2020-Nov/Dec - SSV Medicine

Sierra Sacramento Valley Serving the counties of El Dorado, Sacramento and Yolo

November/December 2020

Medical Malpractice Coverage That Outlasts Today’s Healthcare Challenges ■

Competitive Rates

■

Assertive Claims Management

■

In-house Dedicated Law Firm

■

A+ Superior Rating by A.M. Best

■

Complimentary Risk Reduction Training and Resources

■

Free Tail Coverage at Retirement

■

Guaranteed Issue Disability and Life Insurance

■

Free Practice Management Support

■

Physician-founded and Physician-directed

■

Adverse Event Resolution Programs

For more than 40 years, the Cooperative of American Physicians, Inc. (CAP) has delivered financially secure medical malpractice coverage along with risk management and practice management solutions to help California’s finest physicians succeed.

To see how much you can save on your medical malpractice coverage, get an easy, no-obligation quote at www.CAPphysicians.com/quoteSierra Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code. Members pay taxdeductible assessments, based on risk classifications, for the amount necessary to pay claims and administrative costs. No assurance can be given as to the amount or frequency of assessments. Members also make a tax-deductible Initial Trust Deposit, which is refundable according to the terms of the MPT Agreement.

Sierra Sacramento Valley

MEDICINE 4

16

24

2020 Is Best Viewed in Hindsight

The Skin I’m In

The Nurses of the Great War

PRESIDENT’S MESSAGE

John Wiesenfarth, MD

6

EXECUTIVE DIRECTOR’S MESSAGE

Honoring Our Milestone Members

Aileen Wetzel, Executive Director

8

OPINION

Cycles

Caroline Giroux, MD

12

PROFILE

John Chuck, MD Wants You To Know You’re Not Alone Ken Smith, Managing Editor

POETRY

Eric Williams, MD

18

Teachers

Faith Fitzgerald, MD

BOOK REVIEW

Jack Ostrich, MD

26

Board Briefs

20

27

Sara Toulouie, MS II

28

Coping as a Medical Student In the Age of COVID-19

22

New SSVMS Members

We welcome articles from our readers by email, facsimile or mail to the Editorial Committee at the address below.

Authors will be able to review articles before publication.

Letters may be published in a future issue; send emails to SSVMedicine@ssvms. org.

All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the Sierra Sacramento Valley Medical Society for permission to reprint.

Election Results

SSVMS Museum of Medical History Goes Virtual Bob LaPerriere, MD

Visit Our Medical History Museum 5380 Elvas Ave. Sacramento Temporarily closed due to the pandemic.

Visit our website at ssvms.org/museum for updates and virtual events.

23

PHOTOS

Zooming in on Joy of Medicine Month

VOLUME 71/NUMBER 6 Cover photo: America goes to the polls November 3, 2020 in the midst of a pandemic.

Photo: Ken Smith

Official publication of the Sierra Sacramento Valley Medical Society

5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax info@ssvms.org

SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx

November/December 2020

1

Sierra Sacramento Valley The Mission of the Sierra Sacramento Valley Medical Society is to bring together physicians from all modes of practice to promote the art and science of quality medical care and to enhance the physical and mental health of our entire community.

2020 Officers & Board of Directors

John Wiesenfarth, MD, President Carol Kimball, MD, President-Elect Christian Serdahl, MD, Immediate Past President District 1 Jonathan Breslau, MD District 2 Adam Dougherty, MD J. Bianca Roberts, MD Vanessa Walker, DO District 3 Ravinder Khaira, MD District 4 Ranjit Bajwa, MD

District 5 Sean Deane, MD Farzam Gorouhi, MD Kristin Gates, MD Paul Reynolds, MD Roderick Vitangcol, MD District 6 Marcia Gollober, MD

2020 CMA Delegation District 1 Reinhardt Hilzinger, MD District 2 Lydia Wytrzes, MD District 3 Katherine Gillogley, MD District 4 Anand Mehta, MD District 5 Sean Deane, MD District 6 Marcia Gollober, MD

District 1 Alternate Brian Jones, MD District 2 Alternate Vacant District 3 Alternate Toussaint Mears-Clark, MD District 4 Alternate Vacant District 5 Alternate Joanna Finn, MD District 6 Alternate Natasha Bir, MD

At-Large Delegates R. Adams Jacobs, MD Barbara Arnold, MD Megan Babb, DO Helen Biren, MD Jonathan Breslau, MD Amber Chatwin, MD Mark Drabkin, MD Adam Dougherty, MD Gordon Garcia, MD Farzam Gorouhi, MD Ann Gerhardt, MD Richard Gray, MD Richard Jones, MD Mohammad Khan, MD Carol Kimball, MD Charles McDonnell, MD

Leena Mehta, MD Sandra Mendez, MD Tom Ormiston, MD Sen. Richard Pan, MD Neil Parikh, MD Hunter Pattison, MD Paul Reynolds, MD Ernesto Rivera, MD J. Bianca Roberts, MD James Sehr, MD Christian Serdahl, MD Ajay Singh, MD Lee Snook, MD Tom Valdez, MD John Wiesenfarth, MD

At-Large Alternates Christine Braid, DO Angelina Crans Yoon, MD Lucy Douglass, MD Rachel Ekaireb, MD Karen Hopp, MD Arthur Jey, MD

Steven Kmucha, MD Sam Lam, MD Taylor Nichols, MD Alex Schmalz, MD Ashley Sens, MD

CMA Trustees, District XI Douglas Brosnan, MD

AMA Delegation Barbara Arnold, MD

Editorial Committee

Margaret Parsons, MD

Sandra Mendez, MD

Megan Babb, DO Sean Deane, MD Caroline Giroux, MD Robert LaPerriere, MD George Meyer, MD

Meghana Pisupati, MS II Karen Poirier-Brode, MD Gerald Rogan, MD Glennah Trochet, MD Lee Welter, MD

Executive Director Managing Editor Webmaster

Aileen Wetzel Ken Smith Melissa Darling

2

Sierra Sacramento Valley Medicine

HOSTED BY LOCAL PHYSICIANS

Listen and subscribe to Joy of Medicine - On Call on your favorite Podcast App or visit joyofmedicine.org

Sierra Sacramento Valley Medicine, the official journal of the Sierra Sacramento Valley Medical Society, is a forum for discussion and debate of news, official policy and diverse opinions about professional practice issues and ideas, as well as information about members’ personal interests.

Advertising rates and information sent upon request. Acceptance of advertising in Sierra Sacramento Valley Medicine in no way constitutes approval or endorsement by the Sierra Sacramento Valley Medical Society of products or services advertised. Sierra Sacramento Valley Medicine and the Sierra Sacramento Valley Medical Society reserve the right to reject any advertising.

Opinions expressed by authors are their own, and not necessarily those of Sierra Sacramento Valley Medicine or the Sierra Sacramento Valley Medical Society. Sierra Sacramento Valley Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Š2020 Sierra Sacramento Valley Medical Society SIERRA SACRAMENTO VALLEY MEDICINE (ISSN 0886 2826) is published bimonthly by the Sierra Sacramento Valley Medical Society, 5380 Elvas Ave., Sacramento, CA 95819. Subscriptions are $26.00 per year. Periodicals postage paid at Sacramento, CA and additional mailing offices. Correspondence should be addressed to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396. Telephone (916) 452-2671. Postmaster: Send address changes to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396.

| FEATURED CONTRIBUTORS |

John Wiesenfarth, MD

Caroline Giroux, MD

In his final column as SSVMS President, Dr. Wiesenfarth looks back on 2020 and all that it brought us. There were bright spots, including Operation Shields Up and addressing the need for health equity.

Cycles run through our lives, from its beginning to its end. Dr. Giroux has counted on the cycle of the seasons and daily routines to bring order to life. But like for so many other things, 2020 had different plans.

Eric Williams, MD

Faith T. Fitzgerald, MD

Dr. Williams returns with a personal and masterful poem about the challenges he faces as a Black man outside the hospital, where he is a respected surgeon. That respect is often missing in his daily life.

Faith Fitzgerald, MD returns with a story we can all relate to about the special teachers in her life. Two in particular stand out, one from junior high and one she worked with side-by-side for a half century.

drjohn@winfirst.com

imango@att.net

cgiroux@ucdavis.edu

ftfitzgerald@ucdavis.edu

Bob LaPerriere, MD

Jack Ostrich, MD

The SSVMS Museum of Medical History hosts hundreds of local students each year but is closed due to the pandemic. Dr. LaPerriere says work is underway to take the museum virtual for worldwide access.

