to healthcare). Compassion can help us understand the suffering of others. As Sandro Galea, MD, writes in The Lancet: Compassion extends beyond empathy. It does not motivate our action because we may too be harmed. Compassion motivates action because the phenomena we observe are unjust . . . and pushes us to understand how we have structured the world, and to ask how we can structure it better, not because we may suffer but because others are suffering and that is not how the world should be. Would our approach to COVID19 have been different were we accustomed to seeing health through the lens of compassion?
ART MEDICINEIN
The books have the rich glow of fine bindery: the exquisite endpapers only hint at the artistry within. As readers know, the art of medical il lustration is neither to entertain or delight with detail but to provide a schematic guide to human components, both in their natural state and more importantly, in abnormal states. The Library’s artistry spans from
By David Alex Schulz, CHP
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Art and Science Bound in Beauty
ippocrates tells us, “teachers are the parents of physicians’ skills.”Medical textbooks, then, are the aunts, uncles and grand parents of their practice, since the earliest physicians’ texts predate the Oath by a millennium. The vital importance of medical bibliography to the healing arts is beautifully expressed at the Bexar County Medical Society’s Library, established in 1912.
The collection has grown over more than a century to contain thou sands of volumes. Some are modern reprints reaching back to the ear liest days of bound books, “Paracelsus’ Four Treatises” for example. Others are contemporary to their time and now comprising historical records, like the 16-volume set devoted to Medicine in WW2. The books, relocated variously through the decades, have finally found a permanent library in the boardroom and surrounding corridors of Bexar County Medical Society’s newly dedicated headquarters in San Antonio.Toinclude the collection in a magazine devoted to art in medicine calls for explanation. Attending high school smack between New York’s 42nd St. Library and Barnes & Nobles’ main store, where after noons and summers were spent clerking, taught me to cherish all as pects of books from the touch of their marbled endpapers to their hidden rope bindings. When my first meeting as a member of the
JosephlectedmyandcentSpecies,”“Thecouldless.wasincentlysandsamidstCommitteeCommunicationswasheldthesethouofmagnifiboundbookstheboardroom,IstruckspeechTomyleft,IseeDarwin’sOriginofinmunifiblackbindinggiltlettering;toright,“TheColPapersofLister,”notes
from the pioneering father of antiseptic surgery and preventive medicine. Heady stuff.
The Bexar County Medical Library:
H
David Alex Schulz, CHP is a community member of the BCMS Publications Committee. Images this page, clockwise from top left: Muscles of the Torso - back view Chondroma of the fingers Cellular infiltration of the fatty tissue in the periphery of a hard cancer of the breast; the blood vessels injected Cancer of the mucous glands from the inte rior of the nose
Medicine’s grisly history is also found in the library, where a reprint of Robert Knox’s 1852 “Manual of Artistic Anatomy” is shelved.
Knox’s story is worthy of Mary Shelley: The leading teacher of anatomy in the 1820s, Dr. Knox’s class numbered more than 500 attendees, not only medical students but also noblemen, lawyers, artists and philoso phers. Unfortunately, Knox is best known today for his involvement in the most notorious crime in Scottish history, murders carried out by Burke and Hare. Knox bought the bodies of their victims for use in dis sections at his anatomy school. Losing his license, Knox spent the rest of his life teaching anatomy to artists and sculptors.
Since its initiation in 1912, the library has depended on support of BCMS member physicians, organizing as the Bexar County Medical Library Association in 1920. The Association is a non-profit 501(c)(3), and all active practicing physician members of BCMS are members of the Library Association. If you would like to help support the library, contact Chief Operating Officer Monica Jones at (210) 301-4373.
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reprints of Leonardo da Vinci’s 15th Century “Note-Books on Anatomy” and Sir Charles Bell’s 19th Century “Treatise on The Hand,” to the current day. Artist-drawn sketches still convey greater depth of information than photographs, relieving the flatness of a camera image with perspective, and drawing attention to particular aspects by virtue of technique with pen and ink.
Unfinished
Lauren C. Jameson is a student at the UT Health San Antonio Long School of Medicine, Class of 2023.
By Stephanie Batch
Eighty-five years old
Artistic Expression in Medicine
Author’s Note: I wrote this poem as a reflection of my experience walking into my patient’s room while his wife was serenading him during one of his last afternoons in our care on the medicine service.
Stephanie Batch is a student at the UT Health San Antonio Long School of Medicine in the Class of 2025.
Artist Note: This piece is inspired by my memories of my dad in the hospital when he had coronary artery bypass graft sur gery. As my family and I stayed by his side throughout his recovery, I remember glancing over to see my mom and dad napping together on the couch beside the hospital bed. Using warm tonal hues to imply a dreamy and nostalgic atmosphere, I wanted to capture this moment of inti macy and tenderness during this chapter in our family's lives.
Weathered face, kind eyes Jean jacket, matching denim hat You’ve come to sing to your husband
By Lauren C. Jameson
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He is not long for this world Married for two of my lifetimes How do I provide comfort? I lack perspective You tell me that he is one of the good ones I hold his other hand while you sing Tears fall silently from my eyes He is Mr. P to me But he is your soulmate Your love story unfinished
Ontologically the earth’s bosom Receives then births in cyclic unity
ii. Lysergically meandering Entities, crisp and lucid, Wed each Wednesday, Yearning I cannot reach them Blistering hinges crimp my arms Old wasps flit within my wrists Descending bluntly, statuesque, Yearning I cannot reach them. iii. Vicissitude unwelcomed I’d rather Avoid in passing any judgment Sonorous dealings above are no Concern in this austere hollow Under the luminous glow of Lunar light, my flotsam Approaches and is subsumed by the River that floats me away. iv. All the world’s a stage, a Line from someone famous about the Zoo this world becomes, a whirlwind Hiding all intention or direction
Folly is an oddity for what Reprobate embraces stodgy axiom
Entirely suspended captive and still Mount tan streaks across the sky while Procumbent vines grasp prosaic flesh
In Decline
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Over Elysia’s ambrosial fruits Never plucked and taut for some Talk gurgles between my lips Only to smooth such surfaces that Touch its waves like crystal glass
Erratic eye shifts and movements Interred beyond my perception, a Mugginess masking all identities Erstwhile I wander like Orpheus Remember what I lost, I Say to no one in particular.
Skyler Kanegi is a student at the UT Health San Antonio Long School of Medicine in the Class of 2023.
By Skyler Kanegi i.
Auspicious I triumph in dissent from Liars and denialists on the paved path.
Suddenly his delirium is a fire we cannot put out. One dose of haloperidol, then another. One call to his daughter, then another. Soon, the smoke smothers any hope for a discharge note. In medicine, there are times we do not have answers; all we have is our humanism and care.
55 Word Stories -
An old man trips over a dog. Non-operable pelvic fracture, ortho signs off. “I better get home to my cats,” he smiles, “I never liked dogs.”
