2022 - Jan/Feb - SSV Medicine

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

January/February 2022


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Sierra Sacramento Valley

MEDICINE 4

PRESIDENT’S MESSAGE

What it Means to Be a Doctor Continues to Evolve

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Alan Shatzel, DO: A Quiet Leader, A Fierce Advocate

Paul Reynolds, MD

Ken Smith, Managing Editor

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We Want to Hear Your Voice

Just Breathe

EXECUTIVE DIRECTOR’S MESSAGE

Aileen Wetzel, Executive Director

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Love of Words, Words of Love

Caroline Giroux, MD

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Stories of Dementia Eric Williams, MD Karen Poirier-Brode, MD Brandon Craig

POETRY

Eric Williams, MD

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District 11 Active at Virtual CMA House of Delegates James Schlund, MD

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Curiosity

Faith Fitzgerald, MD

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Board Briefs

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New SSVMS Members

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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.

Bite-Sized Bits of Medical History Bob LaPerriere, MD

“A Legend,” “A Giant”: Faith Fitzgerald, MD (1943-2021)

Visit Our Medical History Museum 5380 Elvas Ave. Sacramento The museum is gradually reopening. Visit our website at ssvms.org/museum for updates and virtual events.

VOLUME 73/NUMBER 1 Cover photo: A remote Icelandic church stands in the wind during a visit by Executive Director Aileen Wetzel to the island nation last year.

Photo by Sharon David

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

January/February 2022

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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.

2022 Officers & Board of Directors

Paul Reynolds, MD, President J. Bianca Roberts, MD, President-Elect Carol Burch, MD, Immediate Past President District 1 Jonathan Breslau, MD District 2 Adam Dougherty, MD Judith Mikacich, MD Susan Murin, MD Vanessa Walker, DO District 3 Ravinder Khaira, MD

District 4 Shideh Chinichian, MD District 5 Christina Bilyeu, MD John Coburn, MD Farzam Gorouhi, MD Roderick Vitangcol, MD District 6 Marcia Gollober, MD

2022 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 Tanuja Raju, MD District 2 Alternate Janine Bera, MD District 3 Alternate Toussaint Mears-Clark, MD District 4 Alternate Shideh Chinichian, MD 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 Jonathan Breslau, MD Carol Burch, MD Amber Chatwin, MD Angelina Crans Yoon, MD Mark Drabkin, MD Rachel Ekaireb, MD Gordon Garcia, MD Ann Gerhardt, MD Farzam Gorouhi, MD Richard Jones, MD Steven Kmucha, MD Sam Lam, MD

Charles McDonnell, MD Leena Mehta, MD Sandra Mendez, MD Taylor Nichols, MD Tom Ormiston, MD Sen. Richard Pan, MD Neil Parikh, MD Hunter Pattison, MD Paul Reynolds, MD Ernesto Rivera, MD J. Bianca Roberts, MD Ajay Singh, MD Lee Snook, MD Tom Valdez, MD John Wiesenfarth, MD

At-Large Alternates Brea Bondi-Boyd, MD Christine Braid, DO Lucy Douglass, MD Karen Hopp, MD Arthur Jey, MD Justin Kohl, MD Vong Lee, MD

CMA Trustees, District XI

Adam Dougherty, MD

AMA Delegation Barbara Arnold, MD

Editorial Committee

Scarlet Lu, MD Derek Marsee, MD Taylor Nichols, MD Ashley Rubin, DO Alex Schmalz, MD Ashley Sens, MD Rishi Sikka, MD Asmaneh Yamagata, MD Robert Oldham, MD Margaret Parsons, MD Sandra Mendez, MD

Megan Babb, DO Sean Deane, MD Caroline Giroux, MD Robert LaPerriere, MD Karen Poirier-Brode, MD

Gerald Rogan, MD Kayla Umemoto, MS II Michelle Ann Wan, MS III Lee Welter, MD Eric Williams, MD James Zhou, MS II

Executive Director Managing Editor Webmaster

Aileen Wetzel Ken Smith Melissa Darling

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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. ©2022 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 |

Paul Reynolds, MD

Caroline Giroux, MD

Eric Williams, MD

In his first message as SSVMS president, Dr. Reynolds reflects on medical training, his dislike of the Socratic Method and the evolution of what it means to be a physician, especially in the age of COVID-19.

When we're faced with the adversities and challenges, we often ask ourselves, “Why me?” Dr. Giroux explains how writing has helped her through tough times and why the real question should be, “Why not me?”

Dr. Williams tells of what it is like for a physician to deal with someone with dementia — not as a doctor, but as a son who has watched his mother go from independence to not recognizing her children.

Brandon Craig

Faith T. Fitzgerald, MD

Everything changed in an instant for Brandon, his family and his mother when she was diagnosed in 2021 with earlyonset dementia at age 60. He and his brothers immediately sprang into action.

Faith passed away on December 3, and the tributes to her and her legacy from around the world were immediate. We've gathered some and also reprinted one of her finest works, "Curiosity."

paul.d.reynolds@kp.org

Karen Poirier-Brode, MD

poirierbrodekaren@gmail.com Dr. Poirier-Brode tells her own story of living with the worsening dementia of her husband and the loneliness that comes when the person who was your partner is no longer there.

Bob LaPerriere, MD ssvmsmus@gmail.com

Dr. Bob never thought he'd be on TikTok, the social media app featuring short videos, and you probably didn't, either. But he and the Museum of Medical History are ready for their 15 seconds of fame.

cgiroux@ucdavis.edu

bcraig@ssvms.org

James Schlund, MD

schlundjames@gmail.com

Dr. Schlund, a Butte-Glenn Medical Society board member, is chair of the District 11 delegation to CMA's House of Delegates. He reports on District 11's active role promoting discussion in the 2021 HOD meeting.

imango@att.net

Ken Smith

ken@kdscommunications.com

Alan Shatzel, DO, is the CEO of Mercy Medical Group. Ken sat down with him via Zoom to learn more about his leadership, the importance of life balance and how he found time to earn an MBA.

January/February 2022

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| PRESIDENT’S MESSAGE |

What it Means to Be a Doctor Continues to Evolve

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he very first words that come to mind as I start my term as president are: Thank you all. If you are reading this, then you likely have more than a passing interest in medicine or the medical field. It may be your full-time profession, you may be in the early stages of your professional training or in retirement after a lengthy and rewarding career. You may be searching for your purpose in life, expanding your knowledge or simply enjoying the creativity and stories members of our medical community bring to our pages. But what matters most is your ongoing support of SSVMS, and I want to thank you for that. This great profession of medicine of which we are a part has certainly evolved over the years. Since my graduation from medical school over 40 years ago, our white coats have figuratively — and in some cases, literally — lengthened to encompass more responsibilities, although today they are more likely to remain on the coat hook as we meet patients in a less formal world. As time goes by, we are less likely to reflect on the experiences that brought each of us to where we are in our careers. There was the morning report, when your residency directors or peers seemed immune to sleep deprivation, and the intimidation that comes from not wanting to be the last one without an answer during rounds. There was a time when the ability to recall and recite the latest literature was prized and a sense of humor was frowned upon. I am certain that more recent trainings have their own emotional stamps, even if they now involve artificial intelligence and YouTube instead of long nights with textbooks. Even today, something will trigger a reminder of my days in medical school, which at least provides some comfort that my distant recall is still intact. Being admitted to this so noble and wonderful profession was an emotional sense of accomplishment: Yes, even I can be a doctor! While I’m certainly not lamenting my training days, I will say I am not a fan of the Socratic method of teaching. I’m sure many of you 4

Sierra Sacramento Valley Medicine

By Paul Reynolds, MD paul.d.reynolds@kp.org

remember, as I do, the “What else?” questions from your attendings that, after the fourth or fifth “I don’t know,” resulted in feeling so small that I was sure I would be walking under, rather than through, the door of a patient’s room. Having felt that emotion, I vowed never to make anyone, whether it was a student, resident or even a family member, feel that way. The challenge today lies in the perception of what it means to be a doctor. It is that very transformative title that evokes a level of knowledge and perfection that

