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spring 2019 • volume 11 • issue 1

Sacrifice Were the sacrifices you made to become a physician worth it? Medical students, residents and physicians share their stories and perspectives

COMPASSION Put on Earth to Help My Patients: Mike Anstead MD


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CONTENTS What I Sacrificed to Study Medicine PAGE 5 Trailblazing the Road to Medicine PAGE 7 PHYSICIAN HEALTH AND WELLBEING Relationships Healing Physicians & Patients PAGE 11

The Sacrifice and the Gift PAGE 15 Squaring the Circle of Sacrifice PAGE 16 Clocking Out PAGE 18 PROFILE IN COMPASSION Mike Anstead MD: Put on Earth to Help Patients PAGE 20 Who Makes the Sacrifice? PAGE 22 COMMUNITY NEWS PAGE 26 PROSTHETICS The Personal Process PAGE 29 Angling for Answers PAGE 30

EDITORIAL

BOARD MEMBERS Robert P. Granacher Jr., MD, MBA editor of Kentucky Doc Magazine Tuyen Tran, MD Lowell Quenemoen, MD Tom Goodenow, MD John Patterson, MD Thomas Waid, MD Danesh Mazloomdoost, MD

STAFF Brian Lord Publisher David Bryan Blondell Independent Sales Representative Jennifer Lord Customer Relations Specialist Barry Lord Sales Representative Anastassia Zikkos Sales Representative Kim Wade Sales Representative Janet Roy Graphic Designer Purple Patch Innovations Website & Social Media

FROMTHEEDITOR • SPRING 2019 Robert P. Granacher Jr., MD, MBA, Editor-in-Chief, Kentucky Doc Magazine

This is KentuckyDoc’s annual edition of resident, medical student, and active physician essays. I invite you to read these and enjoy them, as their rich content demonstrates the diversity of our physicians and physicians to be. We lead off with the resident first place winner authored by Rachel P. Goodwin, DO. The topic to be discussed this year was “What I sacrificed to study medicine.” Rachel’s poignant essay describes the accident that left her father a C5 quadriplegic without use of his hands, and how that changed her life and the sacrifices that were required of Rachel in order to help him while completing her education to become a doctor. The second place resident winner has given us an essay titled, “Trailblazing the Road to Medicine.” In this essay, Dr. Nguyen shares with us the sacrifices of her mother and how she altered her life for her daughter, Dr. Nguyen, to complete her education and study medicine with her added challenge of a diagnosis of autism spectrum disorder. The third-place resident winner is Dr. Anh-Thu Le, MD. Dr. Le characterizes for us the missed moments of life with her family, particularly around crises, that occurred while she studied medicine. She describes how she has surrendered many irreplaceable moments of her life for the sake of medical study; she believes it is a choice she would make again. John Patterson MD, provides an article on relationships and how they heal physicians and their patients. John points out that relationships are critical for both physicians and patients. But even more importantly, the current medical literature shows that they enhance the biology of our brain. The winner of the medical student first place category essay is Leila Mende. Her essay is titled: “Squaring the Circle of Sacrifice.” She chronicles the great sacrifices she has made to come so far from her home to Lexington to study medicine while leaving her husband in Seattle to manage his export business. The second-place medical student essay contest winner is Sarah Bugg. After graduation, Sarah will pursue a residency in Internal Medicine and Pediatrics. She began to note her own sacrifices as she proceeded through each year of medical school. She describes for us that by focusing on what one may give-up by studying medicine, the person may misunderstand what was gained by the giving-up. Dr. Patterson later describes a Profile in Compassion. It features John’s description of Mike Anstead, MD and is titled: “I Was Put on This Earth to Help My Patients.” Dr. Patterson describes the compassionate care provided by Dr. Anstead serving as an Adult and Pediatric Pulmonologist at the University of Kentucky, and as a cystic fibrosis specialist,

“believing that he was put on this earth to help his patients, and that enables him to get through difficult times himself ”. Our first-place winner in the physician category is Asha Shenoi, MD. Dr. Shenoi’s essay is titled: “Who Makes the Sacrifice: A Million Dollar Question Yet to be Answered.” Dr. Shenoi is an Associate Professor of Pediatrics in the Division of Pediatric Critical Care. Her essay recounts the life events that she missed during her times of training to become a physician, and the many losses that she has endured by missing those events. She feels the question of one’s sacrifice to become a physician can only be truly answered by those who are dear and near to our hearts. As a result, her success, happiness, and satisfaction with life and work was fueled by the many sacrifices of her loved ones. The second-place active physician category winner is Fred Ueland, MD, gynecological oncologist. His essay is titled: “Angling for Answers.” He attempts to answer the question of sacrifice by providing us with a fascinating account of trout fishing with his son. During the course of their wonderful experience fishing for trout, his son asked, “Dad, I wanted to ask you, ‘Have you been happy being a doctor? I mean, were the sacrifices worth it? “ Dr. Ueland struggles to answer his son’s questions but in the end, his son seems to have learned well the lessons of life that Dr. Uleland now offers. I hope these essays will provide an insight for us active physicians. It seems to me that our concern about our young people and their pursuits of our profession has been partially answered by these essays, and I believe the future of medicine is in good hands based on what they have to say about their sacrifices while learning to be a doctor. Enjoy!

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By Rachel P. Goodwin, DO

On August 30th, 2009 I was sitting in my college dorm room when I received a call that would change my life forever. I was told my dad had been in a tragic accident and I should find a way to the hospital immediately. I hurriedly packed and my best friend drove me to the hospital three hours away. When I arrived, I found out that my father was in an unfortunate accident that would forever leave him paralyzed from the chest down—a quadriplegic for the rest of his life. It was in that crucial first week in the ICU, as I watched my previously invincible father lie helplessly in the hospital bed, that I realized our lives would never be the same. Spinal cord injuries affect multiple organ systems and autonomics, necessitating immersive involvement in every facet of care. Because of this, my dad was transferred to a rehabilitation center which specialized in spinal cord injuries. I took time away from my undergraduate studies to be with my dad during his transition from the ICU to rehab, serving as an intermediary between family members and friends and attempting to improve communication and understanding of his condition. He spent several months in

rehab which was further complicated by a wound necessitating surgical correction before coming home. In that time, our family and friends spent countless days collectively transforming our home in order to make it wheelchair-accessible for my dad’s return. When he arrived home from rehab it was far from an easy transition. His condition physically limited his freedom, making him fully reliant on other people to take care of him. He went from a physically fit man who worked hard all of his life; constantly putting others first, to a C5 quadriplegic who no longer had the use of his hands and necessitated constant assistance. He required daily skilled nursing care, which was unfortunately not an option for us, thus he leaned on family members like me to take turns performing his activities of daily living with the occasional home health nurse helping out a few times per week. It took several months of wound care, high nursing turnover and inconsistencies in his routine until finally he was able to establish a routine that was physically doable between family and nursing. Unexpectedly, after 23 years of marriage, my mother left my dad within that first year. She hired a moving company who packed up half of everything in the house and called me on the phone to let me know she left and would not be coming back. Suddenly, my dad’s care became my

I watched my previously invincible father lie helplessly in the hospital bed.