By Marybeth Wootan Holst Eight eyes on the vent. Four backs to the patient. He looks like he’s sleeping. His chest rises. His chest falls. He looks like he’s breathing. A young woman sits beside him. Red eyes on white coats And black Patagonias. She wills them to turn around. And see her. By Yolanda Crous I barely knew who you were. Trying to understand your rapid decline was difficult enough, let alone standing beside you trying to communicate while unable to understand your slurred words. Your son said you’d been mentally sharp, a beloved caretaker. Then, two days later I stood before you as you took your last breaths alone. This moment has stayed with me, and I do not think I will ever forget all of the raw feelings I experienced from both myself and the patient’s fam ily. I was in charge of contacting her family members in order to find out more about her baseline mental status. I felt satisfied to have been the person to share such important information with the son and to be able to be a conduit for his frustrations with the healthcare system. It served as an important reminder to follow up with patients’ families as soon as it is pos sible and reasonable.
Medical students in the Class of 2023 at UT Health San Antonio Long School of Medicine use the writing of stories to find humanity and meaning in their clinical experiences. This collection of stories reveals the complexity, vulnerability and compassion woven in the threads of con versations with their patients and the discovery of the power of connection through close listening.
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By Salma Yazji He was a grumpy man, Full of sassy retorts and eye rolls, someone we sometimes did not want to see. But then he got sicker and it seemed like we couldn’t do anything to help. All his organs are failing. And I wish he could tell me I asked a dumb question one last time. By Michelle Sutanto I itch, I’m tired And on a scale of 1-10… We medicalize her pain Emesis, malaise, abdominal tenderness Her slipping grasp on a bright future Already a pediatric cancer survivor Now her faltering pancreas Disassembling her dreams block by block I sit on the bed’s edge, hesitantly Does it hurt? Sure, everywhere, I guess. I wrote this piece as a reflection on how sometimes it can be difficult to balance caring for our patient’s physical and mental health while in the hospital, especially as a trainee where we feel like our time is so limited and these conversations can be vulnerable and daunting. Caring for her was a privilege, and she taught me a great deal about the importance of establishing trust with patients and giving them the space and time in the hospital to be more than a diagnosis.
By Aimee Ramirez
Discovering and Honoring the Voices of Our Patients
By Medical Students
Bad things happen to good people.
By Marie Vu I hope he doesn’t come back. He looks tired and his legs are still swollen, yet there is a strong note of conviction as he says, “I tell everyone, if you are sick and you are not at THIS hospital, you’re Istupid.”smileand silently, desperately hope that he doesn’t come back when he He’sleaves.back a week later. This showed me the positive experience we can have with patients. It also presented the strange dichotomy that comes with working in a hospi tal: both liking a patient and hoping you never see them again, because it would mean they were back in the hospital. It also showed me the hard reality of dealing with a patient with chronic disease.
At the beginning of my third year of medical school, while on an ICU rotation, I had the opportunity to learn from the patient who is the subject of this story. The experience subsequently impacted the way I interact with patients, particularly those who are unable to communicate verbally. The capacity to convey your fears, concerns, and hopes to your physician is so important. As future physicians, we have a responsibility to advocate for our patients, and sometimes that means being their voice when they can not speak. We have to make every effort to do so with the utmost integrity and compassion.
The diagnosis: end stage lung cancer. He cried out, “How did this happen to me? I never smoked a day in my life. Why, God?” He and his wife sobbed together as if he was already gone. I didn’t know why. Why do bad things happen to good people?
By Matthew Maia She walked in but not out. It was never meant to go like this. Sure, she was losing blood somehow. But slowly. She walked in to the hospital that day. Two days later, she was intubated, lost part of her gut. Her family told us she was a fighter. She loved life. We couldn’t save her, though. She didn’t walk out.
By Emily Heydemann, MSW Visit us at www.bcms.org 23
T 24 SAN ANTONIO MEDICINE • August 2022
We also aim to: • Reflect the community we serve, • Improve the experience of our patients and visitors, Communicate our mission through art and design enhancements,
• Faster recovery with less medicine and shorter hospital stays, • Cost effectiveness with faster discharges and bed availability,
Salud-Arte: Art of Healing By
Benefits of art in a healing environment include:
• Staff retention and welcoming environment for patients and families.
• Be good stewards of our financial and natural resources.
• Providing a positive distraction from worry and anxiety,
A poignant example of a positive distraction was a terminal patient several years ago, who entered our emergency department for the first time, due to a relapse in his condition. Instead of sadness and anxiety, this patient almost jumped off the gurney, wanting to look at all the art in this clinical area. As an artist himself, he found great joy in rec ognizing the work of other local artists and gave us seven works before he died a short time later.
ART MEDICINEIN
•
he Salud-Arte: Art of Healing program was established by University Health leadership in 2010, with an appointed staff, community leaders and stakeholder committee, to in tegrate artwork as a healing component in our built environments. The two areas completed during the 2008-2014 Capital Improvement Pro gram (CIP), were the Robert B. Green Clinical Pavilion, which opened in 2013, and the Sky Tower at University Hospital campuses, which opened in 2014. The vision of the program is to use art to inspire heal ing, compassion, hope and trust, and build an understanding of the healing attributes that exposure to art, nature, color and light can pro vide in a medical setting.
The Salud-Arte: Art of Healing program is laid out in three phases following an evidence-based design approach to art integration. 1) De sign Enhancement; artwork actually built into the building such as wall designs, metal works, glass frit and screens 2) Public Art; art selected for a signature area with a central focus such as a hanging lobby sculp University Health, Photography copyright Mark Greenberg
The Robert B. Green Clinical Pavilion, which opened in January 2013, is an over 350,000 square foot, six-story building, containing over 450 art objects that fall within these three phases. Two of our sig nature highlights creating a peaceful, welcoming environment are, “Life in Light” by Cathy Cunningham Little and “Feather Wall” by NedUniversityKahn.
ART MEDICINEIN Visit
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UTH, San Antonio SanUTSAAntonio Museum of Art Say BlueSiStar Contemporary Witte Museum St. Phillips College Carver Cultural Community Center us at www.bcms.org
Hospital’s Sky Tower is a 1.1 million square foot building, with 11 floors and 420 individual patient rooms, that opened in April of 2014. Each patient room includes a piece of handmade glass that is visible from the patient’s bed and family area. Within the three phases, there are now more than 4,000 pieces of artwork, growing from the original program of 1,200 when the building opened. Our highlights here include Riley Robinson’s “Bluebonnets” and “You Activate this Space,” created by Ansen Seale, which won the International CODAworxs Award for Best Art Integration into a healthcare interior category in 2014. Since 2014, University Health has opened numerous new clinics, renovated older clin ical floors, incorporating artwork within all of these locations. The artwork is an impor tant standard and the continuation of quality continues throughout all of our renovated or new built environments. It is our commit ment to compassionate care. Within the new 850,000 square feet and 12 floors of the new Women’s and Children’s Hospital, we are integrating artwork via the three-phase system. We expected to utilize the work of hundreds of artists and small businesses for this project. We are focused on supporting the medical and emotional needs of children and women to create a place of discovery, hope, calm and regeneration. Each floor will incorporate “hidden” art treasures, for children to discover that are colorful and installed at their eye level. Two of our design enhancement teams are composed of mother and daughter artist pairings, utilizing their shared memories and experiences. Since 2015, Salud-Arte: Art of Healing has been partnering to create public awareness and bedside programming for patients and staff. Our current and past community art partners include:
ture, electronic artwork along an entrance corridor or sit-specific mo saics. 3) Art Procurement; we procure unframed artwork from local, regional and national artists, while staff and patients also have a chance to donate artwork to the program. This section can include mixed media and sculpture.