I cannot recall a time in my career in which our vocation demanded as much energy to be present as it does now. cannot be achieved but that we all still strive to reach. It means we are members of a group of professionals who have cared for us, for our family members, neighbors, friends, and even our ancestors. It is truly wonderful to be called a physician. I cannot recall a time in my career in which our vocation demanded as much energy to be present as it does now. Conversations within medicine in which the COVID-19 pandemic is not mentioned are rare these days. This disease is like driving through fog, not knowing where the road bends or how long it will last. It has interfered with our daily lives and has had an unanticipated and devastating impact on untold numbers of patients, colleagues and those we are close to outside of our professional lives. This current chapter has been much longer than imagined and, as I write this, it is still unknown how many more pages are left to it. Whatever memories we might have of how fair our training was or how imperfect our mentors were, what is important now is that the knowledge we gained along the way is critical as the pandemic lingers. Those


long hours of training now benefit patients who may never know your name or your role in their recovery, but who will be thankful nonetheless. Our purpose as physicians and our profession as a whole is continuing to be redefined by what we are doing each day in these difficult times. This great profession of medicine can mean experiencing searing emotional pain and soulwarming successes during a single day. Your purpose, your talents, and your exhausted empathy account is truly valued. And behind all of you, SSVMS has been doing great work to support you on the job and off, whether it’s through providing PPE or helping with your wellness through our exemplary Joy of Medicine program. To our members, our SSVMS staff,

COVID-19 continues to be pervasive in conversations within medicine as it refuses to fade into history. and to everyone who takes the time to contribute to or read this magazine with its unique commentary, creative expression and information that helps to shape our practices, I want to express my gratitude for all you do for your patients and

colleagues. I am appreciative and honored to serve as your president for 2022, and I look forward to working with SSVMS to do all we can to support your practices in the coming year.

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January/February 2022

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| EXECUTIVE DIRECTOR’S MESSAGE |

We Want to Hear Your Voice

Membership Survey Coming in Mid-January

A

t the turn of every year, conversations all over the world revolve around resolutions. Depending on how ambitious they are, people commit to losing weight, learning a new language, getting in shape or maybe just reading more books. Either way, the beginning of a new year is a great opportunity to look around, take stock of how things have gone for you and what you want to change. It's a good time for us as an organization to do the same. We'll keep the same resolution we make every year, which is to serve our members with the strong support you expect and deserve. SSVMS staff worked tirelessly to adjust to working for you during the pandemic, and we have launched new programs, events, and services. But like with your own resolutions, we always look for ways to improve so we can do our best representing and supporting you. That's why we want to hear from you about what you think the Medical Society is doing well and what we can improve upon. We often hear about the programs, such as SPIRIT, that are popular with you and bring a direct, measurable benefit to the community. But the truth is that not every program or event is as successful as you or we would like it to be, and that's when we need to look at shifting resources to other programs that are of more benefit to you. There also may be times when you'd like to see programs a little more under the radar expanded. Our staff takes pride in listening to what our membership wants from us and then delivering it for you. In the coming weeks, you'll receive our 2022 Membership Survey. I encourage you to give us honest answers about what you like, don't care for, what you want to see more of, and to use the opportunity to give us new ideas. Many of our best programs have been the direct result of input from our members. We conduct this survey every few years and it is always valuable. Our Medical Society has a large and 6

Sierra Sacramento Valley Medicine

By Aileen Wetzel awetzel@ssvms.org

diverse membership, from physicians working in large medical groups to private practice physicians, from fifty-year veterans to those fresh out of (or even still in) medical school. The range of comments we receive are equally as diverse as our individual members, and the variety of perspectives we receive helps shape our efforts so our programs and services are more inclusive

SSVMS strives to serve every member the best we can. You can help us do that by completing our Membership Survey. and effective. We strive to provide quality service and resources to every member, but it's hard to know exactly where our hits and misses are unless we hear from you. Please watch for the link to this year's Membership Survey, which will arrive in your email inbox in mid January. We are asking you to think critically about the programs and services you utilize through your membership and indicate what you would like to see more of or less of. You have the option of submitting your survey anonymously if you feel that allows you to be more candid, or you can provide your identifying information so we can follow up with you for a deeper discussion on your thoughts. One bonus for the latter, though: if you do provide your name, we'll send you a small gift as a token of our appreciation for your time and insight. After a couple of dreadful years facing COVID-19 and its variants, I know we're all hoping for a much better year ahead. Your resilience, dedication, compassion for patients and continued support for SSVMS is greatly appreciated. Thank you for taking time to complete our survey so we can do more for you. Happy New Year and good luck on your own resolutions!


HONORS 26 MEDICINE

TH 6-9 PM

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Join Us For Dinner, Wine, and a Night of Magic in Medicine as We Honor Physicians Who Make a Difference In Our Community Golden Stethoscope Award JaNanh C. Scalapino, MD

Medical Community Service Award SSVMS Alliance

Early Bird $100/person by January 31, 2022 Regular $125/person by February 11, 2022 Raffle Tickets $50 each or $100 for three Proceeds support the SSVMS Medical Student Scholarship Fund

TINYURL.COM/HONORSMED22

Medical Honor Award Gary S. Chu, MD Special Recognition Award Henry Go, MD

Featuring

KEVIN BLAKE Magician and Illusionist as seen on America’s Got Talent and Penn & Teller: Fool Us

916.452.2671 SMello@ssvms.org


| OPINION |

Love of Words, Words of Love There Can Be Hidden Treasure in a Tragedy

D

uring your health sciences studies, you read and learn about all kinds of frightening, incapacitating, bizarre diseases. It is easy to memorize some details because they remain there, harmless, in the pages of your textbooks, until they jump out of the pages and onto the patients you will treat. But you still feel somewhat reassured because you think these dreadful markers are not in your genes and nobody in your family has ever been known to suffer from any of those conditions. It couldn’t happen to you — until you wake up with the unmistakable stigmata of a disorder with a Latin name. You never thought your first adolescent love would leave you for your best friend, or that your first partner would cheat on you. You could have never imagined the sacred bond between parent and child could be severed by outside, malevolent forces. Until, one day, one unforgettable soul-ripping moment of unimaginable erasure, you realize, petrified, that it is happening to you. As a child, you might feel part of the fortunate half of families that are not broken after having been reassured by your parents that they will never divorce. Until it happens to them, and you. For the rest of your life after that, you vow to never subject your own children to such a nightmare. Until it happens to you, too. Until it happened to me. When it happens, you might wonder, “Why? Why me?” In fact, we should wonder, “Why not me?” When such a calamity hits you, it can shake your whole being. It can make you drift so far away from your core self that you are only the shadow of yourself. But when it happens to you, you are also reminded to acknowledge the fragility of life, the impermanence of all things, to not take anything or anyone for granted. The unprocessed suffering has to be integrated into the person’s life narrative somehow, not denied. You are better off by acknowledging that yes, it is happening to 8

Sierra Sacramento Valley Medicine

By Caroline Giroux, MD cgiroux@ucdavis.edu

you, whether you like it or not, whether you feel like you deserve it or not. At that point it doesn’t even matter. So it is important to open your eyes wide and try to learn as much as you can from this, as painful as this might be. Writing, telling my story and the stories of those who inspire me in ways large and small is my oxygen even in the midst of torment. If too much time elapses away from the notebook, I start to feel sick. Waking up with a sorrow hangover, I start to experience the unpleasant, deeply shameful sensation of having drifted too far from me. It is an unacceptable act of self-betrayal. Sitting at the piano that became my oracle, backed by the year of lessons I took at age 15, I start to meditate, like I often do, about words, my love for them and for

I see with excruciating pain how some words are tragically corrupted by some people. But those words can be used for a higher purpose, to write your own story and apply your self-compassion and epiphanies to support others. the stories they can tell. When I turned 40, I looked back at my lifelong love story with words. I felt I had not dedicated my life to writing as much as I would have wanted, but at the same time, I also needed to acknowledge what I had been doing since I was a child: mini-stories, plays, student papers, essays, and more. On the invitation to my birthday party, I wrote: “Words are like children. We have to have many of them, and love them very dearly.” Years later, I still feel the same. Conversely, I see with excruciating pain how some words are tragically corrupted by some people. But those words can be used for a higher purpose, to write your own story and apply your self-compassion and epiphanies to support others. The detonation of weapons become melodies.