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responsibility. She told me that everything would be fine because I would be there to take care of him, assuming I would drop out of college to do so. With an absentee mother, I was now a 19-year-old college student left with a decision—would I leave college to move back home and become the primary caretaker for my dad, or would I stay in college and continue on the path towards a career in medicine? This is when my dad told me that he would not let me drop out of college, because he wanted to see me walk across the stage at my college graduation ceremony and make him proud. I continued with my undergraduate studies despite the stress that it put on me and my family being away. My dad’s mother stepped in as his primary caretaker, moving in with him so she could physically be there for him at all times and allow me to continue my undergraduate studies uninterrupted, essential for me to graduate on time. I worked full-time, living paycheck to paycheck to afford to stay in college and travel to my dad every weekend. Despite this, we all recognized that without a college degree, I would not be able to adequately support and provide for my family in the future, so I pressed onward. Throughout college, I continued to drive three hours each way on weekends and used every holiday break to take care of my dad. This also gave my grandmother a break from her caretaker duties and allowed her to spend time on her own wellness. Since my dad’s accident, our family has been through an unbelievable amount of physical, emotional, and financial stress. Despite working full time, studying and traveling home every weekend, I met my future husband during undergraduate training. I graduated early in three years as planned with my Bachelor of Science degree, and because of this my husband and I were able to graduate the same year and apply to medical school together. We continued to work full time the following year in order to save money for medical

school applications, and fortunately were accepted into the same program. During medical school my husband was supportive and understanding of the sacrifices necessary in taking care of my family and was my constant reminder that these sacrifices were not actually sacrifices but what families are supposed to do: take care of one another. We applied for residency and successfully as a couple marched into the Internal Medicine Residency at University of Kentucky. We are now second year residents and look forward to embarking on our next journey together, fellowship. My father’s injury serves as a constant reminder of what I have sacrificed to study medicine, but it also reminds me how grateful I am for the support of my husband, grandmother, and father during these unfortunate circumstances. Throughout everything I discovered a strength I had never known. Being a family member of a quadriplegic provides me with an innate sense of understanding for patients and their respective situations, for which I can definitely empathize. While my father’s condition is dire, he is but one of many in this world who needs a passionate doctor that can provide quality care. I am thankful for the support of my family and the bond that keeps our family strong. I am thankful that I stayed the path to becoming a physician despite these circumstances, as these sacrifices have led me to the person I am today. About the Author Dr. Goodwin is a PGY-2 Internal Medicine Resident at University of Kentucky Medical Center. She was born and raised in Nashville, TN, completed her undergraduate training at University of Tennessee in Knoxville, TN and then attended Lincoln Memorial UniversityDeBusk College of Osteopathic Medicine for medical training. She enjoys spending time with her husband and two German Shepherds, Hunter and Remi.

My father’s injury serves as a constant reminder of what I have sacrificed to study medicine, but it also reminds me how grateful I am for the support of my husband, grandmother, and father during these unfortunate circumstances.


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By Phuong-Lan Nguyen When I reflect on the sacrifices that I’ve made to study medicine, I also note that my mother has altered her life for me to realize my potential. Being diagnosed with autism spectrum disorder could have been a life-limiting event for me. However, my mother knew that while the road would be long and full of heartbreaking learning experiences, she was willing to work tirelessly to give me the foundation I would rely on during my path to becoming a part of the medical community. As I got older, we decided my autism could enhance my life as well as that of my peers, and we hope to increase the level of awareness for autism-related healthcare. I knew, as a child, that I wanted to be a physician. I wanted to study diseases and disorders in a discipline where I could use the highly analytical nature of various conditions

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to spot patterns or characteristics and identify possible culprits. To do so, I understood, would take a tremendous amount of money, time and courage. My mother worked hard behind the scenes (even returning to school herself to be able to change careers) and spent countless hours supporting me as I poured myself into academics. Beyond the education alone was the constant thought that someone such as me was perhaps aiming too high. Therefore, I thought of nothing else and worked towards nothing else but my dream. I had to be conscious to never take any step for granted. Maintaining eye contact and integrating the aspects of my autism into ways that would potentiate my academic and social skills would require that I could not live carefree as a child, as a teenager, or as a young adult. So much was at stake. I could not stay comfortable in my own skin and fall back on my struggles as an excuse. The bigger picture was that through my sacrifice, I could bring affirmations of

humanity through advocacy and awareness of people with autism in health care. When I started medical school in Detroit, Michigan, I knew no one in my class who had lived with autism. I was nervous but excited to be an intimate asset to many patients’ lives as I navigated clinical rotations. I had left the routine cradle called familiarity and home to be an integral part of closing disparity gaps in health care. If there were people who could not afford to live well due to economic circumstances, then the road to wellness was even more treacherous and burgeoning for those living with disabilities. I would soon not only help provide preventive and secondary care to multiple patients with autism living in Detroit but also provide services for what they did need to survive each second. In some cases, I became a resource for those who needed someone who was in their shoes, someone to just listen when hope was far away. At first, my heart mourned for all who had to hike

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At the end of each day of the journey, I believe that the gift far outweighs the sacrifice. such mountains, often falling, exhausting, and going through extenuating pain along the way from multiple losses to being turned away when asking for help. As I followed through with many of the same patients, I learned that these sacrifices made their hearts more fortified and even more compassionate. Likewise, I had begun to look at my own experiences with an intense gratitude of where I am at that moment, and how I viewed my journey to medicine. My heart not only learned to heal the broken and missing pieces, but to empower myself and others to affirm these pieces as moments to self and community growth. Today, I am a first-year pathology resident at the University of Kentucky Healthcare program. Like most budding physicians who are in that time period, I am still learning my role in the vast picture called medicine. Perhaps this is one of the biggest sacrifices I make each day, and the road is still in construction. I choose to live with open eyes for opportunities to evolve. The more I learn from what I did not know before, the closer I am to making a positive difference

for the autism and disability communities. No sacrifice made in training, even in the most difficult moments, is ever in vain if it is going to help someone know their own health and wellness from the perspective of someone who has been through such adversities. Although I may be one of the few and perhaps only one on the autism spectrum to be in medicine, I consider this a blessing in excellent faith to teach about what it means to have lived as a patient and to live as a physician. Furthermore, for every person who does not know about the many sacrifices people with disabilities make to live, there is someone who needs the compassionate hand to guide them to understanding that any adverse experience deserves acknowledgement, hope, and someone who listens and affirms. At the end of each day of the journey, I believe that the gift far outweighs the sacrifice, for me, for my mother, and for all of my peers in medicine. The gift we have received is the opportunity to serve, to lead, and to forge a path that has so many benefits to humankind. For me, that gift was available

even to me with my circumstances, and I believe it is for a reason. To make medicine and health care a more compassionate and knowledgeable place would not only be beneficial for those with autism, but for everyone. To the world, we may be a small part of their life, but to one person, we are their universe. I am proud to be an integral member of the Lexington Medical Society and the University of Kentucky Healthcare, where patient outreach and education are important congruent values for all the goals I have worked and continue striving towards in medicine. About the Author Phuong-Lan Nguyen is a first-year pathology and laboratory medicine resident at the University of Kentucky Healthcare. She earned her Bachelor of Arts in Integrative Human Biology at the University of California at Berkeley and her MD at Wayne State School of Medicine in Detroit, MI.

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PHYSICIAN HEALTH AND WELLBEING

Relationships

Healing Physicians and Their Patients

Physicians consistently report the personal benefits they receive from their relationships with patients.

By John A. Patterson MD, MSPH, FAAFP

Relationships are at the very heart of medicine I recently saw one of my favorite patients whom I had not seen in 10 years. I have thought of her often since the hospital took over my Estill County practice in Irvine and I moved to Lexington. Wanda always lifted my spirits. She always asked me how I was doing because she cared about me. We joked and laughed while managing her chronic medical conditions. She was good medicine for me. Seeing her again got me thinking about relationships in medicine. Consumer choice in the medical marketplace and mandated patient satisfaction surveys highlight the clinical and financial importance of positive relationships. As physicians, we work in relationships with our patients, colleagues,

staff, organizations and community. Importantly, we also work in relationship with ourselves–physically, mentally, emotionally and, some would add, spiritually. Relationships Can Heal Relationship-centered care (RCC) acknowledges the pivotal role that relationships play in medical outcomes, the quality of care and the quality of caring (1). RCC includes the unique humanness and personhood of all relationship participants and a whole-person perspective, including physical, mental, emotional, interpersonal and transpersonal aspects of the human experience. RCC acknowledges the mutual bi-directional impact on all relationship participants and rests on a foundation of reciprocity, ethics, morality, service and justice. RCC underscores the importance of promoting resilience, managing stress, preventing burnout and cultivating compassion–for physicians and all those with whom we are in relationship.