Tandem CenterTamarindPressPressforHealthcare
ART MEDICINEIN Southwest School of Art Good Samaritan Center Guadalupe Center McNayArtpaceArt Museum
the Lobby” musical performances and projects, staff art kits giveaway, art programs in staff “Recharge Rooms” to support the well-being of our teams and staff art exhibitions and cultural outings. We have re cently begun a program of bringing music to the nursing stations and patient floors directly as well as in main areas such as Infusion and Re habilitation.Ourexperiences range from patients or their families who stop and engage with us during these workshops and share how having this type of program impacts them. For staff during the pandemic, it became a comfortable normalcy to hear music, write poetry and even dance and laugh at an outdoor concert in one of our gardens. We have cancer pa tients who do not need to use their medication pumps to ease their pain, because they are engaged with our AYA music and art programs. A young mother with a child in the Neonatal intensive care unit (NICU) who welcomes our Friday workshop can be in community and join us to pass some of the many hours she spends in the hospital. We use the tenets of Trauma-Informed Care to create an arts program to comfort nursing teams who supported a local team struck by tragedy andInloss.the words of the artist Paul Klee, “art does not reproduce what we see, it makes us see.” As we continue into our second century, University Health “sees” art in our future growth. We continue to aspire to use the arts as a healing tool, which can speak many languages, cross age barri ers, open young minds and raise up the spirits of all who come to us seekingInterestedcare. artists and/or local small business owners can find our University Health art procurement calls at www.publicartist.org. This site includes a FAQs, a link to registering as a vendor, dates for upcom ing University Health art tours at the Med ical Center and upcoming outreach talks. For questions and general information about the current art program and partnership op portunities, please contact: Allison Hays Lane Curator & Archivist University (210)Allison.lane@uhs-sa.comHealth743-6839
Design
CODAworx
City of San Antonio Department of Arts and Cultural Affairs
Statewide and National Partners are: Texas Association of Public Art Administrators
NOAH, (National Organization of Art in Health) Hamilton Award, Honorable Mention, 2020, for our art and re siliency programming during CV19 (Healthcare Interior of the Year Award, 2014)
Ecumenical Center Voices de la Luna Hearts Need Art Trinity University
Our programs continue to grow and include patient channel videos of storytelling, art workshops, music performances, poetry reading, artist demonstrations, Pop-up weekly “Art in the Garden” and “Art in
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San Pedro Creek Foundation CBAW, (Community Building Artworks)
Author’s Note: I wrote this short essay while I was rotating through the pediatric hematology-oncology unit at UT Health. It was a pro foundly meaningful rotation for me.
Pictured are Syrian refugee children playing on a do nated slide set, surrounded by a barbed-wire fence and white tents they now call home. Their stories unveil truths of missing family members and homes turned into rubble within seconds. Yet in this moment, all that we see are girls levitating off the ground as none of their feet touch the reality they are in.
Branches
Have you ever seen a tree wither away?
By Malavika Perinchery
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First it drops one leaf; then another. The transformation happens slowly, but surely. If you pay attention to it, every day, you can clearly see what’s going to happen. But if you don’t, you don’t notice until all you’re left with is branches. Just branches. It finally hit me today; what it is that I’ve been watching this week on the pediatric heme-onc inpatient unit. I’m watching young people die. I’m watching in real time as death wraps its tendrils around small, innocent souls. I wish I were exaggerating; I wish this was just a trick of prose, but no. This is what is happening. And if I think about this reality too hard, I want to alternatively scream and cry at the unfairness of it all. I think about my patients and the patients on my floor almost con stantly. I think about the pregnant silence that fills the room once we tell them about another metastasis. I think about the parents who sleep on the chairs in the hospital room while their children go in and out of consciousness. I think about the child who is too young to know why they even have to undergo chemotherapy. When I watch a tree wither away, I wonder if anyone noticed that first leaf fall. I wonder if anyone saw what was coming. Because now, all I see are branches.
Malavika Perinchery is a student at the UT Health San An tonio Long School of Medicine, Class of 2023.
I took this photo on a scorching summer day in July 2014 in the Za’atari refugee camp. At the time, Za’atari was a collection of tents in a desert bordering Jordan and Syria. It has since become the world’s largest camp for Syrian refugees fleeing the endless tragedy of war, having grown into a permanent settlement that houses almost 80,000 refugees. This form of creative expression has been passed down along generations. My grandfather was a coun try-renowned photographer with a shop in the streets of Damascus, enveloped by jasmine vines. My father grew up working days and nights developing film in the studio. Having this photo recognized eight years after it was taken and 11 years into the still ongoing Syrian revolution forces me to reconnect with a con flict, I had found myself inevitably growing numb to.
Salma Yazji is a student at the UT Health San Antonio Long School of Medicine, Class of 2023.
Photography – Art By Salma Yazji Visit us at www.bcms.org 27
“Departed” is taken near Polulū Beach on the northern part of Hawaii’s Big Island a few hours after I receive a lackluster first board exam score, causing me to self-question whether I am ready for my ca reer and the life I have laid out for myself. I describe what ensues as a “hike of hopelessness” with the primary purpose of letting the beauty of the landscape juxtapose itself to my neuroticism and worries—a yin and yang—a visceral attempt to balance the world within my mind and the world from my eyes. My wandering mind soon evolves into wandering legs, and as I trudge through freshly rained-on mud, my newfound anger and tur moil from my board score fuel me on mindlessly. When I arrive at the ostensibly picturesque destination—one I had no aim to reach or even an idea of its existence—it honestly feels very cold, blustery, and mildly depressing to be so alone in a place of such objective beauty. I rest on the bench prepared to wallow in my misery but not ten minutes pass when a motley family—at least 3 generations in tow shouts “We made it baby! This is it!” One of the women begins pointing out features in the landscape, estimating the distance to neighboring islands beyond the misty horizon. The two youngest in their crew pay no heed but rather attempt to play hide-and-seek with a bench that clearly has nei ther hide nor seek potential. Despite the quotidian nature of these in teractions, I feel a little liberated—and a lot lightened. I have grown to think of “Departed” as a reference to the things we have lost—others, opportunities, ourselves—the “what if’s” in life. But I also think about “Departed” as the willing departures of parts of ourselves—our guilts, our regrets, our traumas—in exchange for stoicism, for solace—to look back on life and not say “This is it…a bench?” but rather “This is it, baby!” This, a wooden bench, can be nothing or everything—depen dent upon how you, the explorer and artist, choose to view it.
28 SAN ANTONIO MEDICINE • August 2022 ART MEDICINEIN
Departed
By Christopher Zhu
Christopher Zhu is a student at the UT Health San Antonio Long School of Medicine, Class of 2023.