Dr. Ostrich reviews Easing Pain on the Western Front, Paul Stepansky’s look at how nurses forged a new battlefield role in World War I as they also faced a different enemy: a worldwide plague.

ssvmsmus@gmail.com

jmost119@aol.com

Ken Smith

ken@kdscommunications.com

Dr. John Chuck chairs the Joy of Medicine Advisory Committee and wants physicians to be well, but burnout affects about half of them. Ken profiles Dr. Chuck and how what he’s learned can help you.

Sara Toulouie, MS II

Sara.Toulouie6181@cnsu.edu

The pandemic has had a profound effect on medical students who suddenly have to learn in different ways and have had their lives upended. Sara tells their stories and why more wellness services are needed.

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ssvms.org.

November/December 2020

3

| PRESIDENT’S MESSAGE |

2020 Is Best Viewed In Hindsight T

he year 2020 will go down in history as one to remember. Or maybe one to forget.

To say it has been a trying year is an understatement.

A pandemic unlike any seen for the past 100 years has ravaged the country with millions infected and hundreds of thousands of Americans dead, placing tremendous stress on hospitals and the providers who have had to learn treatments on the fly. Racial tensions brought people to the streets to protest the deaths of unarmed Black men and women by police, and ash has rained down from apocalyptic orange skies.

And not to be forgotten, it’s the year of a presidential election. The politics and campaigning this year has stretched the boundaries of what has been defined throughout my life as right and wrong, and if a grade school student had done just a fraction of what we’ve seen from some politicians it would have certainly gotten them detention.

All this has had a tremendous effect on our communities. From what I’ve learned anecdotally from my colleagues, the number of patients presenting to the emergency room with psychiatric complaints has doubled. I have personally seen how stress and anxiety is an underlying thread in the increased number of patients arriving at the ER. It might seem hard to find silver linings to all this, but the challenges of 2020 forced us to take unprecedented steps to support our members and recognize areas where we were deficient in responding to social issues.

Our most visible effort this year was Operation Shields Up, in which we worked with members of the community to produce and distribute over 15,000 face shields to local health providers and thousands of fabric masks, sewn by volunteers, to nursing homes and medical practices.

Over the past several months we have put an extensive effort into confronting racism in medicine, including frank discussions you have seen in this magazine.

This summer, I appointed members to our new Health 4

Sierra Sacramento Valley Medicine

By John Wiesenfarth, MD drjohn@winfirst.com

Equity in Medicine Advisory Committee. Chaired by J. Bianca Roberts, MD, the committee is studying how racism at all levels affects providers and patients. I am confident that substantive recommendations and a commitment to positive action will result from the committee’s work.

One unfortunate lesson we have learned from the pandemic is that it’s not just families who are unprepared for end-of-life decisions; many physicians are as well when it comes to the guidance they can offer. That’s why we have created the End of Life program to help physicians assist families in making informed, written choices that will provide clear direction and often save patients from unnecessary suffering.

I have personally seen how stress and anxiety is an underlying thread in the increased number of patients arriving at the ER. On a personal level, amid the tumult and unpredictability of the year I have learned to be more grateful.

Social distancing and isolation has given me more time to just sit and talk to my family about whatever is on our minds. We’ve learned to put down our electronics and engage with each other in ways we haven’t for a long time.

I’ve also tried to be more mindful of living in the moment and realizing I have a choice in how to respond to a comment or situation. Reflexive responses often aren’t good responses, and that has become clearer for many of us.

I’m very proud of all SSVMS has done this year to help physicians deal with the anxiety of the pandemic through the Joy of Medicine program, which had to be quickly reconfigured as planned events became virtual instead of in-person celebrations that allowed us to enjoy each other’s company. I want to thank the SSVMS staff for working so hard to make this vital service

available when it is needed more than ever.

Like many of you, I’ve had to embrace the unpredictability of 2020 and have gone from long hours to currently having more time off recently, as my hospital is overstaffed. I’m using that time to make wine, take Spanish lessons, hone my fly fishing skills, play the saxophone and fix many things around that house that have been on the honey-do list for years. If you find yourself with more time these days, enjoy it because even though it might not have been in your plans you’ve earned it.

It has been an honor to serve as your president for the past year.

Thank you for your support and here’s to a brighter and happier 2021!

Operation Shields Up was a high point of 2020. Among the volunteers were medical students who packaged masks produced by a 3-D printer at a local computer lab.

November/December 2020

5

| EXEC UTIVE DIRECTOR’S MESSAGE |

Honoring Our Milestone Members

By Aileen Wetzel awetzel@ssvms.org

This month, I’m very pleased to use this space to recognize our Milestone Members who have supported SSVMS for over three decades and are celebrating anniversaries with us. In addition to the milestones below, we are proud that 235 of our physicians have been members for over 40 years. Thank you for your membership and all you’ve done to make SSVMS the strong and responsive medical society it is today!

Â

 �

Â? Â? Â?

 �

Â? Â? Â? Â? Â?

 � � ­ € �

‚

Â

Â

­

Â

€

­

  Â

­

Â?

 �

6

Sierra Sacramento Valley Medicine

­

Â? Â?

� ƒ

ƒ „

Â?

­ � �

Â?

Â… Â?

� † ‡ �

ˆ � † ‰ Š � †

ˆ �

Contact SSVMS to Access Your

M e m b e r O n ly B e n e f i t s

info@ssvms.org | (916) 452-2671 BENEFIT

RESOURCE

Reimbursement Helpline FREE assistance with contracting or reimbursement.

CMA’s Center for Economic Services (CES) www.cmadocs.org/reimbursement-assistance | (888) 401-5911

Legal Services CMA On-Call, Legal Handbook (CPLH) and more…

CMA’s Center for Legal Affairs www.cmadocs.org/legal-resources | (800) 786-4262

Insurance Services Life, Disability, Long Term Care, Medical/Dental, Mercer Health & Benefits Insurance Services LLC www.countycmamemberinsurance.com | (800) 842-3761 Workers’ Comp, Cyber Liability etc.

Career Center Member groups receive free basic job postings and access to the Career Center resume bank.

California Physician ™ Career Center www.careers.cmadocs.org

Mobile Physician Websites Save up to $1,000 on unique website packages.

MAYACO Marketing & Internet www.mayaco.com/physicians

Auto/Homeowners Insurance Save up to 8% on insurance services.

Mercury Insurance Group www.mercuryinsurance.com/cma

Car Rental Save up to 25% - Members-only coupon codes required.

Avis or Hertz

CME Certification Services Discounted CME Certification for members.

Institute for Medical Quality (IMQ) www.imq.org

Student Loan Refinancing Members receive a rate discount of 0.25% off the approved loan rate.

SoFi www.sofi.com/rate-discount-25

Healthcare Messaging Free secure messaging application

DocBookMD www.docbookmd.com/physicians

HIPAA Compliance Solutions Members receive a discount on the Toolkit.

PrivaPlan Associates, Inc www.privaplan.com

Magazine Subscriptions Members get up to 89% off the cover price of popular magazines.

Subscription Services, Inc www.buymags.com/cma

Confidential Physician Wellness Resources 24-hour confidential assistance hotline is free and will not result in any disciplinary action. Additional Physician wellbeing resources also available through SSVMS’ Joy of Medicine.

Physicians’ Confidential Line (650) 756-7787 www.cmadocs.org/confidential-line www.joyofmedicine.org

Medical Waste Management Save up to 30% on medical waste management and regulatory compliance services.

EnviroMerica www.enviromerica.com

Office supplies, facility, technology, furniture, custom printing and more… Save up to 80%

StaplesAdvantage

Physician Laboratory Accreditation 15% off lab accreditation programs and services Members only coupon code required

COLA (800) 981-9883

Security Prescription Products RxSecurity Members receive 15% off tamper-resistant security subscription pads. www.rxsecurity.com/cma-order

SSVMS Vetted Vendor Partners Maloof Law Group Nicholas Maloof, Esq. Estate planning, business transactions. Physician members receive a 10% discount on all services.

Cooperative of American Physicians (CAP) Medical professional liability protection to over 12,000 of California’s finest physicians.

NORCAL Group Medical professional liability insurance, risk management solutions and provider wellness resources.

Sotheby’s International Realty Mela Fratarcangeli is consistently ranked in the top 5% of all real estate agents in the Sacramento Valley serving the buyers and sellers at all levels in the Sacramento Region.

Crumley & Associates Drawing on more than 120 years of experience, Crumley & Associates emphasizes sound financial planning, along with a variety of personal financial services.

The Mortgage Company The Mortgage Company brings a wealth of experience to every purchase and refinance loan, and exceptional concierge level service.