Epidemic of Stress Former Surgeon General Vivek Murthy actively campaigns to address the epidemic of stress in America (2). He includes social support and relationships, including co-worker relationships, as part of his nationwide public health prescription, citing research showing the positive health impact of having an emotional confidant at work. As Surgeon General, all his staff were offered meditation instruction and often meditated together at work- improving office morale. Widespread Despair A survey by Cigna documents the erosion of supportive relationships and the epidemic of loneliness in our society (3). The CDC reports that nearly 45,000 lives were lost to suicide in 2016 and that life expectancy (a snapshot of national health) declined twice between 2014 and 2017, driven by suicide, drug overdoses and alcohol- the “deaths of RELATIONSHIPS Continued on Page 12


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RELATIONSHIPS cont. from Page 11

despair” (4)(5). This epidemic is affecting all geographic, political, gender and age groups. The great American myth of the solitary, independent, rugged individualist collapses under the weight of evidence that loneliness can kill. Physicians are also affected. My lab partner in medical school committed suicide as an intern. One of my favorite physicians, to whom I referred for 25 years, committed suicide. My physician next door neighbor committed suicide. Physician Burnout– A Public Health Crisis Multiple internal and external stressors can lead to physicians’ compassion fatigue, substance misuse, family discord, burnout, leaving medicine and suicide (6). Harvard Medical School and the Massachusetts Medical Society recently declared physician burnout a public health crisis (7). Our continuing education as physicians has historically focused on cognitive and technical CME as the cornerstone for professional development. But personal development of the whole person of the physician is receiving increasing emphasis. AMA STEPS Forward Program (8) aims to improve practice efficiency and help you achieve the Quadruple Aim of improving patient experience, improving population health and lowering overall costs while also increasing your professional satisfaction. AAFP Physician Health First (9) prioritizes physician health and well-being as the foundation for a satisfying career, keeping you connected to your purpose and helping you provide the best possible patient care. The Mindful Practice Program (U Rochester School of Medicine) (10) helps develop the qualities of the exemplary physician- including the ability to be present and attentive, adopting a fresh and curious “beginner’s mind,” improving our relationships with patients and colleagues and cultivating greater self-awareness, resilience and insight into our personal lives and professional work. Doctor as Drug Balint popularized the phrase “doctor as drug” in his 1957 medical classic The Doctor, His Patient and the Illness, emphasizing the impact of physician communication and behavior on the patient’s clinical course. Cardiologist Bernard Lown, formerly at Harvard School of Public Health and original developer of

the defibrillator, spoke eloquently about “the healing power of words” and “the lethal power of words” in his introduction to Norman Cousins’ 1983 The Healing HeartAntidotes to Panic and Helplessness. Lown gives examples from his clinical practice and Cousins describes his own journey as patient, illustrating the healing power of the physician-patient relationship. A recent RCT (11) showed that a onesentence assurance from a physician in response to an induced dermal allergic reaction significantly reduced participants’ ratings of itchiness/irritation compared to a control. Their use of the sentence “From this point forward your allergic reaction will start to diminish, and your rash and irritation will go away” reminds me of the words I use at the end of patient visits in which some treatment or lifestyle behavior is recommended– I always say “I think this will help”– and I believe it. Patients Can Be Good Medicine Much has been written about the emotional cost of patient care–the vicarious trauma and compassion fatigue suffered by physicians. Less widely discussed is the vicarious healing and inspiration we receive by walking alongside those exceptional beings we call patients. As I interview physicians for a companion Profile in Compassion column in this magazine, I am struck by a recurring theme. In addition to describing their personal story of stress and burnout, physicians consistently report the personal benefits they receive from their relationships with patients. It is uplifting and healing to us as physicians to be in relationship with our patients’ strength, resilience, hope, courage, faith, determination, acceptance, humor, wisdom, forgiveness, compassion, generosity, optimism and gratitude. May you be blessed with healing relationships in your practice of medicinehealing for your patients and healing for yourself. Resources 1. Relationship-centered Care- A Constructive Reframing J Gen Intern Med 2006; 21:S3–8 2. A Nation Under Pressure: The Public Health Consequences of Stress in America https://nccih.nih.gov/news/events/ lectures/SES17 3. Cigna survey on loneliness (2018)

https://www.cigna.com/newsroom/newsreleases/2018/new-cigna-study-revealsloneliness-at-epidemic-levels-in-america 4. Centers for Disease Control and Prevention (CDC) (2017) https:// www.cdc.gov/vitalsigns/suicide/index. html 5. Centers for Disease Control and Prevention (CDC)(2018) https://www.aafp.org/news/health-ofthe-public/20181210lifeexpectdrop.html 6. New England J of Medicine, Tait Shanafelt MD (Mayo Clinic) June 2016 video https://catalyst.nejm.org/videos/ physician-burnout-stop-blaming-theindividual/ 7. Harvard School of Public Health and Massachusetts Medical Society (2019) https://www.hsph.harvard.edu/news/ press-releases/leading-health-careorganizations-declare-physician-burnoutas-public-health-crisis/ 8. AMA STEPS Forward https://edhub.ama-assn.org/stepsforward 9. AAFP Physician Health First https://www.aafp.org/membership/ benefits/physician-health-first.html 10. Mindful Practice® Programs, U of Rochester School of Medicine https://www.urmc.rochester.edu/familymedicine/mindful-practice.aspx 11. Physician Assurance Reduces Patient Symptoms in US Adults: an Experimental Study (2018), J Gen Intern Med 33(12):2051–2 About the Author Dr. Patterson Chairs the Lexington Medical Society’s Physician Wellness Commission, is past president of the Kentucky Academy of Family Physicians, is board certified in family medicine and integrative holistic medicine and is a certified Physician Coach. He teaches Mindfulness-Based Stress Reduction for the UK Health and Wellness Program and Saybrook College of Integrative Medicine and Health Sciences (Oakland). He owns Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations, specializing in stress-related chronic conditions and burnout prevention for health professionals. He can be reached through his website at www. mindbodystudio.org

Much has been written about the emotional cost of patient care–the vicarious trauma and compassion fatigue suffered by physicians. Less widely discussed is the vicarious healing and inspiration we receive by walking alongside those exceptional beings we call patients.


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The Sacrifice and the Gift By Anh-Thu Le, MD I have a small black planner from Japan that has chronicled my life for the past year. It is a compact and sturdy little book I carry back and forth to work. Since the beginning of my residency, I have had several of these, archived in a striped banker’s box once the year is up. If someone were going to be nosey and read one of these books, they would see a rather humdrum list of appointments, tasks, deadlines, and days of call written down in my indecipherable cursive. They may also, however, note several events that I have recorded – events which have an “x” marked through them or furiously scribbled out. Events that I either cancelled or missed due to residency, whether it was because I was on call or a case ran much longer than anticipated. Those planners stand as a record of all the valuable time with my family and friends that I have sacrificed to do the work I came here to do. I do not presume to be unique in this regard. I believe many of my colleagues would agree that time with our loved ones is one of the biggest sacrifices we have made in our pursuit of medicine. As I flip through the pages of the book, I can recall many such events. My best friend from college, whom I cherish as a sister, delivered her first child two years ago and I could not be there for her delivery. I attempted to schedule a vacation around her due date but the stubborn little baby remained in her mother’s womb until after I had returned back to Lexington. In addition, I have missed two weddings (both scheduled rather impetuously by all involved), and my baby sister’s graduation from both college and graduate school. Although the occasions I mentioned above were all joyous, I have also missed several crucial incidents with my family. In some ways, these events seem more critical than the happy ones. Several years ago, my father was hospitalized with acute chest pain and altered mental status. I answered my mother’s frantic phone call in between cases. I wanted to catch a plane home, to fly south several hundreds of miles, to comfort my mother

while she waited for my father’s doctors to find out what was wrong. I wanted to be able to see for myself how my father was doing, to determine if he was having a stroke, and to meet his doctors. Instead, I texted and called my mother and sisters furtively, when I could, for the next two days, trying to decipher what the doctors had told my mother; an endeavor made more difficult by the fact that her knowledge of medical English was much less robust than her conversational English. What did his MRI show? His Echocardiogram? His EKG? Eventually, I understood my father had been hospitalized for a hypertensive crisis and I was finally able to hear his voice on the phone the day he was discharged. The entire ordeal was extremely frustrating. I felt like a negligent daughter who had left my parents to navigate the medical world with its many consultants, bills, and jargons by themselves. One night, last winter, my younger sister flipped her car over the side of a highway in West Virginia going 70 miles an hour. She called me when she was at the hospital and I could feel my heart drop in my chest. I had done several rotations on trauma by this point and all of the victims I had seen rolling through the trauma bay kept flashing in my mind. Thankfully, she underwent a workup and was, on the whole, uninjured. As the oldest sister, it is my job to look out for my younger siblings and my instinct was to get into my car and head east on I-64 to the small hospital in which she was hospitalized. But I was on call that night and for the rest of the week and could not do that. I ensured my sister had arrangements to get home to Virginia and called numerously during the next week, but what I really wanted to do was to just be with her. These missed moments certainly do stand out for me, but other, considerably powerful moments also surface. I remember a veteran with metastatic pancreatic cancer leaving from the VA to die just weeks later, surrounded by his family. He only wanted to spend as much time as he could with his loved ones and we were able to do that for him so he could leave this earth on his terms. I remember the fiancé of a man I felt certain would die inpatient begging us to save