My mother has always cared for the sick, the poor, the rejected. She would bring food and comfort to her students who often came to class without having had breakfast, to lonely and old relatives, and to forgotten neighbors. Our friends who came over adored her. She has been feeding homeless cats or others’ neglected dogs. At times it seemed as if all these creatures even took precedence over my siblings and me. It was not necessarily a bad thing; she taught us through her actions that we have this duty towards one’s kind, that there is something bigger than us we belong to. She modeled generosity and altruism to me. No wonder I have always been drawn to stray people. Everyone who meets my mother and her siblings is struck by the exceptional, sincere love that pervades all their interactions. My uncle Marcel aptly wrote about the world-changing and contagious love of the Grenier family in a poem to his siblings that gave me shivers many years ago, especially when he referred to my mom: “Rita is the verb ‘to love’ conjugated in all tenses.” My uncle is not a major in literature. He worked in a pulp and paper mill his whole life. Yet from that day on, because love spoke so beautifully through him, I wanted to emulate him, this newly discovered poetry divinity. Love will be true and pure if first it is directed at

life through one’s passion and authenticity. I love in a healthier way when I write or do things that matter to me. Without a sense of purpose, focusing on a person becomes obsession or dependence. As anti-romantic as it may sound (and it sure resonated for a while), it can be unsustainable to make loving someone the goal of one’s life. To love something in life, to pour our heart and soul into a mission and give it our all, creates a wonderful by-product called attachment bond between two people. Love is always there, it is the matrix, the structure. To express it, we channel it, we add something to it. And two people vibrating at that same frequency of energy might eventually find each other on the continent of a common purpose. But back to the question of “Why me?” or “Why you?” I believe it happens because we have been deemed ready by life to expand and elevate our consciousness. This “it” can be a privilege if used as an eye-opener meant to liberate you from judgmental tendencies towards aspects of human condition you couldn't fully grasp until now. Maybe life is just a big misunderstanding. And the goal of life is to dissipate it, so that love can be lived, and shared, fully. Now that I have found my way back to love again, my mind has calmed down. My heartbeat is reassuringly constant. To share my truth is to love. To January/February 2022

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go back to words and knit them in a way that liberates is the motor of my love for others. Writing is how I extirpate myself from a toxic narrative. I think of a poem; its length is usually manageable for me to make something out of the tragedy. A novel... I would prefer to write a novel, an outpouring of at least 40,000 words as a legacy for my children, to help them understand. Here I am, talking about the novel without being able to write it, but that is a start. Words are the sacred condensed records that archive memories, hopes and dreams in the soul.

Writing and love are often intertwined. ©2022 Robert W. Baird & Co. Incorporated. Member SIPC. MC-751600. VK2021-1217.

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Sierra Sacramento Valley Medicine

I admit to myself once again that the easiest genre for me is the essay, so I wonder what my next topic will be. The essay is like a love letter to the world. Boom. This realization lands in my head as I replay an invented melody. You see, I cannot meditate on a subject without pondering on love. Writing and love are often intertwined. When the worst happens to you, you may realize your love is bigger than you ever imagined, for it now contains the suffering of all the ones who are living or have lived through it, the ones you are now forever connected with via an invisible, mystical, inalterable thread. The thread of non-aloneness. The thread of interconnectedness through shared humanity. And this web forms the ultimate universal force and visual acuity of the soul that can change everything: compassion. And when this happens to you, it’s a blessing.


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| PERSPECTIVE |

Stories of

Slipping Into the Black Hole of Dementia

My story is a personal one. My mother, now 94 years old, one year ago was an independent woman. She As physicians we treat many medical conditions, prepared her own meals, was a self-aware and proud including dementia. We see the patient and we treat that woman with a tremendous memory of events, people patient, the one we see. We have some knowledge of this and places long past. Her medical problems consisted devastating medical condition but not enough to reverse of hypertension, hearing loss and it or to prevent the undignified the need for dentures. She was demise of the patient. our link to times unknown to A wise man to whom I posed us and people we had not met. a question responded with an Her recollection of medicinal insightful question of his own: herbs and poultices which she “What is the question behind the regularly used was extensive. She question?” What of the people was a seamstress and regularly we don’t see, young and old, baked and intricately decorated who are not sittng across from us wedding cakes. Pre-pandemic, in the examination room when she walked one mile daily withwe diagnose dementia, the ones out walking aids. She attended at home and across the seas, 30-minute-long, biweekly exerthe ones connected by FaceTime cise classes where she was the and Facebook? Dementia affects oldest person in attendance. Now families and all those closely connected to the primary patient. Eric Williams, MD and his mother, Anthonia. she sits and longs for “home” and complains of feeling poorly, The patient goes first into the alone, and useless. More frequently now she would fail black hole which is dementia, followed closely by to recognize one or the other of her 11 children as well those who care for and about them. Left behind is a as whose house she was presently in. fragmented, disconnected group, each member trying Now that I am retired I see the ridiculousness of desperately to slow the progression of the inexplicable, asking “What day is it?” as a measure of time and yet unrelenting, and as yet unsolvable riddle that is this that is still one of the questions asked by her physicians. unseen and exhausting condition. The loved ones cannot She would make unfiltered and unstructured comments pinpoint a specific complaint and the person cannot selfabout others or their children in their presence which identify a symptom, but can only be observed in their could be very hurtful. changes and their demise. Families are left to watch this But, we as her family have her as our charge and will heart-wrenching destruction and loss of sense of self. maintain whatever connection we can for as long as we Eric Williams is a recently retired surgeon, Karen Poiriercan as she slips further into the black hole of dementia. Brode is a retired OB-GYN, and Brandon Craig is Program — Eric Williams, MD and Partnerships Coordinator at SSVMS. SSV Medicine imango@att.net thanks them for sharing their stories. 12

Sierra Sacramento Valley Medicine


Photo courtesy Karen Poirier-Brode, MD. Opposite page: Photo courtesy Eric Williams, MD.

it's an odd sort of comfort. The restrictions on my life would have been deemed so alien to everyday life, and now they are normal life. I'm referring to the loneliness of finding the person I've been with for so long is no longer here. It's early enough that this situation is not a constant, but definitely enough to feel the loss. I know we will lose more. Alzheimer's was not unexpected. His maternal grandfather, maternal uncle, and older brother died from the disease. Subtle changes in his memory and behavior started several years ago though the actual diagnosis came around the time of his cancer diagnosis. Cancer, too, was not a startling discovery with a family history there as well. He's starting to lose weight, and his oxygen sats get very low. At 88, he elected no treatment when his metastatic disease was found. Hospice is involved, so that helps. We have seven Karen Poirier-Brode, MD and her husband Cal share a toast on Thanksgiving 2021.

"Once I Had a Partner" Illness, especially a terminal illness, is never uncomplicated. It's more of a maze when there is more than one terminal illness. It's difficult for the family, too. When one of those illnesses is dementia, there are no words. Actually, there are many words, but they are hard to utter. My husband, Cal, has metastatic aggressive prostate cancer; even so, the disease takes its time. He is not in pain but is getting weaker. He has dementia. Loss of memory, difficulty making decisions, short attention span, and difficulty with new things. Still able to have short conversations, watch TV, but not always follow what he's watching. It's not yet a severe stage, but it progresses and makes life difficult. I'm not a patient person. The increased burden of managing running everything at home is onerous. Once I had a partner, now it's all on me and an additional care burden, too. The stress when I see his health deteriorating, his natural stubbornness, and his sometimes abysmal decision-making about his health is frustrating. Then there is loneliness; I don't mean separation from society. It's odd how COVID has helped there. Everyone is restricted in what they can do away from home. I don't feel alone in the feeling of being constrained, and

Then there is loneliness; I don’t mean separation from society... I’m referring to the loneliness of finding the person I’ve been with for so long is no longer here. sons, so there is some support, though COVID makes that problematic. My niece in Canada typically would swoop in and save the day for me. It's doubly hard when she cannot bring along her little Sophia, so we might meet the newest addition to our family. We have friends. Cal's old tennis and golf buddies visit many Saturday mornings for an hour to have coffee with him. We're more relaxed over the social situation since everyone is "boosted," and all are very good about the social distancing and masking in public. Social media is a valuable tool. I have household help — cleaners and a personal assistant/organizer as I have some health problems of my own and could not otherwise manage. It's fortunate to be able to afford help. I made an intelligent decision about disability insurance. I've been delighted to discover that personal assistants for the disabled can be provided in countries where health insurance is a normal part of life. My sister in Canada, the poet Michelle Poirier Brown, has one. It makes a great deal of difference in one's life; creative existence, not just survival, is possible. — Karen Poirier-Brode, MD poirierbrodekaren@gmail.com