Cuartel de Ballajá in Old San Juan, Puerto Rico. Taken from the periphery of the central plaza just days declaredCOVID-19afterwasapandemic.
Author’s Note:
Visit us at www.bcms.org 29 ART MEDICINEIN
AndersonMargaretJane is a student at the UT Health San Antonio Long School of Med icine, Class of 2023.
By Jane M. Anderson
By David Nweke
NwekeDavidis a student at the UT Health San Antonio Long School of Medicine, Class of 2025.
Alcohol ink on yupo paper
Photography
Bloom
S 30 SAN ANTONIO MEDICINE • August 2022
ART MEDICINEIN ocial media has become an integral part of society, especially with the rise in usage following the COVID-19 pandemic. Studies have shown 86% of adults aged 18-29 use some form of social media.1 Notably, social media has had a major impact on med icine, specifically on the dissemination of medical knowledge and rais ing awareness of particular medical conditions. Individuals with large social media followings known as “influencers” have a large effect on what and how information is distributed to the public. Providers, es pecially within the field of dermatology, have utilized social media to provide educational information regarding various conditions. Many authors note that with the increasing preference of telemedicine, social media may be a new key asset in connecting physicians with other pro fessionals and patients.2-3 In addition to medical professionals, other popular users such as
By Ashley Chakales and Maryann England
Social Media Use in Raising Awareness of Skin Conditions
model Winnie Harlow and Gymshark influencer Whitney Simmons have utilized their social media platforms to share their personal jour neys with the skin conditions of vitiligo and psoriasis, respectively. Har low and Simmons’s large presence on social media has brought awareness to and helped normalize skin conditions. Both of these lead ing ladies promote body positivity and being comfortable in your own skin. This can have immensely positive effects on others who have skin conditions and help others feel more comfortable in their own skin. In an interview, Winnie stated, “The emotional aspects of living with vi tiligo are very real but often overlooked. Many children who have the disorder face egregious teasing and bullying.” Harlow went on to men tion she did not see anyone with her skin condition portrayed in the media, when in fact vitiligo affects 70 million people worldwide.4 Re cently, Simmons posted on her Instagram page how she has stopped hiding her psoriasis plaques. The impact of this post can be seen in the comment section. Many other women with psoriasis, which affects over 125 million people globally, and other skin conditions have com mented saying Simmons’s post has made them feel empowered and more confident in their own skin.5
2. Barrutia L, Vega-Gutiérrez J, Santamarina-Albertos A. Benefits, drawbacks, and challenges of social media use in dermatology: A systematic review. Journal of Dermatological Treatment. 2022:120. doi:10.1080/09546634.2022.2069661
9. Limaye RJ, Sauer M, Ali J, et al. Building Trust while influencing online covid-19 content in the Social Media World. The Lancet Digital Health. 2020;2(6). doi:10.1016/s2589-7500(20)30084-4
Another excellent use of social media raising awareness of medical conditions is the organization Special Books by Special Kids (SBSK), active on many platforms like YouTube and Instagram. This account interviews disabled children and their families about their condition, asking how they feel about their condition and what they wish others knew about it. SBSK introduces the public to various disorders, but skin conditions they have covered include xeroderma pigmentosum, neurofibromatosis, ichthyosis, Goldenhar syndrome and much more.
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6. Get the facts about psoriasis and psoriatic arthritis. The National Psoriasis Foundation: National Psoriasis cessed%942,the%20World%20Psoriasis%20Day%20consortium.20yet.&text=125%20million%20people%20worldwide%E2%80%20Impacts%20of%20Psoriasis,there%20is%20no%20cure%2C%https://www.psoriasis.org/psoriasis-statistics/#:~:text=TheFoundation.AcJune19,2022.
4. Nordlund JJ. Vitiligo: A review of some facts lesser known about depigmentation. Indian Journal of Dermatology. 2011;56(2):172. doi:10.4103/0019-5154.80413
5. Author Bronwen Keyes-Bevan, Author, Keyes-Bevan B. Winnie Har low: Her emotional story with vitiligo. Health 2022. %20depression.%20of%20living,%2C%20embarrassment%2C%20shame%20andtional-story-with-vitiligo/#:~:text=The%20emotional%20aspectshttps://www.healthinsight.ca/advocacy/winnie-harlow-her-emoInsight.PublishedFebruary20,2020.AccessedJune19,
7. Porter A. Normalizing the diversity of the human condition. SBSK. https://sbsk.org/. Published January 7, 2021. Accessed June 19, 2022.
References 1. Smith A, Anderson M. Social media use in 2018. Pew Research Center: Internet, Science & Tech. 7,/internet/2018/03/01/social-media-use-in-2018/.https://www.pewresearch.orgPublishedApril2021.AccessedJune19,2022.
Like all good things, the potential for distribution of inaccurate in formation is possible.
With over three million subscribers on YouTube, SBSK works to “nor malize the diversity of the human condition.”6
Ashley Chakales and Maryann England are medical students at the UT Health San Antonio Long School of Medicine. ART Visit us at www.bcms.org 31
3. Lee K, Finnane A, Soyer HP. Recent trends in teledermatology and teledermoscopy. Dermatology Practical & Conceptual. 2018;8(3):214-223. doi:10.5826/dpc.0803a013
With the rise of individuals turning to social media for advice and information regarding skin conditions, it may be difficult for the gen eral public to distinguish accurate versus inaccurate information. Der matologists can help address this issue by increasing their presence on social media, being active leaders in medical conversations on social media and assisting in dispelling false information.7-8 Dr. Muneeb Shah, a dermatology resident, is an active leader in dermatology-related con versations on social media. He addresses misconceptions and promotes the prevention of many dermatological conditions. He states that his social media presence’s mission is to provide education and is not meant to represent medical advice. Statements similar to this on influencers’ social media pages whether medical professionals or not can help remind the general public that so cial media posts are to provide information on topics in medicine and correct false information, not to diagnose or provide treatment options.
8. Szeto MD, Mamo A, Afrin A, Militello M, Barber C. Social Media in dermatology and an overview of popular social media platforms. Current Dermatology Reports. 2021;10(4):97-104. doi:10.1007 /s13671-021-00343-4
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Source: graphic/homehttps://vetoviolence.cdc.gov/apps/aces-info
For medical professionals, “trauma care” is associated with medical teams in a hospital emergency department working to save persons with critical, life-threatening injuries. However, there are other important life traumas that affect a person’s well-being. These traumas have been described as “Adverse Childhood Experiences” or “ACEs.” The Sub stance Abuse and Mental Health Services Administration (SAMHSA) describes trauma as “events or circumstances experienced by an indi vidual as physically or emotionally harmful or life-threatening, which result in adverse effects on the individual’s functioning and well-being.”