him. He eventually left Chandler Hospital and walked down the aisle with that fiancé. I remember performing a pleurodesis on a teenaged patient who went home to her family and went on to live her life, unimpeded because we had helped her. I felt we had given these patients that most valuable, irreplaceable thing: time. Time to seize what remained of their precious lives. Time to be married. Time to play and time to grow; time to love and be with those who loved them. More often than not, the patients themselves would not thank me, but their families would. Mothers and husbands, siblings, grandparents, best friends, walking up to me and mouthing “thank you so much” silently. A quick embrace from a grateful wife after we had resected her husband’s colon cancer. A tight grasp on my hand from a grateful daughter because we had given her more time with her mother. To sacrifice is to surrender something precious, of value to you, for the sake of something or someone else. Sacrifice sometimes evokes an image of a single great loss or offering, but in medicine, it does not always look like that. I believe that I have surrendered many irreplaceable moments of my life for the sake of medicine and my patients. As demanding as this job is, as much as you give up for it, there must be a part of me and many others that feel it is a sacrifice worth making so that others in the world can live to enjoy the same kinds of precious moments we ourselves have given up. With all that I have seen and all that I have missed out on, I cannot say that it is an easy choice. I do believe it is a choice I would make again because while it appears to be a sacrifice of time on my part, it transforms into something more like a gift of time when I think of my patients. About the Author Anh-Thu Le grew up in Florida and attended college and medical school at the University of Florida. She will be pursuing a cardiothoracic surgery fellowship after completing residency.

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Kentucky

By Leila Mende Here I am turning into the alley I know so well. I spot the neighborhood holy man and beggar with his alms bowl. The restaurant he sits alongside is bustling. The matron calls out to me from behind her steaming peanut and palm nut soups. Next door to her I pass the charcoal seller. I smile and jump over the open gutter fronting her roadside business. My heart is beating faster now as I approach my destination. At the threshold of the house I reach out to the wrought iron gate with trembling hands. I’m here to surprise my 6-year old daughter who I brought to Ghana one year ago to live with my in-laws. Pause and rewind. I am a fourth-year medical student at UK who continues to battle my inner demons about the choices I’ve made in life. When I was accepted to UK College of Medicine, my husband couldn’t follow me to Lexington. His Seattle-based export business supported an extended African family and I understood our separation was a sacrifice both he and I had to make; for his obligations and for my aspirations. My four-year old daughter accompanied me to Kentucky and I started the life of a single mother. There was an ample amount of scheduling flexibility built into the first two years of school and this enabled me to spend afternoons and weekends with my daughter. We danced, we biked, we hiked, we lived a normal life. Well, somewhat normal except for the glaring absence of my husband. He came to visit occasionally but it was not the same. My heart was rent in two, but my daughter, alongside me, seemed to make everything whole in spite of the separation. I couldn’t have survived the first three years without tons of help. My fellow

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students and my roommate babysat and braided hair. Another major source of support were my Dutch neighbors who became close friends and had kids my daughter’s age. I felt utterly destroyed when they moved away in December of my third year of medical school. When it rains it pours. At the same time, I was due to start a number of clinical rotations with working hours that would make single parenting impossible. I felt caught between a rock and a hard place. I couldn’t run from the tough choices thrust upon me. My daughter had spent time in Ghana before. She knew her family there and spoke the language. After painful deliberation, I decided to take a one month leave of absence and travel with her to Ghana’s capital, Accra, to settle her into life and school there. My in-laws were happy and believed my decision showed I truly cared that my child know her roots and not grow to become simply an American. Western expectations regarding nuclear family and child rearing haunted me and caused me to battle with my choice. Fast forward a year later. It’s February 2019 and I have completed a whirlwind tour of family medicine residencies. I’ve arranged an international rotation at a pediatric hospital in Accra with the goal of reuniting with my daughter. I hesitate in the alleyway with my hand poised on the gate of our family compound. I can feel an emotional flood building on the other side. My daughter knows I’m coming this week but doesn’t know I’m here, today. Even though we’ve video chatted, I know little about who she has become in my absence. I swing open the gate and two of my nieces come running. Soon my daughter follows behind. She looks upset. I’m trying not to cry. Minutes later she livens up and contorts herself into various yoga postures to impress me. She snuggles into my lap. The year of separation starts

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to melt away and I’m left with the present moment in hand like a precious pearl. My daughter is unmistakably Ghanaian, from her mannerisms to her accent. My husband joins us a week later. In his wake it’s evident the way he is empowering his family. As they say in Ghana, hand go and hand come. For every good, good follows. The family supports us in turn and the circle is complete. Did I sacrifice motherhood to medical school? Did my daughter sacrifice her mother‘s presence for Africanity? Did my husband sacrifice family time for the American dream? Sacrifice is reaching up to catch the future and dropping something in the process. But what I thought I had dropped in my life, love picked up. When I reached for my future, my amazing in-laws helped my daughter reach for hers. People who love each other uplift each other. What looked like sacrifice actually lifted us all to higher states of self-actualization. My husband’s business grew. My daughter came to know her Ghanaian family, the culture and the language. I moved closer to becoming a physician. Recently I asked my daughter what she wants to be when she grows up“A doctor like mommy and a ballerina.” Her cousin shot back telling her to choose one or the other. I gently told her there was no need to sacrifice. She could be both. About the Author Leila is a fourth-year medical student passionate about primary care and excited to be specializing in Family Medicine. She calls Hawaii home but bleeds blue because she was born in the Bluegrass. Her deepest loves are music and travel.


Lexington Medical Society – U.K. College of Medicine Mentorship Program Make a difference in a young person’s life, become a mentor What: We are requesting physician mentors for our incoming 3rd U.K. College of Medicine medical students. We are simply asking our mentors to support and encourage our medical students as they transition from two years of academic studies to the clinical world. This is not about shadowing, it is about relationships. When: The program goes from September, 2019 to May, 2020. How: LMS will match the mentor to a mentee based on a short profile survey. It is that simple. Why: Help shape the future leaders of the practice of medicine. Contact Chris Hickey, LMS EVP/CEO if interested

cmhickey@lexingtondoctors.org


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Kentucky

By Sarah Bugg Finally—I was so blessedly close to sleep. So far, my eyelids had been closed for the first four hours of our sixteen-hour international flight. So far, this had failed to yield the desired results. Flight attendants rolled up and down the aisles, distributing mediocre dinners and drinks to already weary travelers. Passengers tripped over my feet as they stumbled to and from the restroom. At last, everyone had begun to settle. Reading lights were switched off. Soft snores filled the cabin. Then the terrible shrill beeps of the airplane’s PA system rang out, “Excuse me, but we have a passenger onboard who has become quite ill. If you are a medical provider willing to assist, kindly come to the front of the plane at this time.” I opened one eye and peered out. No one had stood up. No one seemed to be making an attempt to do so. I plucked out my foam earplugs, doffed my scratchy Ethiopian Airlines blanket, and headed toward my new patient. I had “met the parents” numerous times now. The initial intimidation, the sense of having to be on my best behavior ought to have worn off, but still it had not. We sat around the dinner table sharing small talk and ziti. As the plates were being cleared, his dad got my attention and proceeded hesitantly, “So, he tells me you are about to finish medical school.” “That’s right. I’ll finish in May.” “Well, I’m not really sure how much of this you’ve had in school, but I went to the doctor today and had a question. Maybe you could help?” He looked somewhat abashed. “I’d be happy to try.” He scurried off to his office and returned quickly with a packet of papers, which he deposited on the kitchen table. I sifted through the read-outs of an echocardiogram, an EKG, and a host of other lab tests. He pointed out a phrase in the echo that had concerned him, “hypokinetic left anterior ventricular wall…” As I went in search of a piece of paper and a pen, I saw my boyfriend standing in the living room holding Settlers of Catan, his eyes pleading with me to let it go so we could play. I sat down and began to draw a truly terrible