January/February 2022

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One Simple Diagnosis, Immeasurable Impact In spring 2021, my mother was diagnosed with early-onset dementia. This didn’t catch the family offguard. Like many others, we had seen signs but simply chalked them up to getting a little bit older. We’re not an adventurous or exciting family, so it was common for everyone to tell stories over and over again. Forgetting a few details here and there? Obviously they’re minor things, we said, that she hadn’t had to deal with in years, so it’s perfectly natural to get them a little mixed up. And anyone can get lost driving in a neighborhood they’re unfamiliar with. But we were forced to pay attention when she got lost driving home from work and spent three hours driving around town in the middle of the night. Thankfully, no one was hurt, but it spurred my brothers and me into action. We got her scheduled for a video visit with a doctor who assessed her memory and officially diagnosed her. It was heart-wrenching watching her go through the appointment. She was lucid enough to know what it was for, but not enough to name more than five animals in a minute when prompted by the doctor. Tears in her eyes, she peered down at her trembling hands, and reluctantly accepted that everything was about to change. It’s cliché to say that a piece of me died with her that day. But while comforting her in those moments, it became crystal clear that our roles had changed. She could no longer be the woman who raised me, the woman who ran her own business for twenty years, the woman who viewed her mid-fifties as an opportunity to get a master’s degree and become a therapist. Instead, it became incumbent on me and my brothers to soldier up and figure out the plan of attack. Since that time, she’s moved from her house in with me and my wife as we attempt to coordinate professional care for her. The stress involved with this is enormous — and we’re in the perfect situation to take on a challenge like this. My wife and I both work for groups representing physicians, both have a wealth of knowledge of the health system, both have an expansive contact list, are double-income with no kids, and had a spare bedroom. Both of our jobs are flexible and understanding of our situation. And we are at wits end. Every day is filled with new challenges and we can never out-maneuver the demen-

Recollections Recollections of of How How Teaching Teaching and and Learning Learning Were Were Upended Upended in in 2020 2020

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tia. It’s not as simple as making sure she has a place to sleep at night. We have to ensure she eats, bathes, takes her medication, gets outside for exercise, but also that she doesn’t displace important documentation, accidentally release the dogs into the neighborhood, or fill the house with gas from the stove. Meanwhile, we have to remind her of who we are and where she is. And maintain full-time jobs. And keep the house clean. And somehow maintain our own mental and physical health. And, and, and. Even with every advantage we have, we are struggling to combat this disease. I’m left wondering how anyone can expect families with fewer resources than we have to do this. The system has failed such an incredible number of people in this situation and it goes way beyond the patient. Everyone in the patient’s support system — family, friends, neighbors — they’re all affected. A friend of mine recently told me that it sounds like I’m in hell. It reminded me of a sentiment from my mother’s favorite TV show, M*A*S*H. Loosely paraphrased: This isn’t hell. This is war. War isn’t hell. War is war, and hell is hell. And of the two, war is a lot worse. There are no innocent bystanders in hell. War is chock full of them. In fact almost everybody involved is an innocent bystander. One simple diagnosis. One patient. Immeasurable impact on scores of people. — Brandon Craig bcraig@ssvms.org


Member Benefits & Resources

The Sierra Sacramento Valley Medical Society (SSVMS) offers many resources and services exclusively for our over 6,000 physician members. Members receive specialized one-on-one assistance designed to keep your independent practice healthy and viable. Join us today by contacting dbrooks@ssvms.org or by visiting www.ssvms.org.

COVID-19 Advocacy Access up-to-date members-only resources, including financial and practice management tools that will ensure your medical practice is prepared to survive and thrive during and after the pandemic. Economic Advocacy Access to highly trained economic advocates with expertise in physician reimbursement are available to provide one-on-one help with payor issues and contracting at no cost. Statewide, more than $30 million has been recouped over 12 years. Legal Resources Over 5,400 pages of OnCall documents and valuable information for physicians and their staff at no cost. Practice Resources For practices of all sizes, and including HIPAA compliance toolkits, practice management guides, patient forms, resources for starting, closing, or expanding your practice and more. Joy of Medicine No-cost sessions with psychologists and life coaches, CME wellness education, physician interest groups and more. Visit www.JoyofMedicine.org to learn more.

Educational Programs Free CMEs, webinars and in-person seminars. Discounts For insurance services, office supplies, magazines, security prescriptions and more. Partners in Medicine Vetted vendors that provide SSVMS members with exclusive services and discounts. These partners have gone through an application process and provided multiple physician references. They are dedicated to offering special services or discounts to SSVMS members on various products and services designed to accommodate the business and personal needs of physicians. News and Information Stay informed about public health, practice management, and other breaking healthcare news. Leadership Opportunities Serve on the SSVMS Board of Directors, Delegation, or a Council or Committee. Connect with Peers Meet colleagues through virtual networking opportunities.

www.ssvms.org

January/February 2022

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| PROFILE |

Alan Shatzel, DO: A Quiet Leader, A Fierce Advocate Mercy Medical Group CEO Has Eye for Innovation, Commitment to Balance

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lan Shatzel, DO, readily admits that he may not be the most exciting person in the world. “I wish I could tell you I race Formula One cars or do something extraordinarily exciting,” Dr. Shatzel, 52, said. “I’m not a very exciting person outside my work. I’m a brain doctor and I run a very large practice.” Exciting or not as it may be — and there will be some who would say Formula One may be easier than either of those two vocations — Dr. Shatzel has helped build Mercy Medical Group into one of the area’s largest, has had to navigate the organization through the pandemic, and has put a focus on allowing physicians and other providers to do what they do best. He also still spends about 10 percent of his time in his neurology practice, a specialty he became hooked on during his third year of medical school. “Part of why I love neurology is that it’s like the final frontier in medicine,” he said. “There is still so much we don’t know or understand about our brain, specifically the central nervous system.” Megan Babb, DO, a MMG physician, said Dr. Shatzel’s quiet and reserved demeanor is often in contrast with his intense efforts to support the group’s providers. “Mercy Medical Group is lucky to have him as our leader,” Dr. Babb said. “He is a fierce leader with an eye for innovation. He continues to challenge the health care system though his advocacy efforts on behalf of physicians, and he is not afraid of addressing change when it is necessary to keep the practice of medicine safe for those working within it.” Dr. Shatzel, who is also a sleep specialist, says MMG is working to incorporate artificial intelligence to simplify time-intensive tasks such as with documentation, coding and billing. While filling forms and writing reports is a necessary part of the job, he says, it’s not what physicians want to spend their time on.

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By Ken Smith ken@kdscommunications.com

“We do them, but that’s not why we went to medical school,” Dr. Shatzel said. “We go to medical school because we want to help people, we want to care for others, we want to solve problems, to use our knowledge to help our community, to help our patients.” As was the case throughout the health care community, the pandemic changed a lot of the way business was done at MMG. While reducing elective surgeries created a challenge for patients and also for health systems that relied on volume of service, Dr. Shatzel said it also showed the resiliency of a large, multi-specialty group practice.

“The pandemic served as an accelerator for innovation. A year and a half later, we've done a quarter million virtual care visits.” “Everyone just kind of rallied and we did a lot of our best work early on,” he said, adding that the executive team made a commitment to take care of the group’s members that were hardest hit. “In some ways, it created a much tighter bond with our health system partners, because there was a lot of disruption. When you have mandates that are coming down that you have to start reducing your elective surgeries, you have to do a lot of things that will make it very challenging for the care and service of patients.” But there were also positive steps that grew out of the pandemic. “The pandemic served as an accelerator for innovation,” Dr. Shatzel said. “Things that we were piloting — dipping our toe in the water on — for example ambulatory virtual care services, we scaled in less than two and a half weeks. A year and a half later, we’ve