While abuse, neglect and adversity have long been recognized as health stressors, structuring of these adverse events into the ACES framework is owed to the work of Dr. Vincent Felliti and his colleagues. Dr. Felliti noted that the “great majority” of the dropouts in their weight loss program “were suc cessfully losing weight.”2 Setting out to answer the question why persons who lost weight often gained much of it back, Dr. Felliti, Dr. Robert Anda and colleagues published the seminal ACEs study that found a person’s experience of certain adverse exposures in childhood (divorced parents, emotional abuse, physical neglect, etc.) statistically predicted numerous poor health out comes. Using a scale of 0 to 10 exposures, Felliti et al. noted that “persons who had experienced four or more categories of childhood exposure… had 4-to-12-fold increased health risks for alco holism, drug abuse, depression, and suicide at tempt…”3 Since the original ACE study publication, ACEs have been linked to numer ous chronic diseases, often in a dose response re lationship (See Graphic “ACEs Can Increase Risk for Disease, Early Death, and Poor Social Outcomes.” Also see “Resources” for a link to the original ACEs questionnaire).
Trauma-Informed Medical Workgroup: Health Care’s Response to Adverse Childhood Experiences (ACES)
32 SAN ANTONIO MEDICINE • August 2022
Although a higher number of ACEs increases the risk of poor health outcomes, researchers sought to document the protective factors shared by the person and the community which seem to blunt or block the ef fect of adverse childhood experiences.4 Shifting the focus from therapy for ACEs to emphasizing resiliency support explains why a leading re source site on ACEs has rebranded to the Positive and Adverse Child hood Experiences (PACEs) to reflect the importance of protective factors that can blunt the impact of an ACE.
By Edward Dick, MD and Kristen Plastino, MD
Responding appropriately to the reality of trauma in patients and the healthcare team requires a “Trauma Informed Care (TIC)” ap proach. SAMHSA states a trauma informed organization “…realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others in volved with the system; and responds by fully in tegrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.”5
There is no single or exhaustive list of all ACEs but types of ACEs in clude, but are not limited to, emotional and physical abuse, neglect and other household stressors including divorce, Intimate Partner Violence (IPV) and other adversities (See “Types of ACEs” graphic).
Practicing trauma-informed care
In Bexar County, the South Texas Trauma In formed Care Consortium (STTICC) addresses the many mitigating and supportive factors through 12 interdisciplinary workgroups in cluding a medical workgroup. Goals for the medical workgroup include: 1. Promoting com mon understanding and vocabulary of traumainformed care; 2. Increasing awareness of ACEs and protective factors in clinical care and among the clinical care team; 3. Disseminating infor mation on continuing education and training in trauma informed care (TIC); 4. Monitoring and sharing evolving best practices on screening for ACEs; 5. Collaborating with other workgroups and constituencies to improve referral sources and treatment options for trauma; 6. Advocat ing for adoption of best practices that mitigate trauma, prevent trauma, and increase resiliency at the individual and community level; and 7.
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Source: https://www.cdc.gov/violenceprevention/aces/resources.html#anchor_1626996630 Visit us at www.bcms.org
Texas Health Steps
formed-carehealth-wellness/institute-for-trauma-inhttps://www.universityhealthsystem.com/UHSdressing-aceshttps://www.txhealthsteps.com/549-adCMEInstituteforTraumaInformedCare
2. Felitti V. J. (2002). The Relation Be tween Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. The Permanente Journal, 6(1), 44–47.
Edward Dick, MD is the Director of Clinical Complex Care Management at Methodist Healthcare Ministries of South Texas, Inc,, a faith-based, not-for-profit organization working to create access to care for low-income, uninsured families through services, strategic grant-making and community partnerships in 74 counties. Dr. Dick is a member of the Bexar County Medical Society.
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Workgroups https://stxtraumainformedcareconsortium.org/workgroup-sectors/ Training ACEs Aware https://training.acesaware.org/CME
https://stxtraumainformedcareconsortium.org/Southhttps://www.pacesconnection.comPACEshttps://www.chcs.org/topics/trauma-informed-care/StrategiesTexasTraumaInformedCareConsortium(STTIC)
Promoting the pursuit of Trauma-Informed Certification for organi zations and healthcare teams. Members of the Bexar County medical community are invited to learn more at the STTICC website, participation.stticcmanager@gmail.commedicalconsortium.org/workgroup-sectors/.https://stxtraumainformedcareToparticipateinthequarterly,workgroupmeetings,pleaseemailtheworkgroupmanageratforadditionalinformationonmeetingsand
Ace-Score.pdfhttps://www.ncjfcj.org/wp-content/uploads/2006/10/Finding-YourCertification https://www.ecrh.org/trauma-informed-organizations/
Resources
ACEs Questionnaire
4. Howell, K. H., Miller-Graff, L. E., Martinez-Torteya, C., Napier, T. R., & Carney, J. R. (2021). Charting a Course towards Resilience Fol lowing Adverse Childhood Experiences: Addressing Intergenerational Trauma via Strengths-Based Intervention. Children, 8(10), 844.
General Resources Center for Healthcare
1. fographic-TIC.pdforg/wp-content/uploads/https://www.traumainformedcare.chcs.2018/11/In
3. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experi ences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.
References
5. Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-In formed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Ad ministration, 2014, p9.
Kristen Plastino, MD is the Vice Chair of Clinical Opera tions and Professor in the Department of Obstetrics and Gyne cology at UT Health San Antonio. Dr. Plastino founded UT Teen Health and as director, she opened the Teen Health Clinic housed at the Robert B. Green Campus and serves as the medical director. She also consulted on the opening of multiple local school-based health cen ters. She is a member of the Bexar County Medical Society. SAN
SANMEDICINEANTONIO On June 9, 2022, Bexar County Medical Society hosted the 2022 Summer Kickoff Mixer. The event was well attended by a group of medical residents, students, active members and past presidents. The Drew Brown Band performed and entertained the guests while they enjoyed a great BBQ buffet. THANK YOU TO THE EVENT SPONSORS: Premier Sponsor: Cano Health • Presenting Sponsor: ALOFT Hotel Partner Sponsors: TMA Insurance Trust and Texas Capital Bank 2022 Summer Membership Mixer L – R BCMS Past Presi dents, Dr. Vijay Koli, Dr. Manny Quiñones, Dr. Gabriel Ortiz L – R Dr. Manpreet Chhabra, MD; Dr. Duncan Friedman and Mrs. Carly LFriedman–RTom Duncan, Broad way Bank COF Member and BCMS President-elect, Dr. John Nava L – R Dr. Raul Santoscoy, BCMS Board Member and Pedro Gutierrez, Texas Capital Bank (Event Sponsor) L – R Mr. Edward Vargas, Cano Health Texas VP of Business Development –Event Presenting Sponsor 54321 34 SAN ANTONIO MEDICINE • August 2022
Visit us at www.bcms.org 35 Aug 13/27, Sept 10/24 and Oct 8 8 am - Noon TOPICS INCLUDE: Fundamentals of Leadership Design Thinking and Leadership Traits of High-Performing Leaders Economics of the Health Care Industry Go to www.bcms.org to register or use the QR code at left 2022 BCMS Leadership Series
• Eliminating punitive policies for seeking care for mental health and substance-use disorder;
AtlasSkeletalMovable
This is a movable skeletal atlas now pressed between two glass sheets (because of tears and fragility) made by Professor GJ Witkowski, MD in Paris, France from the 1880s. Dr. Seidenfeld’s fa ther practiced law from 1945 –1980, using this book in litigating skeletal injury cases. Visit us at www.bcms.org 39
By Professor GJ Witkowski, MD
SANMEDICINEANTONIO
TMA Wellness Fund Can Help the Texas Medical Association
If finances are keeping you or someone you know from seeking treat ment for depression, anxiety, substance use or other conditions, the Texas Medical Association’s PBF Wellness Fund is here to help over come that Throughbarrier.thefund, physicians with a valid Texas medical license can receive financial support for treatment of conditions that impair their ability to practice medicine safely. In addition, qualifying physicians can receive financial support to cover their family’s living expenses while undergoing treatment. In the Surgeon General’s report, Addressing Health Worker Burnout, Dr. Murthy proposed a variety of approaches to aid the 35% to 54% of physicians and nurses, and 45% to 60% of medical students and residents, reporting symptoms of burnout. He called for individu als, healthcare organizations, academic institutions, government and more to help address the problem.