3-D representation of the human heart. Even though it was well into autumn, it was still warm enough to sit outside. The glasses sitting in front of us had long been empty, but still we sat, laughing and catching up. Then, suddenly, a loud noise. A thud, not like metal on metal, but a sound more sinister. We took little notice of it. Less than a minute later, a waiter appeared on the patio, his face twisted with panic, “Is anyone a doctor? Please, come help!” He ran off, a towel falling from his apron. My dinner companions, many also classmates, stood up simultaneously. We pursued the excited waiter, who led us to a man sprawled on the ground. His motorcycle lay in a tangled mess beside him. A good portion of his blood lay in a puddle under his right leg. An open fracture of the tibia was the clear culprit of a nicked artery that needed immediate tamponing. One of us held pressure, the others checked pulses. Soon the ambulance arrived. We went inside to wash our hands. There is always too much food at my family’s Thanksgivings. After second helpings, the only recourse is a seat on the couch and desperate attempts to fight off the drowsiness that ensues. No sooner had I claimed my corner of the couch and let my eyelids begin to sag than I felt the small weight of something in my lap. I opened my eyes to a collection of “Pat’s Pharmacy” pill bottles. Lisinopril, simvastatin, metformin. The bestower of the bottles was apparently my grandmother, who sat beside me nervously wringing her hands. “Well now, my doctor retired. Why he went and did a thing like that I’m not sure, but he set me up with this new doctor lady, see? And I went to go see her this week for the first time, and, well, she’s just so young, you know? And she talks so fast. I just couldn’t really make out what she was saying and what these new pills are for, you know?” As she talked, I stood her little family of pill bottles at attention in a line across my lap. Starting with “the little pink ones,” we got her all sorted out. It was terrible weather for a race. What had satisfied itself to be a drizzle during the opening announcements had turned into a steady rain as I stood in line for the pool. Now, on the return trip on my bike, the rain had called in its windy companion and together

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they created Hell for the riders. Each of the cyclists coming toward me wore the same expression: squinted eyes, tucked heads, grimaces. Every feature locked in mortal combat with the forces of nature that had also shown up for the triathlon this morning. A steady stream of water sprayed off the rear tire of the rider ahead of me. We were so nearly there. A steady descent, a couple of flat miles back on the major road and we were home free, back to the land of dry clothing and hot coffee. The racer in front of me had entered a sharp turn in the descent. As he leaned in to it, I watched the angle between his bike and the pavement grow acute. Suddenly the angle closed precipitously. Out of the blindness of the turn a pothole had sprung up, swallowing his front wheel, throwing him from his bike. I watched his helmet hit the pavement with sickening force and his body land, extremities akimbo at unnatural angles. For so long I gripped my brakes before my bike finally started to slow, hydroplaning on the flooded pavement before finally coming to a stop. With the awkward clipclop of my bike shoes on the asphalt, I ran back toward the fallen rider, unsure of what support I could lend, but knowing my finish line was no longer a few miles off, but right here, at the back of an ambulance I prayed would arrive soon. Sometime around the end of my third year of medical school I finally came to understand that when I chose medicine, I necessarily relinquished a privilege much of the working world enjoys—the ability to clock out at the end of the day. But, each occasion that I have been called upon to participate in the care of a loved one or stranger outside of working hours has been an honor. Perhaps to focus on what was given up, rather than what was gained by the giving up, is to misunderstand completely. About the Author Sarah Bugg is a Lexington native and is currently in her final year of medical school at the University of Kentucky. She is pursuing residency in Internal Medicine-Pediatrics and is eager to find out shortly where the next four years will take her.


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Kentucky

PROFILE IN COMPASSION

I Was Put on this Earth to Help My Patients Mike Anstead MD By John A. Patterson MD, MSPH, FAAFP Mike Anstead MD is an adult and pediatric pulmonologist at UK and a cystic fibrosis specialist. Growing up in Covington and attending Northern Kentucky University, he worked as a lab tech at St. Elizabeth Hospital. He enjoyed being part of the care team alongside family practice residents and envisioned being a family practice physician. Why Med-Peds? “During medical school, I had great experiences in pediatrics and internal medicine. I also had a mentor who taught physical diagnosis, Dr. Burki, who was a pulmonary and critical care physician. I loved caring for children but also liked the complicated problem-solving of adult medicine. The responsibility and autonomy

we were given on the medicine rotations was exciting to me. I had a medicine-pediatrics intern who was a great role model, so I decided to do an internal medicine-pediatrics residency.” Why pulmonary? “As a resident, I really enjoyed my months in the adult and pediatric intensive care units caring for the sickest patients. I decided to do a fellowship in pulmonary and critical care at UK and began caring for cystic fibrosis patients. When one of the pediatric pulmonologists left UK, Jamshed Kanga, the division chief for pediatric pulmonary and a mentor to me, asked if I would cover some weekends for him.” Dr. Kanga describes Mike as “one of the most caring physicians I know, going out of his way to care for patients, such as making rounds when not on call. He is the reason the adult CF program exists. Most pulmonologists aren’t well-trained in adult CF and aren’t comfortable with their care.”

I found caring for the pediatric pulmonary patients interesting and challenging. It can be tragic but also deeply satisfying work. – Mike Anstead MD

Why CF, knowing many of your patients will die young? “I found caring for the pediatric pulmonary patients interesting and challenging. It can be tragic but also deeply satisfying work. I really bonded with patients and their families, especially the cystic fibrosis patients. I found great satisfaction helping patients and families deal with this terrible, burdensome disease. New medications and treatment strategies became available each year, allowing us to offer a little more hope for patients and their families. When one of my patients lost their battle with this terrible disease, I took solace in knowing I had helped them as much as possible and at least made their journey a little easier. I knew I was there in the trenches with them- standing in their shoes. I think of them as both patients and friends-seeing them as people rather than as their disease.”


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window at their lives. But when you come as part of a medical mission, people want you to understand their lives better and you get to walk in through the front door. As in all of medicine, when I see patients, I do my best to let them know I care about them and try to help them to understand their medical problems better and have a healthier life. They come to us for more than disease treatment. They also want to be cared for by people who care about them.”

Have you ever felt burned out? “I had one period where I felt burned out. I took over as interim medical director for lung transplant a few years ago. I had help from other pulmonologists but spent a lot of time in the hospital, worrying about and caring for these complex patients. I still had all my other duties as a pediatric pulmonologist, director of the adult cystic fibrosis center and director of our Therapeutic Development Center for the Cystic Fibrosis Foundation, where we research new therapies for cystic fibrosis.” “There was never enough time to think about patients who were not doing well or consult with colleagues for their ideas. I also didn’t have enough time with family or enough time to do things to recharge my batteries. I started being short and impatient with my co-workers. My strategy was to refocus on caring for patients and being the best physician I could be until I could get more help with some of my responsibilities.” What is your go-to stress reliever? “My favorite things to relieve stress are biking, hiking and basketball. Nothing is better than a good bike ride with friends. A very close friend was a truly selfless person who never did enough for himself. When he died of lung cancer, I wanted to avoid the same mistake of neglecting myself, so I rewarded myself and bought a nice bike. I ride regularly as weather permits, alone or with friends, and it has been very important in maintaining my health and happiness.” Talk about your mission work and your personal mission. “I am actively involved with UK’s Shoulder to Shoulder Global in India and Ecuador, caring for children with special needs. A multidisciplinary team from UK, including

physicians, residents, medical students, special education teachers and students and physical therapists and physical therapy students travels once a year to India and several times a year to Ecuador.” “In India, we assess children who often have very little schooling due to the socially stigmatizing nature of their conditionscerebral palsy, neurological, behavioral and congenital problems. They aren’t well accepted by childhood peers or the general society, which often believes ‘nothing can be done for them.’ The local community now finally embraces the center in which we provide special education, speech and physical therapy as well as staff training remotely throughout the year for questions about care plans.” “In Ecuador, we maintain a primary care clinic in an underserved area of Santo Domingo. We have an Ecuadorian physician and staff that are there full-time. Three to four times a year, a ‘brigade’ from UK travels there, including physicians, residents, medical students, nurse practitioners and nurse practitioner students, nurses and nursing students, physical therapists and physical therapy students and pharmacists and pharmacy students. We provide people with medications and therapy for acute and chronic medical problems.” “I like being part of Shoulder to Shoulder because of the true partnership with organizations and people in Ecuador and India. I also like the continuity of care and team approach to patient care. These are often lacking in international health missions. I got interested in international health as an opportunity to understand the world better. When you travel to other countries as a tourist, people don’t usually invite you into their lives- we are kind of peering through the