January/February 2022

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Photo: Mercy Medical Group

done over a quarter million virtual care visits to take care of our patients.” Christine Braid, DO, MMG’s medical director of virtual care and innovation, said that Dr. Shatzel had an interest in telehealth and technological advances long before he became CEO in 2017. “He pioneered telehealth over 12 years ago, providing stroke services through the creation of the Telehealth Network,” she said. “His work has been integral in creating a culture of philanthropy to benefit the Sisters of Mercy’s charitable efforts and health care ministries and expanding the reach of Mercy Telehealth Network so everyone in need of specialty medical services has access to the best teams of medical professionals available.” One of Dr. Shatzel’s newest endeavors centers around addressing inequities in care and health outcomes that became more apparent during the pandemic. MMG is in the process of developing a $10 million philanthropic effort to support a planned Health Equity Institute in Alan Shatzel, DO leads Mercy Medical Group, which Sacramento. includes over 500 physicians, physician assistants and “During this COVID pandemic, we witnessed major nurse practicioners. health disparities among the communities who are less privileged, have inconsistent access to health care and after joining MMG as a staff physician, then a departsuffer economic hardship and disadvantage,” he said. ment chair and a medical director with the hospital MMG physicians and advanced practice professionals system overseeing the neurological institute. volunteered for community “There was a point along COVID clinics, staffed clinthe way where I realized “There was a point along the way where ics for migrant workers, that the work as a leader I realized that the work as a leader in and worked to engage and in health care is really health care is really important. If you are inform the homeless so that important,” he said. “The they could be vaccinated. work I love to do in caring in a leadership position in a role where “I am extremely proud for patients is one-to-one, you can influence, you can make the of our professionals, who me and the patient worklives in the practice of a lot of other went over and above and ing together and making professionals much better.” rose to the challenges and medical decisions for good addressed the disparities outcomes. But I realized that the COVID-19 pandemic magnified.” there's a multiple to that in a leadership role, where “His dedication to a patient-centric approach to mediyou can affect on a much larger scale and have a much cal care and his focus on the well-being of our clinicians larger impact. If you are in a leadership position in a is to be commended,” said Jill Walsh, MD, chair of MMG’s role where you can influence, you can make the lives in women and children’s services. “He has provided strong the practice of a lot of other professionals much better.” leadership in navigating Mercy Medical Group through Somehow during that climb, he managed to find the one of the most difficult times in medical history.” time to earn an MBA from Sacramento State in 2017. Dr. Shatzel didn’t see himself, at least at first, as a Asked how he accomplished that while also performing potential CEO. He became division head a couple years his leadership positions, treating patients for neuro-


logical disorders and also raising two teenagers at his Rocklin home, he had a simple answer. “I told you how great my wife is, right?” he said of Julie Wei-Shatzel, DO, a family practice physician. “She’s far more interesting than I am. She writes books and does all kinds of great stuff.” Dr. Wei-Shatzel is the author of Time Restricted Eating, a daily fasting regimen designed to coincide with a person's own circadian rhythm. She has been featured in “The Fasting Movie” and is currently working on an additional documentary project. Although Dr. Shatzel may say he doesn’t have much in the way of exciting hobbies and that he just enjoys being a family man, much of his limited spare time these days is spent taking his 17-year-old daughter, a competitive archer, to meets. He also has a 20-yearold son who is attending college in Victoria, British Columbia. He believes having that time is essential and affects professional performance, so he makes wellbeing a priority for MMG members. “There's a lot about, you know, work life balance,” he explained. “We really like to think about it as life balance.

Work is part of your life but the more important parts of your life are family and loved ones and community. “My life balance is really important, and that's why I know it's important for all our professionals as well.” That’s one reason he is a big supporter of the SSVMS Joy of Medicine program and its focus on physician wellness. He also says the Medical Society’s efforts to address social determinants of health and improving health equity mirrors MMG’s efforts in that area and is important work. But it’s the collaborative nature and common cause among members that he finds to be one of the greatest benefits and why several MMG group leaders are also in leadership positions at SSVMS. “It's great to interact with our colleagues who are in other competitive systems,” Dr. Shatzel said. “When we’re in SSVMS, we’re all working together to make medicine better, make the practice of medicine more sustainable, to help each other out whether you're in independent solo private practice or a large group like ours. We're all equals and we want the best for all of our professionals, knowing that physicians are a very scarce resource and we've got a lot of people relying on us.”

Just Breathe When the world around you is in chaos and there is no one to lead When the strife and struggle is too much to bear and in the pantry there is nothing there When neighbors, once friends, can no longer stand together in disagreement When clouded inky black skies at 8 a.m. creates a world as dark as midnight When fires rage When the world … stage … begins … to spiral Just breathe… — Eric Williams, MD

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| 2021 HOD REPORT |

District 11 Active at Virtual CMA House of Delegates District Delegates Shape Policy, Calls for Diversity

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he 150th session of the California’s House of Delegates (HOD) held its annual meeting in late October, and this year’s version saw fluid adjustments as the pandemic began to transition to an endemic way of life. The 11th District (DXI), which represents a large swath of Northern California, is one of the largest and most geographically diverse delegations to the HOD and is celebrated for its dynamic participation. As COVID-19 variants continue to march through the Greek alphabet, most of our meetings have been virtual but there have been a limited number of mask-to-mask meetings and even the rare face-to-face meeting. In the run up to the House of Delegates, the 11th District had spirited Zoom debates that gathered insight and opinion from the members of the district delegation, including state Senator Richard Pan, MD, public health officers, primary care physicians on the front lines of the pandemic, our DXI CMA past presidents, DXI CMA Trustees, and the DXI AMA delegation. DXI’s Dr. Kathy Gillogley crafted CMA Resolution 202-20, which would support changing California pharmacy law to permit hospitals to supply medications to patients on discharge. This resolution, which is elegant in its simplicity, now has national attention at the AMA. It is an example of how DXI’s commitment to action and inclusiveness can make a substantive difference in protecting patients and the doctor-patient relationship in a changing landscape. The Committee of Delegation Chairs, which brings all the delegation heads together, decided to focus on two major issues at HOD: the corporatization of health care and on racism and other barriers to health equity. We deeply appreciate the work by CMA staff and our own Chris Stincelli and Aileen Wetzel, who orchestrated the distribution of foundational material, scheduled town council meetings, and pulled together platforms

By James Schlund, MD schlundjames@gmail.com

for debate where opinions could be heard and policy shaped. Just moments before the HOD as a whole began its policy debates in a virtual meeting, staff and Dr. Ashley Rubin, a resident physician delegation member, deftly pulled together our own DXI GroupMe chat forum that could operate in the background during the HOD presentations and give the DXI delegation the opportunity to determine our joint position. A highlight was the spirited lobbying on the chat forum over the four respected candidates for presidentelect. The HOD elected Donaldo M. Hernandez, MD, a CMA trustee and chair of CMA’s Justice, Equity, Diversity, and Inclusion Committee. The major issue engagement sessions at the HOD also led to active engagement among the DXI delegation on our chat forum. The invited members of the Corporatization of Health Care panel were called out for being largely white, privileged and male. That was in direct contrast to the second panel that offered insights gathered from a more diverse membership that was assembled to address issues surrounding structural inequality and health equity. As the chair of DXI, I am deeply impressed by how CMA adapted to better listen to the local input and advocacy aimed at protecting the house of medicine. DXI’s participation in robust debates and the discussion in the GroupMe chat forums exemplify those efforts. Inspired presentations by CMA CEO Dustin Corcoran, CMA President Peter Breton, MD, and incoming president Dr. Robert Wailes, along with the thorough update by Janus Norman on CMA’s government relations efforts, indicate a bright future ahead in meeting challenges that disrupt the doctor-patient relationship. We are appreciative of their efforts and we hope CMA will continue to encourage diverse ideas and voices as it shapes public policy.

January/February 2022

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| REMEMBERING FAITH |

“A Legend,” “A Giant”: Faith Fitzgerald, MD (1943-2021)

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ou Gotta Have Faith. That’s what I wanted to name Faith Fitzgerald's column, because, as one member of our editorial committee once said about her stories, “You can never have enough Faith.” That’s as true as it gets. I had the pleasure of meeting her and working with her to bring her unique recollections to print. Over the past few years, I’ve learned about the Russian aristocrat “Mrs. One-Arm” who was her childhood housekeeper and friend, how she crossed paths with rogues, thieves and gamblers in the ER, and even — as she told the story in our last issue — of the unfortunate and unlikely named Mrs. Lot, who passed away from being overwhelmed by the salt in her system in an eerie coincidence to the biblical tale. One of her favorite subjects was the importance of teachers in her life. Of course, for so many she was the teacher who left an indelible mark in the hearts and careers of countless physicians scattered across the globe. We had talked just a few weeks before her death on December 3 at the age of 78. She had more stories to tell and, faced with health issues and a computer that was

a never-ending source of frustration for her, she had suggested that we get together so I could help her write them. Unfortunately, that never occurred and those stories remain untold to the detriment of us all. She was an essential cog in giving our quirky little magazine its special personality. I only knew her for a relatively short time, but others whose lives she touched over many decades, as you'll see below, can do a much better job than I at recalling someone who was always curious, devastatingly funny and a source of inspiration to physicians of all ages. We will miss her terribly. But she left us with wonderful stories in our journal and others, physicians who are better because of what they learned from her, and a legendary reputation as one of the best damned internal medicine doctors and teachers you could ever find. This legacy is the one ray of sunshine on a dark day because of what it means to so many: We will always have Faith. — Ken Smith Managing Editor