• Ensuring access to mental health services for healthcare workers and their families, including the use of telemedicine. Contact TMA if you or someone you know could benefit from the PBF Wellness Fund. Email Chris Johnson, PBF director, at chris.john son@texmed.org or call her at (512) 370-1602 with questions. Or complete an application online. TMA strives to protect the anonymity of fund Contributionsrecipients.from physicians and their spouses support the fund. If you want to help, you can contribute via secure, online donation or send a check to PBF Wellness Fund, Attn: TMA Finance Department, 401 W. 15th St., Austin, TX 78701-1680. The PBF is a 501(c)(3) organization, so charitable contributions are tax-deductible to the full extent permitted by federal law.
By
• Normalizing conversations about mental health challenges, includ ing suicide, in healthcare learning environments to foster a culture of support and awareness; and
Related to mental health, the advisory calls for such actions as:
In a recent advisory calling attention to healthcare worker burnout, US Surgeon General Vivek Murthy, MD, highlighted the broad re sponse the situation calls for: “We must ensure that every health worker has access to affordable, confidential and convenient mental health care.”
Burnout: A National Problem;
CLINICAL
Livingston Med Lab (HHHH 10K Platinum Sponsor) High Complexity Clia/Cola accred ited Laboratory providing White Glove Customer Service. We offer a Full Diagnostic Test Menu in the fields of Hematology, Chemistry, Endocrinology, Toxicology, Infec tious Disease, & Genetics. Robert Castaneda (CEO)
Support BCMS by supporting the following sponsors. Please ask your practice manager to use the Physicians Purchasing Directory as a reference when services or products are needed.
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We learn your individual needs so we can develop a strategy to help you achieve your financial goals. Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you. Elizabeth Olney, Financial www.edwardjones.com/elizabeth-olneyElizabeth.olney@edwardjones.com210-858-5880Advisor
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Joey Martinez (Director of Joey@livingstonmedlab.com210-204-7072Operations)
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Jim Rice, CPA 210-384-8000, ext. 112 www.ssacpa.comjprice@ssacpa.com
Healthcare banking experts with a private banking team committed to supporting the medical community. Shawn P. Hughes, JD Senior Vice President, Private www.broadwaybank.comshughes@broadway.bank210-283-5759Banking
(ManagementBertuzzi-TorresMANAGEMENTWEALTHWealthGroup HHH Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending and estate planning.
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40 SAN ANTONIO MEDICINE • August 2022
ACCOUNTING FIRMS
Michael L. Kreager mkreager@kreagermitchell.com210-283-6227
Synergy Federal Credit Union (HH Silver Sponsor)
(BroadwayBANKINGBank
We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solu tions for discerning healthcare professionals, including asset pro tection, lending & estate planning.
Mike Bertuzzi First Vice President Senior Financial Michael_bertuzzi@ml.com210-278-3828Advisor Ruth Torres Financial http://fa.ml.com/bertuzzi-torresRuth.torres@ml.com210-278-3828Advisor
Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor SERVICE512-649-8113 @ www.oakwellpwm.comOAKWELLPWM.COM
Looking for low loan rates for mort gages and vehicles? We've got them for you. We provide a full suite of digital and traditional fi nancial products, designed to help Physicians get the banking serv ices they need. Synergy FCU Member Services www.synergyfcu.orginfo@synergyfcu.org210-750-8333
PHYSICIANS PURCHASING DIREC-
With over 29 years’ experience, we understand that real-time visi bility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimen sional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager www.expressinfo.comranac@expressinfo.com210-771-7903
Mike Bertuzzi First Vice President Senior Financial Michael_bertuzzi@ml.com210-278-3828Advisor Ruth Torres Financial http://fa.ml.com/bertuzzi-torresRuth.torres@ml.com210-278-3828Advisor
ACCOUNTING SOFTWARE Express Information Systems (HHH Gold Sponsor)
HHH Gold Sponsor)
“Dedicated to working with physicians and physician groups.”
ASSETT
FINANCIAL (ManagementBertuzzi-TorresSERVICESWealthGroup
“We’re here for good.” The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insur ance for the medical community. Brandi Vitier www.thebankofsa.combrandi.vitier@thebankofsa.com210-807-5581
FINANCIAL ADVISORS Oakwell Private Wealth (Management HHHH 10K Platinum Sponsor) Oakwell Private Wealth Manage ment is an independent financial advisory firm with a proven track record of providing tailored finan cial planning and wealth manage ment services to those within the medical community.
Robert@livingstonmedlab.comEmail:210-316-1792
BexarORGANIZATIONVERIFICATIONCREDENTIALSCredentialsVerification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. provides primary source verification of credentials data that meets The Joint Commission (TJC) and the Na tional Committee for Quality Assur ance (NCQA) standards for health care entities. Betty Fernandez Director of www.BexarCV.comBetty.Fernandez@bexarcv.com210-582-6355Operations
Sean Villasana (Chief Scientific Officer, CSO) Sean@livingstonmedlab.com210-237-8557
“Leaders in Healthcare Software & Consulting” (KreagerATTORNEYSMitchell HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation pos sible in providing industry specific solutions. From business transac tions to physician contracts, our team can help you in making the right decision for your practice.
"Making Sense of Investing"
Stephanie Dick Commercial m/tx/austin/stephanie-dickhttps://commercial.firstcitizens.costephanie.dick@firstcitizens.com210-744-4396Banker
Recommended partner of the Bexar County Medical Society
“Serving the medical community.” MedPro Group (HH Silver Sponsor) Rated A++ by A.M. Best, MedPro Group has been offering customized insurance, claims and risk solutions to the healthcare community since 1899. Visit MedPro to learn more. Kirsten Baze www.medpro.comKirsten.Baze@medpro.com512-658-0262
Rana Camargo Senior Account Manager www.expressinfo.comranac@expressinfo.com210-771-7903
TMAINSURANCEInsurance Trust (HHHH 10K Platinum Sponsor) TMA Insurance Trust is a full-service insurance agency offering a full line of products – some with exclusive member discounts and staffed by professional advisors with years of experience. Call today for a compli mentary insurance review. It will be our privilege to serve you. Wendell England Director of Member Benefits www.tmait.org800-880-8181wendell.england@tmait.org512-370-1776
HHHH 10K Platinum Sponsor) With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) pro vides malpractice insurance and related products to physicians. Our purpose is to make a positive im pact on the quality of health care for patients by educating, protect ing, and defending physicians. Patty Spann www.tmlt.orgpatty-spann@tmlt.org512-425-5932
We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life.