How can we help our residents and students navigate these stressful times in medicine and society? “They need to take time to recharge their batteries. It’s important they remember that medicine is not perfect and neither are physicians. We will wonder if we could have done a better job. Maintaining a sense of mission in our work can help. Medicine can be very stressful and complicated. I think spending time getting to know your patients and finding fulfillment in being able to help them makes the job bearable in difficult times. I frequently tell residents and students what a great job we have as physicians. We get to help others and be paid well for it and we generally are respected by society for what we do. I can’t think of a career that is more challenging and fulfilling.” Mike is advisor to the Kentucky Cystic Fibrosis Support Group, which helps patients with relief from financial and social stressors. He participates in the annual Great Strides Walk of the Cystic Fibrosis Foundation. He says “I am not particularly religious but I believe in something beyond myself. I believe I was put on this Earth to help my patients. That helps me get through difficult times.” This interview was conducted remotely while Mike Anstead was on a UK Shoulder to Shoulder medical mission in India. About the Author Dr. Patterson Chairs the Lexington Medical Society’s Physician Wellness Commission, is past president of the Kentucky Academy of Family Physicians, is board certified in family medicine and integrative holistic medicine and is a certified Physician Coach. He teaches Mindfulness-Based Stress Reduction for the UK Health and Wellness Program and Saybrook College of Integrative Medicine and Health Sciences (Oakland). He owns Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations, specializing in stress-related chronic conditions and burnout prevention for health professionals. He can be reached through his website at www.mindbodystudio.org

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A Million Dollar Question Yet to be Answered By Asha Shenoi, MD Were the sacrifices you made to become a physician worth it? This is a question that I get asked at least couple of times every month, mostly by well-meaning friends, parents of kids who are interested in pursuing a career in medicine, parents of my patients and sometimes just random strangers when they know that I take care of critically ill children. Needless to say, I am forced to

ponder on this question more often than I would like to. I have been practicing medicine for 24 years, including my years in training. During this time, a lot happened in life- some good, some neutral and some bad. I met the love of my life, got married to him right out of medical school, gave birth to a beautiful girl, completed a residency in Pediatrics, moved my family halfway across the world, and completed another Pediatric residency and fellowship back to back while raising our daughter as an anchor parent. As I reflect on almost two and a half decades of my life in

medicine, I am humbled by how far I have come and how much I have achieved, and I am so grateful for all the good things in life. I have been an attending in a tertiary academic medical center for the past six years, with a promising career in Pediatric Critical Care and medical education including a leadership position. I am blessed with a happy marriage, a teenage daughter who is a typical teenager (what a relief!), loving extended family members and many close friends. I am honored to be a part of many critically ill children’s lives, who taught me resilience, the essence of time and great appreciation for life.


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www.kentuckydoc.com | Spring 2019 | Kentucky I have also received great appreciation and random acts of kindness for the role I play in helping children and families affected by illnesses. These include hugs and prayers from patients, parents, and co-workers; a speeding ticket write-off when the police officer learned that I was driving over the limit at 2 AM to attend a coding child at the hospital; a flight agent who completely refunded my travel fare (against their usual policy) when he learned that a mission trip to train pediatricians in Haiti got canceled due to political unrest. However, as I start counting the events that I missed during these times, the list went on and on. My mother suffered a stroke; my dad survived two heart attacks; three of my classmates, my grandmother and my 21-year old cousin all passed away; my sister and many of my cousins got married, and I became an aunt to two beautiful nieces. I had to stop counting as I was consumed by guilt and sadness to realize that I was able to be part of only two of these important family events. I found tormented by many questions-Was it just me who had to sacrifice and what exactly did I sacrifice? Did I sacrifice anything or just made choices that forced those in my circle of life to sacrifice? It struck me then that I was not the one who sacrificed the most, it was folks in my life who did. My husband of 17 years has sacrificed his sleep, time and health by commuting between various cities, many life events; he missed many life events due to demands of my training and career and we missed out on quality time as a family

and a married couple. My teenage daughter missed her mom’s presence during most of her elementary school life and, as well as, my care and love during the numerous night calls and 80-hour work weeks during my training. I thought of my parents who dearly missed my presence and help when they needed it most; my only sibling who missed me during both her deliveries and her medical school graduation; and her career advancement opportunities since she was the one who was left with a disproportionate burden of taking care of our aging parents. My friends missed me during some of the most difficult times in their lives, not to count my extended family members and community members who never saw or heard from me during my training years. In all honesty, I feel that this question can only be truly answered by those who are dear and near to my heart. When I try to answer this question and balance my achievements against what I missed, I realize with pain and utmost guilt that the scale tips slightly in my favor, and my loved ones end up getting the short end of the stick. I look forward to being at work most days even though I have short stretches of feeling exhausted and struggle with work-life integration. I have been able to be genuinely satisfied with my career choice and derive immense meaning and advancement in my career. I also realize that my success, happiness, and satisfaction both with life and work is fueled by the many sacrifices of my loved ones. So, for those

of you who aspire to lead a successful and meaningful career in medicine, I can assure you that you will not regret your choice, but your success will be the end result of many painful sacrifices from your family and loved ones. Please keep your loved ones close and deliberately work on maintaining, nourishing and appreciating those relationships, because only they can get you through this demanding yet meaningful career. While I feel that the choices I made are worth the rewarding career that I enjoy now, the question “Were the sacrifices I made to become a physician worth it?” remains to be answered by my dear and near ones. About the Author Dr. Asha Shenoi is an Associate professor of Pediatrics, Division of Pediatric critical care and Assistant Dean, Clinical Learning Environment for Graduate Medical Education at the University of Kentucky. She is a graduate of the University of Kerala, India where she also completed her first Pediatric Residency program. She then completed a second Pediatric residency at Children’s Hospital of New Jersey, followed by a Pediatric Critical Care fellowship at Emory University in 2013 and joined the UK as faculty in 2013. Her research interests include Physician wellbeing, ICU quality and safety, and critical care education initiatives in resource-limited settings. She chairs the University of Kentucky Medicine College of Medicine wellness in training committee. She lives in Lexington with her husband and daughter.

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All I Need to Know is Where I Need to Go! Call 1-844-249-0708! For Information on Free or Low Cost Mammograms and Pap Tests Eligibility Requirements: • Age 21 or older and younger than 65 • Has a household income less than 250% of the federal poverty level • Has no health insurance (no Medicare, no Medicaid, or no private health insurance)


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Quick Guide for Health Care Providers to Kentucky’s Breast & Cervical Cancer Screening and Treatment Programs All I Need to Know is Where I Need to Go! Call 1-844-249-0708! • The Kentucky Women’s Cancer Screening Program (KWCSP) provides breast and cervical cancer screening and follow-up diagnostic services for eligible Kentucky women.

• KWCSP eligibility requirements: – Age 21 or older and younger than 65 – Has a household income at or below 250% of the federal poverty level – Has no health insurance (no Medicare, no Medicaid, or no private health insurance)

• The Breast and Cervical Cancer Treatment Program (BCCTP) provides treatment for breast or cervical cancer, or precancer of the breast or cervix for eligible Kentucky women. • Women who may qualify for the KWCSP or BCCTP must be referred to the local health department PRIOR to screening or treatment by the health care provider.* • The local health department will facilitate completing the application for Medicaid who will determine participant eligibility for BCCTP.

• BCCTP eligibility requirements: – Has been screened and diagnosed with cancer by the Kentucky Women’s Cancer Screening Program through a local health department and/ or contract providers – Has been found to be in need of treatment for either breast or cervical cancer, including a precancerous condition or early stage cancer – Age 21 or older and younger than 65 – Has a household income at or below 250% of the federal poverty level – Does not otherwise have credible health insurance coverage

* Please refer program eligible patients to the local health department or call 1-844-249-0708 prior to screening or diagnosis.