Bank Card USA By eliminating the middleman, Bank Card USA is able to offer special pricing for our members.

www.ssvms.org/physician-resources/vendor-partners. Questions: dbrooks@ssvms.org

| OPINION |

Cycles

A Stolen Spring, a Lost Summer and a Sudden Autumn Interrupt Life’s Rhythms

F

all completely took me by surprise this year. It is as if it had happened overnight, barely a few days after a heat wave. It made its entrance onto the stage from behind a curtain of smoke, with a terrifyingly beautiful red sun as the sole projector and its gravity taking the form of sinister cinders waltzing around.

The change of season came in silence in a way that makes me want to weep. I am not ready for autumn. I have not yet come to terms with my stolen spring and summer.

I have so many unfinished affairs with summer. No travel to Canada, so no reboot of my life with the obligatory poutine fix and the joyous gatherings with beloved family and friends. No berry picking or watching local TV shows with my kids so they can finally learn a little bit more of a Quebecois accent. No real freedom from work duties as I read, swaying peacefully in my mother’s hammock.

Summer kept us from happy hour and BBQs with loud laughter among friends. There was no use for our champagne flutes, now lined up on the counter with starter plants. Even after coming to terms with a lifelong pattern of oscillation between delight and aversion towards certain swimwear, there 8

Sierra Sacramento Valley Medicine

were no trips to the pool so no premiere display of my brand new bikini over a body that I was, for once, not so ashamed of. (Yes, even a middle-age female physique that had been so pregnant—with an almost nine-pounder—and had lactated so resolutely!)

Pandemic, heat wave, raging forest fires with nonbreathable, toxic air. Triple confinement towards the end of the summer. Fall season used to represent this essential backstage of summer and a prelude to the act of winter, an arching bridge

By Caroline Giroux, MD cgiroux@ucdavis.edu

in the outside world. Except the uncertainty, the sadness in aloneness, the aloneness in sadness.

Or maybe there is a back to something, something not yet known, something new and special. I need to give it time, to wait through October, and November… maybe there will be cause for celebration, a time to enjoy a suspended state of friendship where hugging is forbidden, but not the smiles or sitting together or enjoying each other’s energy and warm presence.

And we can hope for a better

Cycles are not only a silent continuous thread of one’s existence, but they are also an invisible tie to generations before and after our own. between boiling hot and freezing.

It is normally synonymous with school supplies and going back to classroom.

I remember fondly my ceremonial supply list, how I looked for­ward to buying those “cahiers Canada” notebooks and later, thick spiralbound binders, the Prismacolor pens, the eraser with a strange, unpronounceable name (Steadtler), a magical geometry set, and, yes, perhaps I could even dream of a new checkered pencil pouch, lunchbox or school leather bag. But this year there was no back to anything

future, as 2020 threw at us some challenging life tests! We had to come up with solutions even though we couldn’t prepare for the exams, forcing us to think out of the box, fervently.

Cycles, like the seasons, are important. They imply there is a beginning, an end, and a new beginning. It makes all interrelated aspects of life dynamic and evolving. The moon, the tides of the ocean, the aging and birth processes, hormonal shifts in our bodies, memory consolidation when we sleep, the structure of a balanced day.

An optimal children’s bedtime routine obeys the laws of a cycle.

My own routine needs to make sure I can marvel at the moon before escaping in dreams. It has not been possible for many days because of the forest fires. Someone remarked in the midst of it that every moment of the day looked the same, and it is disorienting. No wonder fall made its entrance rather incognito.

The four seasons in the now seemingly faraway land where I grew up used to make the landscape of my year somewhat predictable, well balanced. I knew that the color of my wardrobe would change in synchrony with the leaves in the maple trees. The celebration of splashes of bright red, luminous orange and bright yellow was a cue to wearing my checkered shirts, skirts and socks.

Just like the first snow announces hazardous sledding, bewildered snowmen and flu-spreading family festivities, cycles provide some harmony, a back-and-forth as comforting as the waves, the hugs from the sea. But the pandemic seems to have flattened them. I miss the “everyone-leaving-the-house-inthe-morning” cycle so I get a few minutes of silence before starting my workday. Now noise and chatter are constant. I miss the picture day at school (my sons don’t, but I miss the struggle over combing their beautiful hair).

Cycles are not only a silent continuous thread of one’s existence, but are also an invisible tie to generations before and after our own. Cycles remind us that there is a before, an after and a back to normal or baseline. Even life and death, death and life cycles are

not so obvious anymore. Too many people have suffered and died alone this year, only accompanied by a vile ventilator or a two-dimensional image of a loved one on a tablet.

Then, too many aggrieved people had to skip the cycle of communal mourning provided by a funeral.

As life cycles forward, women reaching my age group have traditionally often been led to obsolescence (during perimenopause and after, society at some point decided that women at this stage were no longer attractive, hence being denied roles in movies, TV shows and other public appearances or functions, although the same apparently doesn’t apply to aging men).

We need to resist this. It’s time for a revolution! Women from all ages and cultures are needed more than ever in public life, to roll back their sleeves and be involved in urgent discussions around denouncing and criminalizing medical acts leading to mass sterilization (no woman should ever be mutilated to

have life-bearing potential removed against her will), protecting abortion rights (no woman should ever be told what to do or not to do with her body and her life), obtaining pay equity, ending racism, preventing violence, and addressing other gender gap issues and injustices. It is not the time to give up, even if we are wiped out by the incessant turmoil and polytrauma this year.

I fear that an ominous cycle may have begun, one that may lead us toward stagnation, or worse, regression. With Justice Ruth Ginsburg’s death, we wait in angst and hope for a reawakening that will leave untouched the fundamental rights so many people fought for.

But we can’t sit idle. Let’s use the explosions of our values and the vortex of adversities we have been sucked into as source of momentum, to shift the trajectory, and share shocking stories to raise awareness, change the settings of our civilizations and to co-author a proper ending of the tale. Storytelling will November/December 2020

9

Imagine the Power of Experience We’ve been a trusted financial partner to businesses and families across generations since 1919. Let us put that insight and expertise to work for you.

Patty M. Estopinal, CIMA®, CDFA 916-783-6554 . 877-792-3667 pattyestopinal.com | pestopinal@rwbaird.com

©2018 Robert W. Baird & Co. Incorporated. Member SIPC. MC-237590.

10

Sierra Sacramento Valley Medicine

help the oppressed reclaim their lives and define themselves, before toxic societal structures and malignant narcissism do it for them.

We are standing on the shoulders of giants­(some still alive and others now living in another dimension, the same one our dreams inhabit) who asserted the role of fellow women and other oppressed populations in the world. They continue to inspire me: Justice Ginsburg, Eve Ensler, Gloria Steinem, Rosa Parks, Michalina Wislocka, Harriet Lerner, Françoise Héritier, Janette Bertrand, Hillary Clinton, Frida Kahlo, Margaret Atwood, Roxane Gay, Lucy Maud Montgomery, Mary Magdalena, to name just a few. The legacy of these women and the obstacles they overcame inspired me in accessing my deep truth over the years, like a corkscrew slowly digging through the plug until aliveness gushes forth again.

While the pandemic may have appeared to have abolished some cycles, the reality is that they continue to turn, unceasingly, backstage. I sense that in myself and in many others there is rage, epiphanies swirl, and ideas are spiraling upwards. Together, we can keep the cycles that have brought more— but not enough—justice moving forward and not allow them to move counterclockwise to erase what so many have fought for.

Maybe my biological clock is shifting to a spiritual one. Maybe I am entering a new adolescence, maybe both. But beware, for either way I will be rebellious as I join kindred souls in a journey back to asserting morality, with my words screaming truths loud as artillery, clear as a trumpet and triumphant.

PRACTICE

CONFIDENCE Confidence in your coverage instills confidence in your practice.

Medical Professional Liability Insurance Risk Management Professional Wellness

844.466.7225 | NORCAL-GROUP.COM

© 2020 NORCAL Mutual Insurance Company | ng5125 NORCAL Group includes NORCAL Mutual Insurance Company and its affiliated companies.

| PROFILE |

John Chuck, MD Wants You To Know You’re Not Alone Burnout Affects Almost Half of All Physicians, But Joy and Meaning in Medicine Can Be Rediscovered

N

ow that he has retired after spending 31 years in family practice and the last 15 in leadership positions promoting physician wellness at The Permanente Medical Group, Dr. John Chuck is literally starting a new chapter in his life.

“I’m writing a book called Pearls From the Practice of Life,” he said. “It’s a compilation of all the things I’ve learned through my practice and my personal life about man’s predicament and the means of its resolution.”

Despite his retirement from TPMG in August, physician wellness continues to be a focus in his personal and professional life.

“Every year in America, 300 to 400 physicians successfully take their own lives,” Dr. Chuck said. “Roughly 30 times that many attempted it and 150 times that many considered it. One of my goals as a physician wellness leader, if nothing else, is to reduce the suicide rate.”