Karen Leckie Senior Vice President | Private karen.leckie@amegybank.com210-343-4558Banking
HOSPITALS/ HEALTHCARE
INVESTMENT ADVISORY REAL ESTATE Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and de velopment opportunities for our in vestment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and fi nancial restructuring (equity, debt, and partnership updates). Jon Wiegand, Principal www.alamocapitaladvisors.comjw@alamocapitaladvisors.com210-241-2036
“People Bank with People” “Your Practice, Our Promise” Amegy Bank of Texas (HH Silver Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things. Jeanne Bennett EVP | Private Banking Manager Jeanne.bennett@amegybank.com210-343-4556
Denise C. Smith Vice President | Private Banking www.amegybank.comDenise.C.Smith@amegybank.com210-343-4502
UT Health San Antonio MD Ander son Cancer Center, is the only NCI-designated Cancer Center in South Texas. Our physicians and scientists are dedicated to finding better ways to prevent, diagnose and treat cancer through lifechanging discoveries that lead to more treatment options. Laura Kouba, Manager, Physician NorrisKouba@uthscsa.edu210-265-7662Relations
“Leaders in Healthcare Software & Consulting”
“We offer BCMS members a free insurance portfolio review.” (Guardian ★★★ Gold Sponsor) Live Confidently. Every financial dream deserves a well-crafted plan. Ned Hodge www.nedhodge.comned@nedhodge.com210-332-3757 | www.Opesone.com “Take care of today then plan for tomorrow” (Humana HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. Jon Buss: Jbuss1@humana.com512-338-6167 Shamayne Kotfas: www.humana.comskotfas@humana.com512-338-6103
(TexasMALPRACTICEINSURANCE/MEDICALMedicalLiabilityTrust
Aspect Wealth Management (HHH Gold Sponsor)
“Community banking partnership”
UTFACILITIESHealthSan Antonio MD Anderson Cancer Center, (HHH Gold Sponsor)
“Get what you deserve … maximize your Social Security benefit!”
continued on page 42
Michael Clark, President www.aspectwealth.commclark@aspectwealth.com210-268-1520
Lauren Smith, Manager, Marketing & SmithL9@uthscsa.edu210-450-0026Communications San7979dersonUTAppointments:Cancer.uthscsa.edu210-450-1000HealthSanAntonioMDAnCancerCenterWurzbachRoadAntonio,TX78229
Robert Lindley Senior Vice President | Private robert.lindley@amegybank.com210-343-4526Banking
HEALTHCARE BANKING
Visit us at www.bcms.org 41
First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a re lationship bank. We get to know you. We want to understand you and help you with your banking.
(ProAssurance HH Silver Sponsor)
ProAssurance professional liability insurance defends healthcare providers facing malpractice claims and provides fair treatment for our insureds. ProAssurance Group’s rating is AM Best A (Excellent). Mike Rosenthal Senior Vice President, Business www.ProAssurance.comMikeRosenthal@ProAssurance.com800-282-6242Development
The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insur ance for the medical community. Katy Brooks, CIC www.thebankofsa.comkaty.brooks@bosainsurance.com210-807-5593
INFORMATION (ExpressTECHNOLOGIESANDInformationSystems HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visi bility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimen sional reporting that helps you accommodate further growth and drive your practice forward.
1LT Thomas Alexandria milAlexandria.n.thomas12.mil@army.210-328-9022
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https://recruiting.army.mil/mrb/ “Service to Country, Army Medi cine, Experientia et Progressus”
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STAFFING SERVICES
Valerie Rogler, Program Coordinator www.thehealthcell.orgValerie@thehealthcell.org210-904-5404
★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and de velopment opportunities for our in vestment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and fi nancial restructuring (equity, debt, and partnership updates).
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MOLECULAR (iGenomeDxLABORATORYDIAGNOSTICS
MEDICAL BILLING AND COLLECTIONS SERVICES Commercial & Medical Credit (Services HH Silver Sponsor)
San Antonio Army Medical Recruiting office (HH Silver Sponsor) Mission: Recruit highly qualified and motivated healthcare professionals for service in the Army Reserves or Active Duty Army, in support of Sol diers and their families. 1LT Thomas Alexandria https://recruiting.army.mil/mrb/Alexandria.n.thomas12.mil@army.mil210-328-9022
SanMILITARYAntonio Army Medical Recruiting office (★★Silver Sponsor) Mission: Recruit highly qualified and motivated healthcare profes sionals for service in the Army Reserves or Active Duty Army, in support of Soldiers and their families.
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A bonded and fully insured San Antonio-based collection agency. Henry Miranda www.cmcs-sa.comhcmiranda@sbcglobal.net210-340-9515
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“Where San Antonio’s Healthcare Leaders Meet” San Antonio Medical Group Man agement Association (SAMGMA) (HH Silver Sponsor) SAMGMA is a professional nonprofit association with a mission to provide educational programs and networking opportunities to medical practice managers and support charitable fundraising. Alan Winkler, www.samgma.orginfo4@samgma.orgPresident
CARR Realty (HH Silver Sponsor) CARR is a leading provider of commercial real estate for tenants and buyers. Our team of health care real estate experts assist with start-ups, renewals, reloca tions, additional offices, pur chases and practice transitions. Brad Wilson Agent www.carr.usBrad.Wilson@carr.us210-573-6146
PHYSICIANS PURCHASING from
DIRECTORY continued
“People Bank with People” “Your Practice, Our Promise” MEDICAL SUPPLIES AND (HenryEQUIPMENTScheinMedical HH Silver Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere.
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Jon Wiegand, Principal www.alamocapitaladvisors.comjw@alamocapitaladvisors.com210-241-2036
“BCMS members receive GPO discounts of 15 to 50 percent.”
Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare commu nity since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle. Cindy M. Vidrine Director of Operations- Texas 210-918-8737 cvidrine@favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”
REAL ESTATE
“Our Focus is People” Our mis sion is to support the people who propel the healthcare and bio science industry in San Antonio. Industry, academia, military, nonprofit, R&D, healthcare delivery, professional services and more! Kevin Barber, President 210-308-7907 kbarber@bdo.com(Direct)
★★★ Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a re lationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial m/tx/austin/stephanie-dickhttps://commercial.firstcitizens.costephanie.dick@firstcitizens.com210-744-4396Banker
Dr. Pramod Mishra Co-founder, COO & www.iGenomeDx.compmishra@iGenomeDx.com210-381-3829CSO “My DNA My Medicine, Pharma cogenomics” (TheORGANIZATIONSPROFESSIONALHealthCell HH Silver Sponsor)
page 41 42 SAN ANTONIO MEDICINE • August 2022
RETIREMENT PLANNING Oakwell Private Wealth (Management HHHH 10K Platinum Sponsor) Oakwell Private Wealth Manage ment is an independent financial advisory firm with a proven track record of providing tailored finan cial planning and wealth manage ment services to those within the medical community.