– Is a United States citizen or qualified immigrant – Is a resident of Kentucky – Is not eligible for medical assistance or public insurance in any other eligible group – Is not a resident of a public institution (e.g. prison)

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doc | Spring 2019 | www.kentuckydoc.com

Kentucky

ANNOUNCEMENTS AWA R D S N E W S TA F F EVENTS AND MORE

EMAIL brian@rockpointpublishing.com TO SUBMIT YOUR NEWS

Saint Joseph Hospital Earns Disease Specific Care Sepsis Certification Gold Seal of Approval® from the Joint Commission Only facility in Kentucky to receive the Gold Seal of Approval® for sepsis care Lexington, Ky. (March 19, 2019) – Saint Joseph Hospital has earned The Joint Commission’s Gold Seal of Approval® for Disease Specific Care (DSC) in Sepsis Certification. The Gold Seal of Approval® is a symbol of quality that reflects an organization’s commitment to providing safe and effective patient care. Saint Joseph Hospital underwent a rigorous on-site review for consideration to receive this certification. Joint Commission experts evaluated compliance with national disease-specific care standards, as well as with sepsis-specific requirements. Clinical practice guidelines and performance measures also were assessed. “Saint Joseph Hospital is pleased to receive Disease Specific Care Sepsis Certification from The Joint Commission, the premier health care quality improvement and accrediting body in the nation,” said Bruce Tassin, CEO, CHI Saint Joseph Health, and president, Saint Joseph Hospital. “Certification by the Joint Commission illustrates our commitment to a culture of excellence in serving our patients and community.” Established in 2002 and awarded for a two-year period, The Joint Commission’s Disease-Specific Care Certification evaluates clinical programs across the continuum of care and addresses three core areas: • Compliance with consensus-based national standards; • Effective use of evidence-based clinical practice guidelines to manage and

optimize care; and • An organized approach to performance measurement and improvement activities. “Saint Joseph Hospital has thoroughly demonstrated a high level of care to protect patients from sepsis,” said Patrick Phelan, executive director, Hospital Business Development, The Joint Commission. “We commend Saint Joseph Hospital for becoming a leader in sepsis care, providing a higher standard of service for patients in its community.” For more information about CHI Saint Joseph Health and Saint Joseph Hospital, please visit www.CHISaintJosephHealth.org.

CHI Saint Joseph Medical Group to Host Weight Loss Surgery Seminars in Campbellsville More than 34 percent of Kentuckians suffer from obesity and may qualify for bariatric surgery Campbellsville, Ky. (March 12, 2019) – The CHI Saint Joseph Medical Group – Weight Loss & Surgery team will now offer weight loss surgery seminars in a new location, Campbellsville, Ky. Those suffering from unhealthy excess weight are encouraged to attend and learn more about the benefits of weight loss surgery. Upcoming seminars will take place Thursday, March 28 and Tuesday, May 14, beginning at 5:30 p.m. The seminars will be held in the Education Classroom at Taylor Regional Hospital, located at 1700 Old Lebanon Road in Campbellsville. Kentucky has the seventh highest obesity rate in the nation, with approximately 66 percent of Kentuckians classified as overweight and 34 percent considered obese, according to the Centers for Disease Control and Prevention. Those classified as obese may qualify for weight loss surgery, which

can help to lower cholesterol and blood pressure, reduce joint pain, help control blood sugar, and improve overall health. For those considering weight loss surgery, the seminars in Campbellsville are a great place to begin. Attendees can meet Robert Farrell, MD, FACS – Bariatric Surgeon, and learn more about the different types of surgery, including gastric bypass, adjustable gastric banding, SIPS and sleeve gastrectomy. Dr. Farrell will speak about the benefits, risks and expected results of each procedure, as well as dietary and lifestyle changes needed for lasting success. Medical professionals from the CHI Saint Joseph Medical Group – Weight Loss & Surgery team will be at the event to answer questions about costs, insurance coverage, and who may qualify for weight loss surgery. Attendees can also speak with likeminded people in the community, who are considering weight loss surgery. For more information or to register, visit chisaintjosephhealth.org/weight-losssurgery-seminar or call 866.704.1423. Those attending should park near and enter through the Outpatient Services entrance of the hospital.

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doc

www.kentuckydoc.com | Spring 2019 | Kentucky

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PROSTHETICS

The Personal Process of Prosthetics With constantly evolving technology and increasing national exposure, the field of prosthetics has finally begun to garner the attention it has long deserved. While many now know more about prosthetics than ever before, the clinical and technical process involved in designing and creating prosthetic limbs for amputees is still relatively a mystery to most. Increasing exposure and social media attention allow viewers to witness amazing outcomes and aesthetically pleasing prosthetic devices. At Hi-Tech Artificial Limbs, the clinical team strives to educate amputee patients, family members, surgeons, physicians, case workers and physical therapists on the processes involved to reach the final prosthetic outcome. Realistic goals, options and timelines will almost always result in better outcomes. The very beginning of this process, in my opinion, should simply be the initial meeting between amputee patient and the prosthetist. Because this is a very important relationship, the amputee must make sure that they are completely at ease and comfortable with the practitioner that will be guiding them through this life-changing process. Patients have a choice and should never feel like they are “settling” into a scenario in which they are only being told what is going to happen without feeling like they are the most vital part of the process. Understandably, questions should always be welcomed and even encouraged. Once the amputee decides they are comfortable with their relationship with the prosthetic practitioner, a thorough evaluation is performed. The prosthetist will take into consideration the patient’s age, health, level of amputation, motivation, cognitive skills, range of motion and strength. Most importantly,

it will be important for the prosthetist to attain a clear and accurate picture of what life looked like for the amputee before losing a limb. Previous or current employment and hobbies will help guide important decisions on prosthetic design as well. After a clear picture is developed, the most appropriate and detailed prosthetic design is formed for the amputee to reach their goals. The next visit would likely be for casting and measurements. This is when the prosthetist will decide what interface (prosthetic sock, silicone gel) material will be worn against the amputee’s skin inside the prosthesis. Next, the prosthetist will most likely take an extensive amount of length, circumference and angle measurements of the remaining (residual) limb as well as the sound side limb for proper comparison. Finally, a cast or mold is taken of the residual limb resulting in a very accurate representation of the residual limb. This is often done by using a plaster or fiberglass wrap. While computer aided design and scanning techniques are now becoming more and more popular, my practice prefers to use hands-on casting techniques. I feel that it allows the prosthetist to truly feel and capture the limb shape with accuracy as well as greater understanding of any sensitive areas that must be addressed. It also helps that, at Hi-Tech Artificial Limbs, we have our own on-site lab and perform all our own fabrication. At this point, a clear diagnostic fitting is performed to test the fit, comfort and function of the prosthesis. Allowing the amputee to try out a prototype version of the prosthesis helps the practitioner make any necessary on-site modifications and helps the amputee become more familiar and comfortable with the device they will be receiving.

When the prosthesis is complete, the next visit will likely be for the amputee patient to return for a definitive fitting and delivery of their prosthesis. Once again, comfort and proper function will be tested and evaluated. The amputee will continue to receive instructions on proper use, care, schedule of wear, cleaning and any warranties for components and soft prosthetic goods. Family members are always encouraged to be present and ask questions throughout this process so we are creating a very informed “team” and support system for the new amputee. If the amputee will be attending physical therapy, which we always encourage, we will share all information with the therapist as well. Communication remains key throughout any prosthetic process. At Hi-Tech, we always schedule a 1-2 week follow up after the delivery of a prosthesis and make sure the amputee knows that they are encouraged to call us at any point if they have questions or problems before that time, so we can schedule them sooner. We also provide a 24 hour emergency contact line for all our patients. Understandably, this process can vary depending on the level or type of amputation, prosthetic design being provided and number of additional fittings that may be necessary for more challenging cases. However, we are able to provide most amputees with their first prosthesis within 3-4 weeks from the initial casting appointment. Although there are many factors and details involved in the design and creation of a prosthesis, we at Hi-Tech Artificial Limbs try to create a comfortable, friendly atmosphere throughout the entire process. When the amputee patient is at ease, open communication and goals are made a priority, we are able to see some truly inspiring outcomes. At the heart of all the science, anatomy, biomechanics and technology is simply people helping people. After more than 20 years in this field, that never gets old.