My fond remembrances of Dr. Fitzgerald are primarily related to her interest in medical history. She stood out always, not only because of her interest in medical history, which is unique and rare, but due to her personality, enthusiasm and fascinating approach to the topic. She generously provided numerous programs for our Medical Museum Lecture Series over the past 17 years and was always the attendees’ favorite lecturer. Her ‘Magical Medical History Tours’ always packed in the crowds. She will be missed… and also remembered as a part of our history.” — Bob LaPerriere, MD, Curator, SSVMS Museum of Medical History

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Wow. We just lost a legend. I don't have the words to describe how amazing Faith Fitzgerald was at being a doctor, teacher, and exemplary human being. She was larger than life in all the best possible ways. I keep thinking about the first time I met Dr Fitzgerald. I asked her a question about my skin. She took my hands, felt how rough they were from years of rowing, then said, ‘Oh, callouses. That's a pleasant surprise. Hands like these are rare around here.’ Every time you talked with her, you came away smarter and feeling better for the experience. I wish I could be a fraction of that.” — B. Bobby Chiong, MD, Radiology Chair, St. Barnabas Hospital, The Bronx


Photo courtesy UC Davis Health Copyright: UC Regents

She’s a legend who inspires me to use this phrase when faced with diagnostic uncertainty: ‘Gotta have Faith.’ I, too, can work through dx challenges and have joy in medicine. Thank you for laying the groundwork for women in medicine, Dr. Fitzgerald.” — Heather Hoffman, MD

She was a giant in the field of medicine. What she was to me was a brilliant colleague, a friend, at times refreshingly sardonic, at other times annoyingly sardonic, warm, kind, friendly, funny, not afraid to speak her mind — ever. Someone unafraid to re-examine what we do and why we do it, and someone who is always 110% about patients, their stories, their lives, each patient’s uniqueness. She will be missed for all that she was to so many of us.”

—Paul Aronowitz, MD, Clerkship Director of Internal Medicine, UC Davis

I was saddened to hear of the passing of Dr. Faith Fitzgerald, a giant among internists and an inspiration to generations at @UCDavisMed. I’ve been reflecting for the last few days since hearing this news — she was such an incredible force for so many. I met Dr. Fitzgerald on my medicine clerkship. Morning report was like a well-crafted mystery tour with a master storyteller — she loved a good case. She loved all cases — the simple and elegant, the esoteric, the frustrating, and she was a master teacher. She was happiest and proudest, though, when one of us asked the right question or got the dx. That twinkle in her eye was magic. I think her magic and prowess came from her insatiable curiosity. She wondered and asked. She knew more than all of us yet marveled at the mysteries of medicine. She was brilliant yet made you — somehow — think you could be, too. She loved what she did and loved us learners. What a legacy. Thanks, Dr. Fitzgerald.” — Andrew Olson, MD Associate Professor, Pediatrics, U. of Minnesota

We should all celebrate a life well lived. I remember reading her articles and seeing her discuss unknown cases at the IM meetings. I was in awe of her reasoning and her eclectic knowledge. Faith always put patient care and physician responsibility as her guiding star. She leaves an incredible legacy. She epitomized the consummate internist. She loved and excelled at the cognitive side of internal medicine. Her reasoning was impeccable and she beautifully shared her thought process to teach us and role model for us. She loved patients. She loved getting to know them. Read her essays in the Annals of Internal Medicine and you will start to know Faith. When the Emperor or Empress was walking around with garb, she would quickly tell everyone. And moreover express that thought with brilliant humor. Her legacy includes the many learners she influenced, the patients she for whom she cared, and the many educators who found her an important role model of clinical education. I only wish (as do many) that I could have one more wonderful conversation with Faith. Every conversation we had was a privilege and a growth opportunity.” — Robert Centor, MD (@Medrants)

Faith was an exceptional storyteller — her stories were meant to demonstrate empathy and human­ ism. She also was not afraid to speak truth to power.” — Keith Armitage, MD IM Program Director, Case Western Reserve University

With all due respect to… every other author ever, Curiosity is still my favorite article ever written.” — Todd Barton, MD, IM Residency Program Director, U. of Pennsylvania January/February 2022

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| REMEMBERING FAITH |

Curiosity A

bout 15 years ago, when I was dean of students at the University of California, Davis, School of Medicine, yet another of the periodic paroxysms of “holism” in medicine occurred. Several importunate politicians called to tell me that, in their opinion — which presumably reflected that of their constituents — medical students, by selection or by their isolation by the medical curriculum, were insensitive, mechanistic, technocratic, inhumane brutes. The solution, these politicians insisted, was the intercalation of humanities courses into an already crowded curriculum. I had several concerns about this. The first was that the addition of required courses in literature, drama, sociology, music, and art might actually limit students’ opportunities to read, go to the theater, be with friends and family, and attend a symphony or museum. Even if one argues that students would not have done these things anyway — possessed as they were by the intricacies of glucose metabolism — the addition of these courses would cut down on contemplative time, volunteerism in free clinics, hobbies, and sleep. Second, I wondered what evidence supported the idea that being well versed in the humanities made one more humane. I was encouraged in my skepticism by the knowledge that perhaps the most broadly educated of physicians at the beginning of this century practiced in Germany. Moreover, I could not understand why science — a most human pursuit, the exercise of which is one of the defining characteristics of our species — should make students “inhumane.” I decided to do a “scientific” study Curiosity, one of Faith’s most memorable articles, originally ran in the January 5, 1999 issue of Annals of Internal Medicine, which has graciously given SSV Medicine special permission to reprint it for our readers. Its message is as relevant today as it was when it was first published. 22

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By Faith Fitzgerald, MD

of the effects of humanities courses on humaneness in medical students. Several colleagues and I read more than 10 years’ worth of the subjective descriptions of performance of third- and fourth-year medical students on their clinical clerkships. We looked for adjectives suggesting humane behavior: “caring,” “warm,” “concerned,” “good with patients and families.” Each of these descriptors got “nice” points. Words like “callous,” “abrupt,” and “arrogant” got subtraction points. Then we compared “nice” points to the total number of units taken in the humanities in the student’s premedical career. What a shock: We found a direct correlation. I still thought it did not make sense. These were adults, after all. Was fundamental character, which is usually well formed by adolescence, changed by a class? I did what confused scientists have done for centuries to nonconforming data: I reanalyzed them. This time I ran a correlation between “nice” points and premedical units taken in science. Surprise again! Another direct correlation. Those students who had taken the most units in science had the highest number of “nice” points. In fact, in this idiot-driven experiment, “niceness” correlated directly with the total number of course units taken, regardless of the category. What did it all mean? I did not know, but I wondered: What is kindness, as perceived by patients? Perhaps it is curiosity: “How are you? Who are you? How can I help you? Tell me more. Isn’t that interesting?” And patients say, “He asked me a lot of questions”; “She really seemed to care about what was going on with me.” Is curiosity the same, in some cases, as caring? Curiosity is the urge to investigate, to discover. It can be seen in all small mammals; just watch a kitten explore a paper bag. Evidently, although curiosity can be dangerous (“What’s down this dark hole, I wonder?