“If you don’t have a plan to be well as a physician, you will be unwell.”

In addition to starting his book, which he hopes to finish by Christmas, Dr. Chuck serves as chair of the SSVMS Joy of Medicine Advisory Committee. His vision for the committee is to help physicians understand that resources are available to help them deal with burnout, but also to provide a safe place to share best practices in wellness and discuss individual successes and challenges.

Dr. Chuck has found that it is often hard for physicians to recognize when they can benefit from help, he said, because they fail to realize that focusing on their own well-being is “not selfish, but a healthy self-interest.” One of the obstacles encountered toward self assessment is that physicians can feel guilty about

thinking about their own health when they’ve made their lives all about their patients—even though being in a better place emotionally will help them to do a better job for those patients.

The pandemic has added to burnout problems by giving physicians additional reason to grieve the loss of the personal connections they have with their patients.

That, along with personal concerns for their families and professional challenges such as trying to implement virtual care, have added to the stress physicians often simply try to plow through.

“There is a well-established culture in medicine of armor up and be perfect and suppress any feelings of disengagement or depression for fear of being perceived as weak by your colleagues or the community,” Dr. Chuck said. “I’ve done extensive work with physician well-being leaders who handle impaired physicians.

They said without exception that all of the physicians they’re helping felt, despite being surrounded by caring colleagues, as if they were all alone in their suffering when they were not.”

GEAR Up for Wellness

He has an approach to well-being with four elements that he has coined as “GEAR up for wellness.”

The “G” is for gratitude: he suggests starting each day thinking about things you’re grateful for. The second element is exercise; “30 minutes of walking is 30 minutes of not watching TV and getting depressed,” he explained. “A” stands for being adaptive by adopting best practices and, if you don’t know what they are, copying those who do.

“R” is for relationships and involves enhancing your social life with others, your emotional life (your relationship with yourself) and your spiritual life, the relationship you have with God or another higher power.

SSVMS Forms Health Equity Advisory Committee

12

Sierra Sacramento Valley Medicine

By Ken Smith ken@kdscommunications.com

systems promote physician wellness in order to improve outcomes for patients.

Recent studies have shown that nearly half of physicians nationwide showed signs of burnout, which was defined as feeling emotionally exhausted, being disengaged from patients and experiencing low selfesteem.

“It really is a frightening number, to know that half the people operating on your body or listening to the story of your chest pain in the emergency room are burned out,” he said. “That is not sustainable.”

Dr. Chuck believes that 90% of health for everyone is based on mental health, because a person who is emotionally well will properly manage their diet, exercise and relationships with other people.

Photos courtesy John Chuck, MD

His decision to retire from TPMG at age 60 was not an impulsive one. His father was a minister at a church in San Francisco’s Chinatown for three decades, about the same length as Dr. Chuck maintained his family practice, and was a role model for making a career transition at that age.

“At age 60, he did an intentional pivot shift and became a seminary professor in Berkeley for 15 years,” he said. “I always had the idea that I would do one career until age 60, and then pivot shift and do a different one for another 10 or 15 years.”

The pivot is more of a change in employment status than it is his professional focus. In addition to writing the book, Dr. Chuck has opened a consulting firm designed to help medical groups and hospital

Dr. John Chuck “I would say that the average physician is woefully behind other people in in regard to thoughtful introspection and self care,” he said. The reason: While most of the general population is out exploring the world and relationships in their youth, physicians-to-be are often hunkered down studying subjects such as physics and preparing for their Medical College Admission Test. “If you don’t have a plan to be well as a physician, you will be unwell.”

Serotonin Surge

Races and other events have enabled Serotonin Surge to raise over $4 million for safety net clinics in the 21 years since it was founded by Dr. Chuck. Serotonin Surge is a major sponsor of the SPIRIT program.

Upbeat and energetic, Dr. Chuck is as dedicated to supporting the wellness of communities as he is to physicians. Twenty-one years ago he founded Serotonin Surge, a nonprofit that supports local safety net systems by helping to fill the gaps left after government funding.

“We called it Serotonin Surge because the goal was not only to

November/December 2020

13

raise awareness and funds for worthy causes, but to show people that doing so could really make you feel good and be fun,” he said. “One thing that I am especially grateful for is the collaboration of all the major medical groups in our community and the Medical Society in supporting these fundraisers.”

Serotonin Surge is a major supporter of the SPIRIT program and has funded over $4 million toward safety net medical care during its existence. Money is raised through events co-sponsored by SSVMS such as golf tournaments, fashion shows, food and wine events, and runs.

The pandemic has forced him to get creative, and in January the charity will hold a virtual fundraising event called “Great Adaptations.”

It’s a call to action to support safety net medical care at a time when it is needed more than ever before due to COVID-19 along with the social, political, and moral unrest facing our nation.

It’s a Time to Look Out for Colleagues, Too

Especially in this difficult time, Dr. Chuck encourages physicians to look out not only for themselves but also for their colleagues. Telltale signs of someone who may be struggling include physical and emotional withdrawal, increased cynicism and negative attitudes, poor work performance, and an uptick in somatic complaints and illnesses.

“It’s important to reach out to that person and just ask them how they are doing,” he said, adding that only another physician can truly understand the personal and 14

Sierra Sacramento Valley Medicine

Dr. Chuck with his daughter Kelly, wife Lesli and son Tyler enjoy women’s lacrosse senior day at UC Davis in 2018. professional challenges that come with the job. He noted that the physician support groups offered

by SSVMS provide a safe space for honest discussion and can be a

Tell-tale signs of someone who may be struggling include physical and emotional withdrawal, increased cynicism and negative attitudes, and poor work performance. powerful step toward restoring the joy and meaning that originally led to medicine as a career choice.

Dr. Chuck is adamant that the executive leadership at medical groups and health systems must state that wellness is a priority. That commitment requires a wellness leader having a seat at the table at operations meetings, or else decisions will be made with disregard to physician wellness.

“You can’t insert physician wellness programming in arrears of operations programming that set us up for failure,” he said.

Dr. Chuck said that when he is working with physicians, his approach is to be a facilitator who can help doctors recognize the positives in their lives. In large part, success comes down to helping physicians be themselves rather than an idealized and unsustainable version of the perfect doctor.

“I’m trying to bring out the joy and meaning that are already within you,” he said. “You’re a physician, you’re smart, you have insight, but the busy nature of your life is shrouding that joy and meaning.

“It’s not like I’m going to tell you something you don’t already know.

I’m just trying to bring out and celebrate what you already have.”

Ken Smith is the managing editor of Sierra Sacramento Valley Medicine.

Gala Week & Virtual Auction Free Reception & Exposition of Auction Items

Benefitting the SSVMSA Community Endowment Fund Auction items can be viewed at: AOM2020.givesmart.com On November 7th and 8th, view auction items in person “by appointment only” at the Medical Society building. Appointments can be made by visiting the GiveSmart website or by calling (916) 718-2568. Bidding opens at 10AM on November 7th and closes at 6PM on November 15th.

Registration is FREE. Pre-register to receive important updates and to view auction items.

By Jon Davids, MD

November 7th – 8th 5380 Elvas Ave., Sacramento For more info, contact Mary Sosa at masosa5@icloud.com

jdavids@shrinenet.org

To register, scan the QR code or go to: AOM2020.givesmart.com

SSVMSA is a 501 (c) (3) not for profit organization

November/December 2020

15

| POETRY |

The Sk in I’ m In I looked in the mirror As many do as one of their first acts of the day.

I saw my Black body With black skin suspended around my middle, Below my navel and that area at the side which was above the hip bone but now lies with some flesh and mostly skin at or below that bone.

It’s a testimony to the change in the scale from 197 to 183 pounds.

It’s a very familiar welcoming-unwelcome site to All like me who have walked long and hard and seen the results of the stretched suspended skin with little fat.

It is not an embarrassment but a sign of progress and of victory.

It says that our efforts are bearing fruit though of a still strange kind.

It is the skin We’re in You see, I’ve been walking miles Among my neighbors, through the trails and parks where I live, sometimes once sometimes twice daily but always five to ten miles.

And as I approach, some cross the street to the other side of the more than 6-foot sidewalk.

In the trails I am sometimes viewed with suspicion by approaching individuals, pepper spray at the ready, until well past the point of ‘danger’.

Though I walk softly, I consciously slap my feet to the ground if I approach from the back of a lone female.

She is reassured that this is no sneak attack and I would not have to look into her face of fear and angsts.

I wonder if my face shows a smile alone, which I sometimes feel.

Or, does it show the disdain and ignorance of the privilege, the stealing of my serenity in this place, by the other.