859.278.2389 1641 Nicholasville Road, Lexington, KY 40503 M-Th 8am–4:30pm, F 8am–3pm

 www.hi-techartlimbs.com  /hitechartificiallimbsinc  /Hi-Tech-Artificial-Limbs  View our YouTube Channel

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Kentucky

By Frederick Ueland, MD

“Keep the rod tip up!” I shout. The water erupted soon after his fly landed near the riffle’s foam line. “She’s got spirit,” my son roars, gathering extra line. “Watch and learn old man.” The Roaring Fork is a freestone mountain river that rages in torrents in the early summer while washing over boulders and fallen trees. Our Western drift boat is made for this challenge. The flat-bottom gently arcs from bow to stern allowing it to walk on water providentially. We named her Integrity, a loose reference to Antarctic adventurer Sir Ernest Shackleton for his legendary character of endurance and sacrifice.

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PLACE

PH YSI CIAN CATEGOR

“She’s still running,” he says, his right arm reaching skyward and his left deftly working the reel. “Plenty feisty.” I coax the Integrity through a narrow wash and into calmer water. Although the powerful fish has not yet breached, her shadow is arresting. The sunlight’s wavy mirage can trick an angler into seeing trophies that are not real, but the rod tip bows deeply again and there is hope. When trout break the surface, I feel a surge of energy, both physiologic and frenetic. It endures until the fish is safely in the net. Even when I am on the oars and the rod is not mine, there is a fear of loss, a feeling all too familiar to an aging physician, father, and fisherman. The fish runs and rests then leaps in a nervy but exciting ballet. Eventually, she tires and is safely in, witnessed, and freed. A catch like this lives in perpetuity.

Y

Angling for Answers

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PHYSICIAN PERSPECTIVE

C O NT E AY

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“What a fish,” I say, peering into the quieting water. “Watching you just then, casting and landing that Brown… can I just say it was beautiful?” “Thanks, Pops! Exhausting. What say we break for an early lunch?” I guide the boat ashore. Ice-cold beers and fresh sandwiches from the cooler rekindle our spirit and fuel the conversation. It is there, in the shade of an Aspen stand on a river high in the Rockies, where philosophy seduces reality, and my thoughts are profound. “I just read a book about Aristotle and happiness,” I say. “Twenty-three centuries ago he put pen to papyrus saying happiness is attained by developing one’s character and acquiring virtues.” He sits in silence before saying, “Really, Dad? Are you going to turn philosopher on me today?” Then he adds, “I think


doc

www.kentuckydoc.com | Spring 2019 | Kentucky

I remember the classic virtues. Justice, prudence… temperance… and wait for it… courage!” “That’s right,” I nod. “To Aristotle, happiness wasn’t wallowing in life’s torrid pleasures, or even obtaining a virtue. It was the exercise of virtue. Basically, it was habitually doing the right thing.” My son eyes me seriously. “Dad, I’ve wanted to ask you, have you been happy being a doctor? I mean, were the sacrifices worth it? My friends are going to grad school and getting big jobs at consulting firms. When I mention medicine, they groan and say it used to be a good gig, but not anymore.” “Why do you suppose they say that?” “Because everyone knows medicine is a long and punishing journey, with countless exams in med school, then years of residency training, and way too much debt. And in the end, even the veteran docs complain about most everything.” Then he scowls, “Did you put cranberry sauce on this turkey sandwich?” I raise my sandwich as if to acknowledge its intrinsic worth. “Nothing like sweet cranberry and a hoppy IPA in the morning,” I emphasize with a swig. “So that’s what your friends think about medicine. What do you think?” “I know you don’t like to fish the rhetorical surface water, but you really didn’t answer MY question either. I remember Mom saying when you were a med student you arrived two days before your wedding ceremony, scruffy and exhausted with $20 in your pocket.” “Not exactly a knight in shining armor, but it was during my surgery rotation and the eighties so scruffy and disheveled was a thing.” “WHAT I AM ASKING IS… was it all worth it?” he bellows. “Truthfully, I never really considered anything else. Well, I contemplated being a cowboy after my dude ranch gig in Wyoming, but that was youthful myopia. I loved science and people, and medicine was part of my heritage: my great grandfather, uncle, and father were all respected physicians. I never worried about the sacrifices.” “Interesting but a little unexpected, like this sandwich,” he says. “Your buddies are probably reminiscing about the Golden Age of medicine when fee-for-service allowed docs to do and charge whatever they wanted. It was unsustainable.” “So,” he says sarcastically, “Are you suggesting there might be more to happiness than ‘show me the money’?” “I think Aristotle would say that wealth without generosity is not very virtuous. He probably said it first, better, and more clearly

than anyone has since. Happiness comes from finding your purpose, realizing your potential, and working to be the best version of you. Then sharing it.” “So we are in control of our own happiness. Like landing that trophy Brown.” “A virtuous fish indeed,” I say. “And yes, there were sacrifices. Many. Thank God for your mother. Life was hectic, particularly when babies started coming in duplicate. Raising children is always an odyssey, but doing it early in both marriage and career is an epic challenge. I missed family dinners, Sunday Masses, and tournament weekends. I missed my wife. Worst of all, I wasn’t always present even when home. I had to learn to carry the burdens of others.” I pause to watch the Aspen leaves wriggling in the breeze. They color the water with copper-yellow reflections. “Your classmates may worry that their future income won’t justify the effort, which is a legitimate question. But more importantly, you need to decide for which journey you are intended. Whichever you choose, ask yourself will it be enough?” I notice the sun is low on the horizon casting long, lean shadows. It is why autumn afternoons feel so melancholy. “As a healer, I feel our purpose is centered on human life and its relationships, but also preserving, prolonging, and celebrating it. Frankly, loss hasn’t gotten any easier for me. But these thoughts are mine. It is my journey.” My son doesn’t answer immediately, weighing what he heard. Then he says, “That’s some powerful river philosophy. So what’s your take on the future of medicine?” “As a profession, medicine is honorable and timeless. For me, being a healer has been truly fulfilling, and even exhausting days end with systemic contentment. I would do it forever again. Yes, there are inconveniences, but the act of healing is no different today than for Hippocrates. People suffer. They need our counsel; they need our help.” Several fishermen have floated past, and I sense the pull of the river. “Son, what say we try our luck some more?” He rises quickly and says, “Thought you’d never ask. Trust me with the oars today?” “Yes, sir! Keep us dry, greenhorn.” The water in the lower river increases as tributaries converge under gravity’s pull. Standing in the bow with thighs pressed to brace, I unhook my caddis and with familiar cadence begin to separate fly from fisherman. Like his questions, his rowing is attentive. Over the next hour, I turn a few fish, enough for a feeling of success. Eventually, we see the sun arcing toward the ridgeline, and we know it’s the twilight of the float. I sense he wants to cast again. “Let’s beach it up ahead. We can wade that stretch together.”

We both settle streamside atop a granite boulder. While surveying the water’s potential, I think to myself. I want my son to know that the ancient virtues are balustrades common to all people, all cultures, and all faiths. They are habits, a path to happiness. I want him to know that if healers exercise courage, wisdom, and benevolence, then our lives are the real trophy. And I want him to know that as for Shackleton, the sacrifices are few if the expedition completes you. I fumble several attempts to unite fly and tippet. My waning vision is a reminder of mounting burdens, of family, friends, and patients lost. Breaking the silence, I say, “Improve the world, first in your own heart and head and hands. Then work outward from there. I think this is especially true for surgeons and fishermen.” “Love yourself and then love others,” he concludes eagerly. Then after a pause, he pleads, “In the name of love and Aristotle, can we fish?” “Yes, yes. Let’s fish.” We stand side-by-side in the river. He covers the water effortlessly, casting with rhythm and efficiency that’s far more art than sport. With a few fish fooled, the light has faded to dusk. We store the rods and navigate the final stretch of the river in silence. At takeout, light is all but gone save the soft glow of flickering streetlights. With gear secure, I run a hand along the Integrity’s white ash gunnel and say, “This boat is perfectly crafted for its work, now you must decide if you will be for yours.” “Indeed, I am,” he says without hesitation. “And I don’t fear sacrifice, particularly if it means no cranberry sauce.” About the Author Frederick R. Ueland, M.D. is a Professor and Director of Gynecologic Oncology at the University of Kentucky. His academic interests are in ovarian cancer diagnostics and treatment. He and his wife Michaela live in Lexington and have five grown children, chickens, horses, and honeybees. They travel regularly to the Colorado Mountains to enjoy family and the outdoors.

Was it all worth it?

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