Photo courtesy UC Davis Health Copyright: UC Regents

What does this bright pill taste like? What’s the funnylooking black animal with the white stripe down its back?”), it also has a redemptive adaptive function that exceeds the risks. Otherwise, puppies and small children would be wiped out. Curiosity is how we learn about our world. Dr. Erich Loewy, in an unpublished paper, points out that curiosity, this primal “wonderment” that stimulates exploration, engages both imagination (conceiving the alternative explanations of new phenomena) and intelligence (mapping out the best way to determine which explanation is likeliest). Both imagination and intelligence are integral to humanities, science, and the synthesis of the two, which is clinical medicine. Rather than stating that the study of humanities makes one humane, I propose that humane people are curious and therefore choose to explore the humanities as well as the sciences. An endowed lectureship at my medical school allows us to invite Nobel Prize–winning scientists to visit and lecture for several days. What impressed me most about my conversations with these luminaries was the extraordinarily broad range of their interests, their enthusiasm, and their thought patterns. One thinks

science has a sequential and controlled pattern of logical ideas, firmly grounded in antecedent principles and constantly cleansed of intellectual debris by the abrasion of skepticism. Listening to Nobel laureates in medicine was revelatory. No linear thought here. They uninhibitedly threw forth multiple ideas in their observations, the connections between which were often invisible to me. As if the ideas were the small bright stones of a mosaic, forming many possible pictures, these scientists looked at them and rearranged them until they found a picture they liked. Dr. Baruch Blumberg, for example, explaining how he found the hepatitis B virus, told me stories of Australian aborigines, roof thatch, wombats, guitars, bedbugs, the Babylonian Talmud, and manned space flight. No doubt the disciplined thought of scientific proof came later. The scientists seemed oblivious to intellectual constraints and unconcerned about being seen as naive or unknowledgeable. I suppose being a Nobel laureate means that one has little left to prove of one’s adequacies as a thinker, but I have no doubt that these thought patterns preceded and were the reason for these people’s Nobel Prize–winning discoveries, not a consequence of the prize. Curiosity without constraint, no preconceived

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image to emulate, no need for the facade of competence, opening inquiry into any area that stimulated their interest — these qualities seemed common to them all. In fact, the best clinical diagnostic thinking is more like the forming of a mosaic than linear thinking: It requires the physician to constantly alter diagnoses as each new piece of data enters the picture. One conceives constantly of many possible diagnoses, narrows down, re-expands, and generates an ever-evolving flux of ideas; the more information gained from patients, the better. For example, a 30-year-old woman with shortness of breath and fever (maybe a virus: pneumonia, of course) for three months (tuberculosis, multiple pulmonary emboli, lupus, sarcoidosis) recently returned from India (malaria, hepatic abscess, weird tropical disease) where she was visiting her mother, who was dying of breast cancer (anxiety; metastases from breast, ovarian, or colonic cancer; maybe she visited a guru and got toxic herbal medications), and so on. What does curiosity have to do with the humanistic practice of medicine? Couldn’t it just convert patients into objects of analysis? I believe that it is curiosity that converts strangers (the objects of analysis) into people we can empathize with. To participate in the feelings and ideas of one’s patients — to empathize — one must be curious enough to know the patients: their characters, cultures, spiritual and physical responses, hopes, past, and social surrounds. Truly curious people go beyond science into art, history, literature, and language as part of the practice of medicine. Both the science and the art of medicine are advanced by curiosity. One problem for medical students and physicians is that they must already have two things before engaging in uninhibited curiosity: a sense of competence (without which one tries to cultivate the appearance of competence, which generally means having more answers than questions) and time to think. The former is threatened by modern medical education and the latter by modern medical practice. How is curiosity suppressed in medical students and physicians? It is. I have discovered, in nonclinical settings, that students who, on the wards, seem totally without curiosity or culture — dolts, in short — were, in their private worlds, avid poets, artists, musicians, and craftspersons of exquisite skill, vitally interested in a wide range of topics. They just did not think it wise to let anyone know because they had received a 24

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message from housestaff, faculty, or peers that interest in anything other than purely biological medicine was inappropriate for a medical student. Medical education itself suppresses the expression of curiosity, emphasizing examinable facts rather than more ineffable thought processes in order to provide reproducible experiences for students. It may even substitute virtual patients (case discussions, simulations, CD-ROMs, and syllabi) for real ones. Patients languish on the wards wondering who their physicians are while their physicians discuss abstract patients in small rooms or play diagnostic games on the computer. Acting as a preceptor to second-year students, I discovered to my dismay that they gave up a physical diagnosis session to study for the written examination in physical diagnosis. Does this make sense? Efficiency, in which patients are seen as “work units,” also suppresses curiosity. One senior resident once presented a patient in morning report and, as part of the physical examination, mentioned a scar in the patient’s groin. When I asked how the scar had been acquired, she said, “He told me he was bitten by a snake there.” “How did that happen?” I asked. “I don’t know,” she said. How could that be? How could one not ask? The imagination runs riot with the possibilities of how this man got bitten by a snake in the groin. But the resident was too busy (or not curious enough) to ask! The sacrosanctity of print and the ancient human belief that what is written is more true than what is said suppress curiosity. A third-year student presenting a patient to me at the bedside told me that the patient had had “BKA [below-knee amputation] times two.” Standing there, I saw that the patient had legs. I asked the student, “Did you find legs on your physical examination?” “Yes,” he said. “How then did he have bilateral below-the-knee amputations?” The student was confounded. He could not understand it. He was struck mute. He reached out and touched the legs: warm, hairy, clearly the patient’s own and not prosthetics. “I don’t know,” he said. “What makes you think the patient had bilateral below-the-knee amputations?” “It said so in the chart.” We got the chart, and indeed, for this patient’s past three admissions, “BKA times two” was listed under history. It was only after looking at


the past five admissions that the transcriptionist’s error became clear. The patient had been previously admitted twice for diabetic ketoacidosis — DKA. But once typed, BKA became enshrined chart lore and was repeated by every subsequent house officer as if it were true, even in the face of the evidence of their own senses. Technology is wonderful and seductive, but when seen as more real than the person to whom it is applied, it may also suppress curiosity. When I was a house officer and installing one of the first right-heart catheters, the machine that showed intrapulmonic arterial pressures was enormous and was equipped with strain gauges rather than computer chips. Making it work was difficult. After the line was in, the attending, the nurse, and I tried desperately to adjust the machine to show the pulmonary arterial pressure waves. We could not get them. The line on the screen remained flat. We manipulated toggle switches and strain gauges for about 15 minutes. Nothing. Finally, I glanced at the patient: He was dead. We had been so engaged with the machine that we had missed this significant clinical event, which explained why the pulmonary arterial pressures were unobtainable. We assumed that the answer to the question lay in the machine and explored no further until it was too late. What is the reward of curiosity? To the patient, it is the interest and physical propinquity of the physicians, which is therapeutic in and of itself. To the physician, curiosity leads not only to diagnoses but to great stories and memories, those irreplaceable “moments in medicine” that we all live for. When I was a young attending at San Francisco General Hospital, morning rounds usually consisted of briefly going over the 15 or 20 patients admitted to the team the night before and then concentrating on the “interesting” ones. I was righteous and was determined to teach the housestaff that there were no uninteresting patients, so I asked the resident to pick the dullest. He chose an old woman admitted out of compassion because she had been evicted from her apartment and had nowhere else to go. She had no real medical history but was simply suffering from the depredations of antiquity and abandonment. I led the protesting group of housestaff to her bedside. She was monosyllabic in her responses and gave a history of no substantive content. Nothing, it seemed, had ever really happened to her. She had lived a singularly unexciting life as

a hotel maid. She could not even (or would not) tell stories of famous people caught in her hotel in awkward situations. I was getting desperate; it did seem that this woman was truly uninteresting. Finally, I asked her how long she had lived in San Francisco. “Years and years,” she said. Was she here for the earthquake? No, she came after. Where did she come from? Ireland. When did she come? 1912. Had she ever been to a hospital before? Once. How did that happen? Well, she had broken her arm. How had she broken her arm? A trunk fell on it. A trunk? Yes. What kind of trunk? A steamer trunk. How did that happen? The boat lurched. The boat? The boat that was carrying her to America. Why did the boat lurch? It hit the iceberg. Oh! What was the name of the boat? The Titanic. She had been a steerage passenger on the Titanic when it hit the iceberg. She was injured, made it to the lifeboats, and was taken to a clinic on landing, where her broken arm was set. She now was no longer boring and immediately became an object of immense interest to the local newspapers and television stations — and the housestaff. For whatever reason — economics, efficiency, in­creased demands on physicians for documentation, technology, or the separation of education from patient care — curiosity in physicians is at risk. I believe it is our duty, as those who now teach young physicians, to identify medical students with a gift for curiosity and take infinite pains not to suppress but to encourage that gift. Not only will patient care be enriched, but so will the lives of these physicians and the vigor of our art and science. Besides, it will be much more interesting. January/February 2022

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| BOARD BRIEFS |

Board Briefs November 8, 2021 THE BOARD: Received a report from Dan Cavanaugh, VP Membership Development for Cooperative of American Physicians (CAP), an SSVMS Partner in Medicine. Approved the appointment of Ravinder Khaira, MD to a third term as Director representing District 3, Office 3. Approved the Scholarship & Awards Committee Recommendations for 2021 SSVMS awards: Golden Stethoscope Award: JaNanh Scalapino, MD Medical Honor Award: Gary S. Chu, MD Medical Community Service Award: SSVMS Alliance The awards will be presented at the SSVMS Honors Medicine Event scheduled for Saturday, February 26, 2022 at The Elks Tower. Received a presentation from Drs. Adam Dougherty and Margaret Parsons, 11th District Trustees, regarding a proposed 2022 ballot initiative to defeat MICRA, the Medical Injury Compensation Reform Act.