I feel stripped and vitiated, as though I am a danger unless proven otherwise...

Because of the Skin I’m in This is maddening since there is nothing to steal out here in a large wide open park, surrounded by reassuring solitude.

We are surrounded by the serenity of trees with deer and skunk and the lonely infrequently seen fox; a quiet assuring and calming place—normally...

Except for this Skin I’m in In the trails I am not entering a grocery store where, despite available cameras, I am made aware as an act of ‘not so overt’ intimidation by the armed security guard closely following as I peruse the aisles.

I am not at the Home Depot which I frequent and where I am told that my driver’s license was flagged.

I had returned several unneeded items among which was a single ‘frequently lifted’ item; no mention of the receipt presented for the other items returned and for which neither money nor store credit was offered.

There was shame and embarrassment to be felt as others stared as this act reinforced what others felt they always knew.

I am no Maleeka Madison

As I walk with intention I take care to reassure with a smile or hello or open hands not only in civility but as an act of survival.

If I am holding my phone I must be certain that it is clearly a phone because others are looking and sometimes people see what they seek.

16

Sierra Sacramento Valley Medicine

I am not in the 7th grade This is the year 2020 And this is still America And this is still...

The Skin I’m in

By Eric Williams, MD imango@att.net

POSTAL NOTICE

November/December 2020

17

| ESSAY |

Teachers

Therapies and Technology Evolve, But Lessons in Character and Compassion Are Timeless

A

ll of us who are teachers of medicine know that scientific data are fungible, technology evanescent, and therapies fleeting. What those of my age remember, value, and still use of what we were taught in medical school, residency, and fellowships is not really what our teachers said—which is pretty well out of date now—but what they were: thoughtful, curious, caring, skilled and empathetic.

For me, awareness of the impact a role model teacher can have on students came very early in my life, way before college or medical school. It was in the person of Mr. Joe Blake, my junior high school homeroom and civics teacher. A gentle but impressive man, he had fought the Germans in Europe in World War II and had come, after the war was over, to beautiful Santa Barbara, California, where I lived as a child.

My seventh-grade class at Santa Barbara Junior High School was almost entirely white, with only one darkerskinned member of our group: Jose, who was of Mexican lineage. During a lecture on early- and mid-20th Century history, Mr Blake suddenly stopped talking in midsentence, pointed at Jose and said, “Don’t do that again!”

We all turned to see what Jose had done, but he was just sitting at his desk, looking sullen. Mr. Blake then resumed his lecture, but after a few minutes, he again spoke to Jose.

“Be careful!” he said with a serious look directed at Jose. “Next time you do that, you are out!”

Again we looked and saw nothing. Then very shortly came the third interruption. “Jose, I warned you!” he said. “Go to the principal’s office, now!”

We watched Jose, shoulders slumped, go out the door and close it behind him. Then we all turned our attention toward Mr. Blake, expecting him to continue his lecture. But he didn’t. Instead, he asked the class a question.

“What did Jose do wrong?”

We all again looked around, but this time at each 18

Sierra Sacramento Valley Medicine

By Faith Fitzgerald, MD ftfitzgerald@ucdavis.edu

other. No one spoke. Nobody knew. Then one student said, “He must have done something really bad if you sent him to the principal’s office.”

Mr. Blake left his desk, went to the door and opened it to let a grinning Jose back in. They had been in on it together, these two, because both knew Jose had been pretty much ignored by our class, had no offers of friendship from us, and was thought by us to be kind of slow.

Mr. Blake and Jose walked together to the wide windows of our classroom, pulled the curtains and opened a sliding glass door to reveal a big shiny motorcycle on the outside balcony. The boys in the class immediately got up and went to examine the beautiful bike, chatted with Jose, who (at the age of 12, mind you) had built it himself from spare parts. Almost all asked if they could get on it and, later, take a ride.

When the hoopla over the bike had settled, Mr. Blake called everyone back to their seats and began to tell us the history of the Nazis, the authoritarian “Aryan Master Race” and the Holocaust. And so my classmates and I learned how very wrong it was to judge “the other” solely on the basis of their perceived differences to “us,” and also how one could not assume that any “authority,” just by virtue of being called an authority, was therefore always right.

Years later, as a medical student, I was again lucky to meet another great teacher.

Preclinical medical students in the mid 1960s at the University of California San Francisco were assigned to one full night of observation in the emergency room at Moffitt Hospital. My classmate and I went to the ER, as we had been told, but were disappointed: there was only one patient there throughout our entire 12-hour shift, as all seriously ill or injured patients were automatically taken by ambulance to Mission Emergency at San Francisco General Hospital.

Our patient was a young woman who had come in to be seen in the early evening. With the intern (the only

Photo: UC Regents

doctor in the ER at the time) we went over her history and physical exam rather quickly, as she was in no overt distress or had current symptoms of any kind. She had discovered a small painless lump in her left breast during a shower, and wanted to know what it was.

We all felt the small, non-tender lump. The intern wrote a note, suggesting a biopsy be done, then went to take a nap.

We waited for the attending.

When the attending arrived at dawn, he also took us to her bedside. But his was a very different approach. He seemed able to immediately connect with her, to listen to her story with deep attentiveness and concern. She gave a much more detailed history than she had given the intern, including that she, fearful of the possibilities, had put off seeing a doctor for several months after she had felt the lump. She mentioned for the first time that a good friend of hers had recently been diagnosed with breast cancer. This had really scared her and led her to the first palpation of her own breasts. She began to cry.

Then the attending, with great gentleness, did a much more thorough examination than had the intern. He got her permission to let us also examine and learn from her. He showed us, among other things, how to observe, compare, and palpate the breasts, including the overlying skin and nipples, how to probe for axillary lymph nodes, how to auscultate heart and lungs, and how to

percuss and palpate the liver.

More importantly, throughout the process he taught us how to interact with the patient.

While still at her bedside he told her and us about the non-cancer differential diagnoses of breast lumps, including benign cysts, fibroadenomas, and traumatic fatty necrosis. When he mentioned this, she suddenly recalled that she had been hit by a baseball in the left breast months before, but had no pain or bruising, so quickly forgot about it.

He gave her true attention. He listened. He was caring. He treated her with respect. He thanked her for allowing my classmate and me to learn from her. He gave her hope and, indeed, the biopsy, done over the next several days, was benign.

I thought then, and now, that I could do no better thing than to emulate him, and so I worked under his tutelage for nearly a half century. Dr. Hibbard Williams, when he became dean at the University of California Davis School of Medicine, recruited me here in 1980. He was the ER attending I’ve just told you about, and shall always be my greatest teacher of medicine.

Above: Hibbard Williams, MD, dean of the UC Davis School of Medicine from 1980-92. Dr. Williams passed away in 2016.

November/December 2020

19

| LIFE IN A PANDEMIC |

Coping as a Medical Student In the Age of COVID-19 Learning, Life Change in the Midst of a Pandemic

T

he pandemic has disrupted the medical school way of life, just as it has the rest of our community and world. Medical students have been pulled from classrooms, hospitals, and clinics to minimize the risk of spreading the virus, conserve scarce resources, and to protect fellow students and staff.

One particular jarring change to our medical curriculum is the transition to remote learning. For many of us who attended lectures religiously, the transition to online classes has been difficult. Nevertheless, as students we are expected to power through as we self-study, engage with course materials on our own, and join faculty in virtual classroom settings to discuss, debate, and apply knowledge to clinical problems.

I’ve found creating a work environment at home that is conducive to my learning and a structured daily routine to be helpful. Ensuring that my desk is far from any distractions and having adequate lighting allows me to focus on course material. Maintaining personal routines that include staying hydrated, exercising earlier in the morning as a substitute to my cup of coffee, and creating to-do lists the night before so that I can easily track my progress and see what tasks are still left in the day to complete also help maintain focus and improve productivity.

As luxurious as it may be to wear pajamas throughout the day while studying in my bed, changing into a new set of clothes that I would normally wear to school helps restore a sense of purpose.

To cope amid the pandemic, some students have invested more energy into community projects while others have rekindled relationships For links to wellness resources at California medical schools and other ways to help cope with pandemicrelated stress, scan the QR code.

20

Sierra Sacramento Valley Medicine

By Sara Toulouie, MS II Sara.Toulouie6181@cnsu.edu

with family and friends.

As a co-director for Clínica Tepati, a student-run clinic serving the uninsured Latino population of Sacramento, I’ve found relief in continuing to provide basic health care services for our patients, many of whom feel resistant to in-patient visits given their comorbid conditions.

The use of telemedicine has allowed us to maintain our patient volume while expanding our availability to see patients seven days a week. It also offers a unique opportunity to provide care to patients of underrepresented backgrounds, and by working at Tepati I am reminded of my calling.