Visit us at www.bcms.org 43
REVIEWAUTO
44 SAN ANTONIO MEDICINE • August 2022
2022 Mercedes S580
By Stephen Schutz, MD
Stephen Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the US Air Force. He has been writing auto reviews for San Antonio Medicine since 1995. Visit us at www.bcms.org 45
The seventh generation S-class, known internally as the W223 model, doesn’t look radically different from its predecessor, but it’s way ahead technically.
For starters, the 12.8-inch OLED touchscreen display above the center console along with a second 12.3-inch customizable screen in front of the driver are very advanced. Using the navigation system on the smaller display gives you a 3-D image of the S-class moving across the land, and it works in concert with the heads-up display that places directions onto the reality that you actually see. It’s better than other satnav systems and is impressive to experience in person.
The new Mercedes S-class is a wonderful top-shelf ICE sedan that’s as good as it gets, as long as you’re not in the market for a car that costs a half million dollars. And even then, it’s competitive. If you don’t have to have an SUV, then this is the sedan for you. Just make sure you get the rear-axle steering.
Actually, driving the S-class under any circumstances is a calming experience. Whether running errands in town, eating up miles on the interstate, or hustling down a B-road, the Mercedes flagship sedan excels. The aforementioned engine and transmission get much of the credit, but a top-shelf suspension system and advanced software con tribute significantly. Every time I drove the S580 I thought, “this must be the best sedan ever built.” And it mostly is. Certainly, Bentley and Rolls Royce make the absolute best sedans in the world, but those ve hicles are three to four times more expensive than the S-class, and no way are they three to four times better.
I’ve noted previously how much better Mercedes interiors are than they used to be, and that’s doubly true for the S-class. Everything you touch feels comfortable and reassuring, and everything you see looks expensive. Plus, there’s the sleekly modern tech described above that’s integrated with the cushiness in a very pleasing way.
Nevertheless, a new S-class is still a big deal, and I was definitely paying attention when Mercedes launched the most recent version of their flagship sedan last year.
REVIEWAUTO
Note for readers: A trauma surgeon friend and I have launched an automotive podcast that may interest you. It’s called, “Cars on Call,” and it features discussions about a myriad of automotive subjects from two physicians’ perspective. It’s available on Apple, Spotify and other platforms, and I hope you give it a listen.
Design-wise, Mercedes played it conservative with the latest S. Given the many upgrades and enhancements, I honestly would have expected more groundbreaking styling. Presumably the brass at Mer cedes AG decided to put all of their advanced styling chips on the all-electric EQS rather than the “dinosaur” internal combustion en gine (ICE) S-class, which is a shame. By the way, the S580's powertrain is as clean and modern as ICE gets. It’s a 4.0-liter twin-turbocharged V8 producing 496HP and 516ft-lb of torque, augmented by a 48-volt mild hybrid system that adds 21HP to the mix, mostly when you’re accelerating from a stop.
For the record, my test car carried a sobering MSRP of just under $140,000, and the Environmental Protection Agency (EPA) rates the S580 at 16 mpg city and 25 mpg highway, not Sierra Club-friendly numbers. Asalways, call Phil Hornbeak at BCMS to get your best sale or lease price on a new Mercedes or any other car, truck or SUV.
I’ve written previously that the introduction of a new Mercedes Sclass sedan isn’t as big a deal as it used to be because SUVs have in truded so much into the luxury sedan market. In fact, you could argue that the launch of the new Range Rover earlier this year was more important than the introduction of the latest S-class.
The bottom part of the central display shows climate controls all the time, which I appreciate, along with a few physical buttons be neath that for changing driving modes, turning up the volume and activating the hazards. In addition, there are four USB-C ports in the center console for front-seat occupants to use, if they’re so inclined.
The V8 is plenty powerful by itself, but with the mild hybrid boost, the S580 feels like it has an even bigger engine.
The nine-speed automatic transmission does its thing with near imperceptibility, and optional rear-axle steering—a $1,300 option— means that the S580 is easy to navigate through parking lots and other tight confines.
A word about the rear-axle steering: I live in an in-town condo minium with a parking structure and this-is-your-spot parking. Ma neuvering any vehicle into my spot is generally difficult, but impressively, with the S580 it was easy, because the rear-axle steering made this decidedly large sedan move like a Honda Civic. Pro tip: do not order an S-class without checking the rear-axle steering box. The rear-axle steering also makes changing lanes on the interstate smoother by the way. In those situations, the rear wheels turn the same way as the fronts, enabling calmer direction changes.
As always, call Phil Hornbeak, the Auto Program Manager at BCMS (210-301-4367), for your best deal on any new car or truck brand. Phil can also connect you to preferred financing and lease rates.
Rick
North
Raymond
Tripp
Land Rover
North
North
Mazda
TX 78216 John 210-253-3300Kahlig Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX Al Cavazos 210-366-9600Jr. 9455 IH 10 West San Antonio, TX 78230 Douglas 210-764-6945Cox Bluebonnet Chrysler Dodge Ram 547 S. Seguin Ave. New Braunfels, TX 78130 Matthew C. 830-606-3463Fraser Northside Ford 12300 San Pedro San Antonio, TX Marty210-477-3472Martinez Northside Honda 9100 San Pedro Ave. San Antonio, TX 78216 Paul 210-988-9644Hopkins 14610 IH 10 West San Marcos, TX 78249 Mark KahligKahlig832-428-9507HenniganAutoGroupAutoGroupKahlig Auto GroupKahlig Auto Group Kahlig Auto GroupKahlig Auto Group Kahlig Auto Group Kahlig Auto Group
Audi
Northside Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216 210-912-5087Williams Nash Chevrolet Buick 3209 North Interstate 35 San Marcos, TX 210-859-2719Boyd Park Lexus 611 Lockhill Selma San Antonio, TX 210-308-8900Bridges San Antonio 13660 IH 10 West San Antonio, TX 210-561-4900Tang Park Lexus at Dominion 25131 IH 10 W Dominion San Antonio, TX James 210-816-6000Cole Park Lincoln 9207 San Pedro San Antonio, TX Sandy 210-341-8841Small Park Subaru at Dominion 21415 IH 10 West San Antonio, TX 78257 Phil 877-356-0476Larson Park Subaru 9807 San Pedro San Antonio, TX 78216 210-308-0200Rangel
William
North
Cameron
Coby
Mercedes
North
Charles
Chuck
North
North
Cavender Toyota 5730 NW Loop 410 San Antonio, TX Gary 210-862-9769Holdgraf Park Toyota 10703 Southwest Loop 410 San Antonio, TX 78211 Justin 210-635-5000Boone Benz of Boerne 31445 IH 10 West Boerne, TX James 830-981-6000Godkin Park 9333 San Pedro San Antonio,
GMC
11911 IH 10 West San Antonio, TX 78230 210-696-2232Allen Dominion 21105 West IH 10 San Antonio, TX 78257 210-681-3399Cavender