Approved the following Membership Reports: October 25, 2021 For Active Membership — Faisal Ahmed, MD; Lutfi T. Al-Khouja, MD; Amina N. Choudhry, MD; Sean M. Gunther Maher, MD; Sharon G. Leano, MD; Leslie B. Littlefield, MD; Lindsay Platter, DO; Vishal Raj, MD; Isabel V. Stephens, MD; Gilbert A. Valasquez, MD; Hima B. Venigandia, DO. For Reinstatement to Active Membership — Rajbarinder S. Hundal, MD. For Resident Physician Active Membership — Kaitlyn Stettnich, MD (Sutter Residency Program); 286 UC Davis Residents & Fellows. To see the list, visit https://tinyurl.com/UCD-Residents-and-Fellows. For Retired Membership — Thomas N. Atkins, MD; Clifford C. Marr, MD; Captane P. Thomson, MD. For Transfer of Membership — Joanna B. Eldredge, MD (to Alameda-Contra Costa); Justin S. Louie, MD (to Stanislaus); Vivan Vuong, MD (to Alameda-Contra Costa); Weichen Xu, MD (to Placer-Nevada).

Approved a contribution to the CMA Physician Education Fund to help fund a campaign to defeat the ballot initiative to defeat MICRA.

Deceased — Margaret L. Masters, MD (d. 10/1/2021); A. John Quinn, MD (d. 4/30/2019).

Approved the 2022 proposed budgets for SSVMS General Fund, the Building Fund and the Community Service, Education and Research Fund (CSERF).

November 8, 2021

Approved the 2020 SSVMS and CSERF 990 Tax Returns.

For Retired Membership — Linda C. Schaffer, MD; Scott M. Wigginton, MD.

Approved the 3rd Quarter Financial Statements and Investment Reports.

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For Active Membership — Darrow Haagensen, MD; Huykien C. Le, DO; Zeynep B. Uzumcu, MD.

For Resignation — Russell F. Lim, MD (moved out of state).


| NEW MEMBERS |

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.

Faisal Ahmed, MD, NCC, Pulmonary Medicine Associates Lutfi T. Al-Khouja, MD, GS, The Permanente Medical Group Fatima Awan, MD, OBG, The Permanente Medical Group Carmel Bellacose, MD, OBG, The Permanente Medical Group San T. Bui, MD, P, The Permanente Medical Group Amina N. Choudhry, MD, FP, The Permanente Medical Group Sonja I. Dardenelle, MD, R, The Permanente Medical Group Sean M. Gunther Maher, MD, CCM, Pulmonary Medicine Associates Darrow E. Haagensen, Jr., MD, GS Richard Ho, MD, U, The Permanente Medical Group Max P. Horowitz, MD, OBG, The Permanente Medical Group Rajbarinder S. Hundal, MD, MS, CD, Elk Grove Cardiology Sheeva Johnson, MD, IM, The Permanente Medical Group Huykien C. Le, DO, PM, Woodland Clinic Medical Group Sharon G. Leano, MD, APM, Capital Pain Consultants, Inc Leslie B. Littlefield, MD, PCC, The Permanente Medical Group Lancy L. Lu, MD, PD, The Permanente Medical Group Tyler B. Moore, MD, ORS, The Permanente Medical Group

Ryan D. Navarro, MD, R, The Permanente Medical Group Mamta D. Patel, MD, FP, The Permanente Medical Group Lindsay Platter, DO, PD, The Permanente Medical Group Lindsay N. Poston, MD, OBG, The Permanente Medical Group Ryan J. Quigley, MD, ORS, The Permanente Medical Group Vishal Raj, MD, CCM, Pulmonary Medicine Associates Isabel V. Stephens, MD, NCC, Pulmonary Medicine Associates Cyril Duane L. Torado, MD, FP, The Permanente Medical Group Zeynep B. Uzumcu, MD, FP, UC Davis Health Gilbert A. Valasquez, MD, FP, The Permanente Medical Group Hima B. Venigandla, DO, IM, Pulmonary Medicine Associates Allen K. Zhu, MD, PD, The Permanente Medical Group

New Resident Physician Active Members Sutter Family Medicine Residency Program Shreya Chandrashekhar, DO Travis Hays, MD Sukhpreet Janda, DO Kaitln Stettnich, MD UC Davis Resident & Fellow Program See the list of 284 new UCD Residents at https://tinyurl.com/UCD-Residentsand-Fellows

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| THE LAST WORD |

Bite-Sized Bits of Medical History SSVMS Museum Brings Its Collection to TikTok

By Bob LaPerriere, MD ssvmsmus@gmail.com

L

ike most people over a certain age — let's say 40 in this case — I didn’t see myself as someone who would be spending my time on TikTok. If you’re familiar with TikTok and its short videos, you probably didn’t expect me to be getting my fifteen seconds of fame on it any more than I did. But then the Sacramento History Museum hit gold when it went on TikTok with videos featuring its print shop and more. It is now the most popular museum TikTok account in the world and has over 2.2 million followers. I love working with other museums, expanding the minds of students and others in our community and beyond, and the last two years of the pandemic had already forced us to get creative with the museum doors locked. So, with the example set by the Sacramento History Museum and the help of some of our younger SSVMS staff members, the Museum of Medical History’s voyage on TikTok set sail. I doubt I’ll ever be as famous as Howard Hatch, the Sacramento History Museum printer who the Washington Post said earlier this year is being called a “national treasure.” But with almost 70% of TikTok’s users under the age of 40 and a quarter of those teenagers, the social media platform is a great way to bring our museum to new audiences both in our region and around the world. And it doesn’t cost us anything, which is even better. Even though I’ve been curator of the museum for 20 years, or maybe because of that, it was difficult at first to discuss items in our collection in just 15 to 30 seconds. These turned into “appetizers” to promote the museum and the stories behind our collection, which we expand upon on our website. With our expanded online presence, virtual visitors can take a tour, learn more about the oddities and items that have advanced medicine that are on our shelves, watch lectures, and even do a scavenger hunt at ssvms.org/museum. While the pandemic closed the doors of the museum for many months, it opened up others to the world as we were forced to build a bigger online presence. We’ve had several hundred to over a thousand views of several of our videos, and Sammy the Skeleton has become one of our biggest stars since we started posting this fall. I’m looking forward to sharing videos about robotic surgery and the extensive collection of ephemera we have at the museum. We’d 28

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Let's give Dr. Bob, our new TikTok star, a hand. love to give the Sacramento History Museum a run for their money as the leading museum presence on TikTok, but we’ll settle for just building our base and bringing more of the fascinating history of medicine to TikTokers of all ages even if I don’t become as famous as Howard Hatch and his 100-year-old printing press. You — or your kids or grandkids — can find and follow us on TikTok at @sierrasacmedsociety.


Closer to home + enhanced referrals = easier access to world-class care Chief of Pediatric General, Thoracic and Fetal Surgery Shinjiro Hirose, M.D., F.A.C.S., is a nationally recognized cancer surgeon and UC Fetal Therapy Consortium cofounder.

UC Davis Health offers nationally ranked expertise— now with added convenience for referring providers. From the most delicate robotic and catheter procedures to the latest precision therapeutics, we’re proud to offer up-to-the-minute diagnostic and treatment options for both adult and pediatric referring providers across Northern California and the Central Valley. Your referred patients benefit from shorter drives, less traffic gridlock, affordable lodging, and more support from local family and friends. We also offer robust telehealth and telemedicine options, for both initial consultations and follow up care. Referring your patients to UC Davis Health specialty and subspecialty care is now easier than ever. Our physician referral liaison team is here to serve as direct lines of communication — helping to navigate and expedite referrals, obtain information, resolve process questions, and more.

Our liaisons can also help to: ■

Facilitate access to our secure EMR system, PhysicianConnect Arrange meetings and/or webinars with our clinicians Assist with UC Davis Health clinical trials and telemedicine Keep you abreast of new services, providers and research programs Share information about CME and events such as tumor boards, grand rounds, lunch-and-learns and symposiums

We welcome you to reach out to your local UC Davis Health Physician Referral Liaison today: Tracy Bayne | 916-281-8734 | thbayne@ucdavis.edu

referrals.ucdavis.edu