A number of hospitals have rolled back rotation opportunities in order to minimize the spread of COVID19 among patients, health care providers, and health care providers-in-training. It is a balancing act to protect everyone involved while ensuring the next generation of physicians is equipped to care for patients and prepared for future, unpredictable events such as this pandemic.

For fourth-year student Tony Alarcon, transitioning to a virtual clinical setting has made the active engagement between students and patients a challenge. He has put a premium on maximizing in-person time with patients, especially since more is being done virtually, and noted that schools have worked to preserve clinical training.

“For example, our objective structured clinical examinations have transitioned to a virtual physical exam,” he said. “Standardized patients are interviewed by students through breakout rooms in Zoom.”

Virtual examinations have their limitations, however.

“The ability to connect with patients at a basic level to demonstrate a sense of compassion through facial expressions or the act of a simple touch like a handshake is lost,” third-year student Cindy Ma said.

Beyond the changes in learning, some students expe-

Pham said she found some relief by initiating contact through video calls with friends across the country who were facing similar challenges.

Small activities like establishing weekly Netflix calls or delving into online exercise routines with friends also helped her gradually adjust to her new lifestyle.

The mental health challenges faced by medical students are tough

Screenshot by Cindy Ma, MS III

rienced dramatic lifestyle changes that now force them to navigate family life and medical school under the same roof. May Kyaw, MS II, moved back to her parents’ Bay Area home for the last three months of her first year.

“It’s a small home for the seven of us,” she said. “It was challenging to find a study space and headspace necessary for productive learning.”

A didactics class at California Northstate University, 2020 version.

But with her family’s help she was quickly able to adapt.

COVID-19 restrictions have left many students feeling socially isolated, and the loss of a sense of community has been a huge detriment to mental health. Angela Pham, MS II, said one of the most important sources of support during her first year consisted of friends she could confide in when challenges arose. An abrupt move from California back to her home on the East Coast led to the sudden loss of that support system.

“I had a routine of balancing school with social activities before the pandemic,” she said. “It was hard to stay motivated and I felt really lonely.”

enough during a regular year, but 2020 has heightened to focus on how medical schools can support student wellness. To better understand what services are available to medical students in California and their awareness of these services, a survey was distributed to medical schools throughout the state by the American College of Physicians California Council of Student Members. Responses were received from nearly 150 medical students across 10 different institutions.

A majority of students (94.5%) reported being offered information on student wellness in general. Just under half said their school had a director of student wellness, but an almost equal number said they

didn’t know. Exercise facilities were chosen by over 60% of respondents as the wellness resource they would most like at their schools, even though just 39% reported having those facilities available to them.

Wellness services that the largest numbers of students said were available to them include mental health services (92%), followed by academic support services at 88% and stress reducing events—such as visits from puppies—at 86%.

Notably, as learning becomes more remote, only 56.8% of students reported accessible online wellness resources. The results from this survey emphasize the need to increase connectivity among students and to expand the availability of programs online to promote wellness.

“I think it’s important to find a way for students to connect, especially those isolated away without many loved ones around,” one student commented in response to a question about what other wellness programs are needed. “Resources regarding coping mechanisms for common issues during quarantine as well as daily meditation sessions could be great!”

While navigating this pandemic, it is imperative that we remember to be present in the moment for each patient and for each other.

Even though medical students are resilient, we share hardships in this quickly evolving reality that the novel coronavirus has brought us. But we can be comforted by the privilege of being in medicine at this time, when we need to be ambassadors of science and advocates for our patients, as we work together to bring the pandemic to its end.

November/December 2020

21

| WHAT’S NEW AT THE MUSEUM |

SSVMS Museum of Medical History Goes Virtual Online Tours, Documents, Exhibits Make Museum Accessible to the World

T

he SSVMS Museum of Medical History collects, preserves, archives and exhibits artifacts representing the evolution of medicine, both locally and worldwide, over the last two centuries with a special emphasis on Northern California and the Gold Rush era.

The Museum’s collections and exhibitions provide our community, especially students, with an understanding of the art and science of health care.

There are relatively few medical museums in the United States and only three in California. This creates a challenge for the education of students and adults alike about the evolution of California medicine. Our museum is small, but through organized tours for students we have tried to reach out to our community and offer grants to help defray the cost of transportation for school tours. We are always looking at ways to expand our reach, including doing exhibits at various events and through plans to increase information on our website.

While the museum’s closure due to COVID-19 has been difficult, the good news is that the pandemic has hastened the process of markedly expanding the accessibility of our collection and information beyond those who are able to visit physically, making our museum and collection more widely available to the world.

We are creating a virtual walking tour through the museum that will be available soon. We have also recently added new vignettes on California medical history and will be adding a presentation of circa 1900 glass slide photographs from the collection of Dr. Junius Harris.

I am also working on a virtual tour of the graves of gold rush-era physicians interred at the Sacramento Historic City Cemetery, a tour that I conducted “live” for years. We are also considering making Zoom sessions available, especially to students, in which museum

22

Sierra Sacramento Valley Medicine

By Bob LaPerriere, MD ssvmsmus@gmail.com

docents can discuss topics of interest and respond to questions.

We are very excited that we are now able to make photographs and information on many of our individual artifacts available online. This is being enabled by our new database, CatalogIt, which allows us to publish selected items to their hub that can be accessed through a link on our website.

Our well-attended quarterly programs are also now being done virtually, meaning more people have access to them and they are also recorded so they can be available on demand. In addition, we will be able to introduce speakers from out of the area whom we would otherwise not be able to afford.

We are unsure when we can allow visitors back in, but it is likely it will not be until well into 2021.

Reopening is further complicated by the fact we do not have regular museum staff who can oversee and limit the number of attendees. As a small museum, our space dramatically limits those who can attend at the same time and our docents, when available, all are in the high risk category by age for COVID-19.

In the meantime, we are using this opportunity to promote information that has been on our website for some time but that many are not aware of. We have links to dozens of articles on medical history from the past 20 years of SSV Medicine, a PDF of the book The History of the Medical Society of the State of California (with more PDFs to come) and a bibliography that includes many of the books in our collection.

Keep your eye on our website for additions and updates. You’ll find it at www.ssvms.org/museum.

We are hoping that all these additions will expand the reach of our museum, even after the pandemic is over, and we are all looking forward to when we can meet physically in the museum again.

Zooming in on Joy of Medicine Month A Zoom “paint and sip� session, virtual physician lounge, small group meetups, and presentations on physician wellness were enjoyed by physicians throughout the region in September. Clockwise, from top left: Danton Kono, MD and his family show their creations; Rajiv Misquitta, MD, conducted a live plant-based diet cooking session; William Benko, MD applies finishing touches; Ruth Haskins and friend; women physicians from UC Davis exhibit their works; physicians and SSVMS staff socialize online; Leena Mehta, MD creates a masterpiece while enjoying the sunset.

November/December 2020

23

| BOOK REVIEW |

The Nurses of the Great War

How WWI Changed the Role of Nurses in Combat

I

n Easing Pain on the Western Front, medical historian Paul Stepansky, Ph.D., transports us to the world of nursing practice, mainly American, during World War I. The first 126 American nurses—all female and all volunteer—departed for the theater of war on September 12, 1914, three months after the start of the war. They went as non-combatant volunteers from a then neutral country, and some were assigned to duty in Russia, Germany, England and France.

It was not until the United States entered the war in April of 1917 that large numbers of American nurses, organized and trained by the American Red Cross under the auspices of the American military, journeyed to the European and Asian war zones. All female, they had to be native born, Easing Pain on the white, unmarried, and 25 to Western Front by Paul E. Stepansky, McFarland 35 years old. About 10,000 (244 pages, $39.95) of them eventually served in Europe, many stationed quite near the front lines in so-called Casualty Clearing Stations or not a great deal farther away at field hospitals.

These nurses took orders from their military colleagues, but had no military rank or benefits.

Dr. Stepansky begins by announcing what his book is not: “I do not review the nurses’ family origins, their formative years, or their reasons for entering the nursing profession… (or) their personal relationships, romantic or otherwise…” Instead, his focus is on documenting the actual caregiving activities of the nurses, their role in clinical decisions, and their rapid transformation into respected assistants to the all-male Medical Corps.

24

Sierra Sacramento Valley Medicine

By Jack Ostrich, MD jmost119@aol.com

The 244-page book is divided into seven chapters and includes extensive footnotes, a bibliography and a very useful index. It begins with a brief history of wartime nursing in which he reminds us of the “Nightingalean” tradition that began in the middle of the 19th century and had not changed much until the end of that century.

From the American Civil War to the Spanish-American War, nurses had little to do for the sick or wounded other than offer merciful comfort, food, water, help with personal hygiene, or assistance composing a letter to home. Basic medical, surgical and post-operative care was done by military physicians, and male orderlies did the “dirty work” such as disposing of body waste or soiled bandages. Wound care, such as it was, was done by the doctors.

Dr. Stepansky opines how germ theory led to an evolution of the role of nurses. By the opening of WWI, a typhoid vaccine had been produced and tetanus antitoxin was available for general use. Both of these agents began to be independently administered by nurses and no doubt saved many lives. Dressing changes, previously done by the surgeons, also became the purview of the nursing staff.

The numbers of wounded men who required emergent treatment often overwhelmed the medical officers.

Nurses therefore found themselves acting as assistants at surgery, as primary wound care specialists, and many became adept at starting and maintaining intravenous or clysis resuscitation.

Dr. Stepansky devotes an entire chapter to “shell shock.” It was thought by some physicians to be due to subtle brain damage caused by nearby explosions of shells and bombs, and nurses noted that the victims had “shivering and trembling, accompanied by rapid heartbeat and difficulty breathing.”

Dr. Stepansky writes passionately about the primary

care afforded the shell-shocked soldiers by the nurses.

“They simply nursed on, relying on intuitive understanding, common sense psychology, and compassion,” he writes, adding that Freudian theory was no help, as Freud had mused that the syndrome might arise from “the danger of external violence… manifesting itself as the ego’s fear of an internal enemy.” One of Freud’s pupils, psychoanalyst Karl Abraham, had worked as a general medical officer in the German Army, and opined after the war that shell shock victims were, “incipiently neurotic, with restricted sexual activity that derived from libido inhibited by fixations.”

As Dr. Stepansky dryly notes, “Such pearls of psychoanalyzing theorizing… were worthless to battlefield nurses.”

Dr. Stepansky’s penultimate chapter, “Plague,” covers the influenza pandemic that swept from the

Julia Stimson, chief of the Army Nurse Corps, received the Distinguished Service Medal from Gen. John Pershing in 1918.

Nurses aboard the ship Red Cross bound for Europe in September 1914. heartland of America to Europe in 1918. The flu killed over 600,000 Americans, and about 30,000 died of the flu even before arriving in Europe. In the war zone, about 57,000 military deaths were attributed to infectious disease, mostly flu.

That exceeded the the 50,000 deaths attributed to battlefield injuries.

Although three American nurses were wounded by enemy action, none were killed. But 272 died due to infections, mostly flu. Dr. Stepansky calls the pandemic, “the bacteriologist’s quandary and the nurses’ special hell.” Nurses had become the primary care providers for flu victims, and their own flu-related mortality rate was about 60 per cent higher than the medical officers.

Among those nurses caring for flu victims was Julia Stimson, a first cousin of Henry Stimson, an artillery officer in France who would later serve as Secretary of War and Secretary of State. Ms. Stimson was awarded the Distinguished Service Medal for her work in Europe during WWI and was the first woman to attain the rank of Army major. She

rejoined the Army at the start of World War II to help organize and train the Army Nurse Corps and gained the rank of full colonel just before her death in 1948.

The present Army Nurse Corps numbers about 11,000. No longer are all of them white, female (about 35 per cent are male), unmarried, and between 25 to 35 years old.

Their official creed was written in 2009. It ends: “We remember those nursing professionals who came before us and honor their legacy, determination, and sacrifice.

We are fundamentally committed to provide exceptional care to past, present, and future generations who bravely defend and protect our nation.”

Dr. Stepansky’s narrative is terse, informative, and easy to read. Even if you aren’t a die-hard medical history buff it’s worth a read, especially since the spread of COVID-19 is as close as anything we’ve seen in the just over 100 years since the combination of a global conflict and a pandemic that killed millions ravaged the world.

2020 November/December 2020

25

| BOARD BRIEFS AND NEW MEMBERS |

Board Briefs September 14, 2020 THE BOARD: Welcomed Olivia Kasirye, MD, Public Health Officer, Sacramento County, who provided an update regarding the pandemic in the county.

Approved the Nominating Committee recommendations for nominations to vacancies on the Board of Directors and SSVMS Delegation to the California Medical Association in 2021.

Approved the recommendations from the Scholarship & Awards Committee to provide 2020 medical student scholarships to: Brynn Sargent, 2nd year medical student at UC. Irvine School of Medicine; Lisa Teixeira, 3rd year medical student at Albany Medical College; Wendy Woo, 2nd year medical student at Virginia Commonwealth University School of Medicine; Kathleen Barnett, 2nd year medical student at California Northstate University College of Medicine; Amanda Blake, 1st year medical student at Rush Medical College; Kimberly Lau, 2nd year medical student at California Northstate University College of Medicine; Tess Perez, 1st year at UC Davis School of Medicine; Nathaniel Varghese, 1st year at California Northstate University College of Medicine; Thai-Than T. Vo, 1st year medical student at Burrell College of Osteopathic Medicine, recipient of the Paul J. Rosenberg Medical Student Scholarship.

Approved the 2019 SSVMS 990 Tax Returns.

As the Board of Directors to the Community Service, Education and Research Fund (CSERF), approved the 2019 CSERF 990 Tax Returns.

APPROVED THE FOLLOWING MEMBERSHIP REPORTS September 14, 2020 For Active Membership — Obai Abdullah, MD; Kristen Buono, MD; Kellie Corcoran, MD; Brent Jackson, MD; Hanh La, MD; Zachary NaPier, MD; Xuan (Trudy) Pham, MD; Adriana Santana, DO. For Reinstatement to Active Membership — Guanglan G. Zhu, MD. August 24, 2020 For Active Membership — Andrea Casillas-Chavez, MD; Robert Greer, MD; Jason Lee, DO; Rishi Sikka, MD. For Retired Membership — Mark Levy, MD. For Resignation — Anjani Amladi, MD (left area); Victoria Bell Yea Ri Shin, DO (left area).

Membership Discontinued for Nonpayment of 2020 Dues — David Beffa, MD; Scott Braley, MD; Isabella FloresMerrit, MD; Ryan Gorton, MD; Kaitlin Nicoletti, DO; David Tang, MD. July 27, 2020 For Active Membership — Adeela Ansari, MD; Lorianne Burns, MD; Erin Gonzales, MD; Withman Haro, MD; Ron James, MD; Elizabeth Kailath, MD; Randy McCreery, MD; Cheng Nguyen-Xiong, MD; Rakhal Reddy, MD; Savitha Reddy, MD; Paramjit Takhar, MD; Lindsey Van Brunt, MD. For Status Change from Resident Active to Active Membership — Enkhee Tuvshintogs, MD. For Government Employed Membership — Steven Kmucha, MD (transfer from San Joaquin).

For Resignation — Aaron Hanyu-Deutmeyer, MD (left area); Guofeng Gao, MD (moved to Maryland).

Approved appointments to the SSVMS Delegation to the California Medical Association.

For Transfer of Membership — Sophia Chong Yi, MD (to Stanislaus).

Approved the 2nd Quarter Financial Statements and Investment Reports and Recommendations.

For Retired Membership — Marvin Gatz, MD; Arun Patel, MD.

26

Sierra Sacramento Valley Medicine

New SSVMS Members The following applications have been approved by the Sierra Sacramento Valley Medical Society. Information pertinent to consideration of any applicant for membership should be communicated to the Society. — J. Bianca Roberts, MD, Secretary.

New Active Members

*Physician specialty abbreviated following name

Obai Abdullah, MD, CD, Mercy Medical Group

Roger E. Goldman, MD, IRDR, UC Davis Health

Ivy Nguyen, MD, N, UC Davis Health

Orwa Aboud, MD, N, UC Davis Health

Claire E. Graves, MD, GS, UC Davis Health

Mary K. Orsulak, MD, FP, UC Davis Health

Maryam Afkarian, MD, NEP, UC Davis Health

Mikah C. Owen, MD, PD, UC Davis Health

Garima Agrawal, MD, HOS, UC Davis Health

Robert D. Greer, MD, IM, Mercy Medical Group

Shushmita M. Ahmed, MD, GS, UC Davis Health

Anu Gupta, MD, P , UC Davis Health Maheen A. Hassan, MD, PG, UC Davis Health

Xuan T. Pham, MD, OBG, Camellia Women’s Health

Roger S. Akins, DO, DBP, UC Davis Health

Nisa Hatami, MD, HOS, UC Davis Health

Sishir Rao, MD, IRDR, UC Davis Health

Adrienne Atencio, MD, HOS, UC Davis Health

Heidi D. Horstman, MD, HOS, UC Davis Health

Elizabeth R. Raskin, MD, CRS, UC Davis Health

Henry C. Hsiao, MD, HOS, Mercy General Hospital

Carolyn Reyes, MD, OBG, UC Davis Health

Hanine N. Inaty, MD, PLM, UC Davis Health

William M. Ridgway, MD, IM, UC Davis Health

Jameson J. Azul, MD, END, UC Davis Health Jazmin Bains, MD, HOS, UC Davis Health Rostam Bakhtari, MD, AN, UC Davis Health Brittany Anne G. Bartolome, MD, HOS, UC Davis Health Sindhura T. Batchu, MD, PG, UC Davis Health Nazma Begum, MD, IM, Mercy Medical Group

Brent C. Jackson, MD,FACS,MS, GS, Mercy General Hospital Hershan Johl, MD, HOS, UC Davis Health Michael J. Jung, MD, APM, UC Davis Health

Fatma Berk, MD, NRN, UC Davis Health

Bob B. Kiaii, MD, CTS, UC Davis Health

Hema P. Bhargava, MD, PDC, UC Davis Health

Eric C. King, MD, IRDR, UC Davis Health William A. Klas, MD, FP, UC Davis Health

David P. Bissig, MD, N, UC Davis Health

Alan Koff, MD, HOS, UC Davis Health

William S. Bradford, MD, HOS, UC Davis Health

Alexander Kuo, MD, GE, UC Davis Health

Kristen K. Buono, MD, OBG, Urogynecology Consultants Med Cor

John C. Landefeld, MD, IM, UC Davis Health

Rachael A. Callcut, MD, TRS, UC Davis Health Janai R. Carr-Ascher, MD, ON, UC Davis Health Andrea L. Casillas-Chavez, MD, FP, El Dorado Community Health Centers

Hanh H. La, MD, ON, Mercy Medical Group Hai V. Le, MD, OSS, UC Davis Health Lien B. Le, MD, GE, UC Davis Health Jason M. Lee, DO, P , Woodland Clinic Medical Group Michelle J. Lim, MD, CCP, UC Davis Health

Melony Chakrabarty, MD, ID, UC Davis Health

Andrew Lin, DO, N, UC Davis Health

Yi-Chun Chen, MD, D, UC Davis Health

Scarlett T. Lu, DO, FP, Greenhaven Family Practice

Kellie N. Corcoran, MD, OBG, Camellia Women’s Health Branden J. Cord, MD, NS, UC Davis Health Anna Dahov, MD, HOS, UC Davis Health Lauren E. Damon, MD, HOS, UC Davis Health Nicole C. DeValle, MD, HOS, Methodist Hospital of Sacramento Michael S. Edwards, MD, NS, UC Davis Health Guinea S. Fan, MD, GE, UC Davis Health Daniel M. Fentress, MD, FP, UC Davis Health Reihaneh Forghany, MD, AN, UC Davis Health Paul N. Frank, MD, AN, UC Davis Health Ahmadreza Ghasemiesfe, MD, R, UC Davis Health Luis A. Godoy, MD, TS, UC Davis Health

Irene C. Liu, MD, AN, UC Davis Health

Jeffrey H. Ma, MD, OPH, UC Davis Health Lou Rose M. Malamug, MD, END, UC Davis Health Marievic G. Manrique, MD, AN, UC Davis Health Neal M. Mineyev, MD, TTS, UC Davis Health

Vinu Ninan, MD, FP, UC Davis Health

Swati S. Patki, MD, HOS, UC Davis Health

Kate M. Richards, MD, FP, UC Davis Health

Rosa D. Rodriguez, MD, DBP, UC Davis Health Usha Saldanha, MD, AN, UC Davis Health Adriana Santana, DO, FP, Woodland Clinic Medical Group Bradley C. Sanville, MD, PCC, UC Davis Health Mimi K. Sato-Re, MD,MS, FP, SOLO Amol M. Shah, MD, IRDR, UC Davis Health Smita S. Shah, MD, PUD, Mercy General Hospital Joseph J. Shen, MD, CG, UC Davis Health Nicole K. Shirakawa, MD, ACA, UC Davis Health Paul A. Sieving, MD, OPH, UC Davis Health Rishi Sikka, MD, EM, Sutter Health Corporate Office Anita Singh, MD, HOS, UC Davis Health Krishna R. Singh, MD, OBG, UC Davis Health Joseph I. Sison, MD, CHP, UC Davis Health Namita Sood, MD, PCC, UC Davis Health Alyssa Speciale, MD, PM, UC Davis Health Narin Sriratanaviriyakul, MD, HOS, Mercy San Juan Med Ctr Shin-Ping Tu, MD, GP, UC Davis Health Jeffrey L. Tully, MD, AN, UC Davis Health

Armaiti P. Mody, MD, PDE, UC Davis Health

Mai C. Vang, MD, FP, Mercy Medical Group

Brian M. Morrissey, MD, PCC, UC Davis Health

Rashmi Verma, MD, ON, UC Davis Health Jeffrey R. Vitt, MD, N, UC Davis Health

Kevin M. Mullins, MD, PM, UC Davis Health

Nasim Wiegley, MD, NEP, UC Davis Health

Lakshmi Nagaraju, MD, PDC, UC Davis Health

Ryan S. Woodman, DO, END, UC Davis Health

Ravi N. Nakrani, MD, OBG, UC Davis Health

Kenneth K. Zhou, MD, IM, UC Davis Health

Zachary M. NaPier, MD, ORS, Sierra Spine Institute Anh P. Nguyen, MD, PDI, UC Davis Health

Serena Yang, MD, PD, UC Davis Health Guanglan G. Zhu, MD, HOS, Woodland Clinic Medical Group

November/December 2020

27

2021 SSVMS Election Results President

Carol Kimball, MD President-Elect

Paul Reynolds, MD Immediate Past President

John Wiesenfarth, MD District 1 (North): Jonathan Breslau, MD

District 4 (El Dorado County): Ranjit Bajwa, MD

District 2 (Central): Adam Dougherty, MD; J. Bianca Roberts, MD; Vanessa Walker, DO

District 5 (TPMG): Christina Bilyeu, MD; Sean Deane, MD; Kristin Gates, MD; Farzam Gorouhi, MD; Roderick Vitangcol, MD

District 3 (South): Ravinder Khaira, MD

District 6 (Yolo County): Marcia Gollober, MD

2021 SSVMS Delegation to the CMA District 1: Reinhardt Hilzinger, MD Alternate: Brian Jones, MD District 2: Lydia Wytrzes, Alternate: Vacant District 3: Katherine Gillogley, MD, Alternate: Vacant

District 4: Anand Mehta, MD Alternate: Vacant District 5: Sean Deane, MD Alternate: Joanna Finn, MD District 6: Marcia Gollober, MD Alternate: Natasha Bir, MD

At-Large Delegates R. Adams Jacobs, MD Barbara Arnold, MD Megan Babb, DO Helen Biren, MD Jonathan Breslau, MD Amber Chatwin, MD Mark Drabkin, MD Adam Dougherty, MD

Gordon Garcia, MD Farzam Gorouhi, MD Ann Gerhardt, MD Richard Gray, MD Richard Jones, MD Mohammad Khan, MD Carol Kimball, MD Charles McDonnell, MD

Leena Mehta, MD Sandra Mendez, MD Tom Ormiston, MD Sen. Richard Pan, MD Neil Parikh, MD Hunter Pattison, MD Paul Reynolds, MD Ernesto Rivera, MD

J. Bianca Roberts, MD James Sehr, MD Christian Serdahl, MD Ajay Singh, MD Lee Snook, MD Tom Valdez, MD John Wiesenfarth, MD

At-Large Alternate-Delegates Christine Braid, DO Angelina Crans Yoon, MD 28

Lucy Douglass, MD Rachel Ekaireb, MD Karen Hopp, MD

Sierra Sacramento Valley Medicine

Arthur Jey, MD Steven Kmucha, MD Sam Lam, MD

Taylor Nichols, MD Alex Schmalz, MD Ashley Sims, MD

My Employee Got Stuck with a Dirty Needle ...

Now What?

CAP’s Free Guide Can Help You Protect Your Practice and Your Patients!

Future-Proofing Your Practice: Eight Resources and Lessons for Success During the Pandemic and Beyond was created by CAP’s team of risk and practice management experts to help physicians: • Navigate today’s uncertain scenarios • Find new opportunities for practice profitability • Ensure safe and successful business operations • And much more!

As a leading provider of superior medical malpractice coverage in California for more than 40 years, The Cooperative of American Physicians, Inc. (CAP) is pleased to offer this free resource to help physicians and their staff run a safe and successful practice.

Request your free copy today!

CAPphysicians.com/FutureSierra 800-356-5672 md@CAPphysicians.com

Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code.