Spring2025 - The Heart of Medicine

medicine worcester Volume 94

• Number 1

Published by Worcester District Medical Society

Spring 2025

WDMS.ORG

WORCESTER MEDICINE

The Heart of Medicine

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Spring 2025

ContentsHumanities in Medicine WORCESTER MEDICINE

The Heart of Medicine

Spring 2025

The Heart of Medicine

Editorial 4

Broken Steps, Unbroken Resolve: A Journey Through Adversity in Medicine 14

Parul Sarwal, MD

Parul Chhatpar, MD

President’s Message 5 Alwyn Rapose, MD

Curbside with Dr. Baker 16

Doctoring in Tortoise Mode 6

Christopher Baker MD, UMass radiologist/contributing cartoonist to Cartoonstock.com

Heather Finlay-Morreale, MD

Learning the Ropes, Literally 18

Older Adults Read the Obituaries 8

Sahil Nawab, BS

Gary Blanchard, MD

Feature Photo 19

An Option to Cure 9

J. Aaron Scott, DO, FCCP, FCCM, FASA

Hugh Silk, MD, MPH

A Covenant 10

Photo Corner

Raphael A. Carandang, MD

Photography from contributing members of Worcester District Medical Society 20

Are Some of My Best Students Some of Your Difficult Patients? 11 Lucia Z. Knoles, PhD

2025 Berlin Award Winners 21

Book Review 12

Medical Director Needed! 21

Thoru Pederson, PhD

The Heart of Medicine: Running Toward, Not Away 13

In Memoriam

Joyce Zoe Cariglia 22

Arunava Saha, MD

B. Dale Magee, MD

published by

wdms editorial board

Worcester District Medical Society

Lisa Beittel, MBA Parul Chhatpar, MD Sonia Chimenti, MD Lloyd Fisher, MD Larry Garber, MD Rebecca Kowaloff, DO Anna Morin, PharmD

321 Main Street, Worcester, MA 01608 wdms.org | mwright@wdms.org | 508-753-1579 wdms officers

President Alwyn Rapose, MD Vice President Michelle Hadley, DO Secretary Justin Maykel, MD Treasurer Adib Karam, MD wdms administration

Nancy Morris, PhD, NP Thoru Pederson, PhD Sarah Petrides, DNP, CNP, FNP-BC Joel Popkin, MD Alwyn Rapose, MD Parul Sarwal, MD

developed by

Parul Sarwal, MD, Editor-in-Chief Sloane Perron, Copy Editor Robert Howard, Designer

Martha Wright, MBA, Executive Director advertising

Inquiries to Martha Wright mwright@wdms.org 508-753-1579

Robert Sorrenti, MD Martha Wright, MBA Peter Zacharia, MD Arunava Saha, MD, Pulm/CC Fellow, Tulane School of Medicine Olivia Buckle, Student Representative

thanks to

The Reliant Medical Group, UMass Memorial Health Music Worcester Physicians Insurance Mechanics Hall UMass Chan Medical School Beechwood Hotel

Worcester Medicine does not hold itself responsible for statements made by any contributor. Statements or opinions expressed in Worcester Medicine reflect the views of the author(s) and not the official policy of the Worcester District Medical Society unless so stated. Although all advertising material is expected to conform to ethical standards, acceptance does not imply endorsement by Worcester Medicine unless stated. Material printed in Worcester Medicine is covered by copyright. copyright is claimed to any work of the U.S. government. No part of this publication may be SpringNo2025 reproduced or transmitted in any form without written permission. For information on subscriptions, permissions, reprints and other services contact the Worcester District Medical Society.

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WORCESTER MEDICINE

Editorial

Editor-in-Chief Parul Sarwal, MD

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n healthcare, our identities often become inseparable from the two letters that follow our names. But like everyone else, we are more than our titles. We carry stories, convictions, doubts, and dreams, many of which rarely make it into our morning rounds or the notes that follow. This issue of Worcester Medicine is special because it invites us to pause and reflect. It reveals a more vulnerable side to our medical community, one that reminds us that even behind the most composed white coat is a human heart.

Many years ago, I was told, "You have a rich inner voice," which was probably a gentle cue to speak up more. But that didn't come easily. As an international medical graduate starting my medical journey in the U.S. back then, I was still absorbing the nuances of culture, the subtleties of vernacular, calibrating the right measure of humor, and acutely aware of all that I didn’t know – awareness that paradoxically held me back. There was much I wished I could say to my patients – words to reassure, comfort, connect – but somehow I couldn’t give these words a voice.

That changed during my second year of residency. The pandemic hit, and I was, fortunately or unfortunately, in the thick of it. I say "fortunately" because it accelerated everything.

My clinical judgment, my comfort with confidence, and, most unexpectedly, my voice.

I spent much of the first surge in the ICU, which in hindsight became the most formative experience of my training. The acuity was undeniable but so was the clarity it brought. We triaged PPE. We triaged convalescent plasma. We triaged ventilators. We triaged visitors. We triaged ECMO transfers. And sometimes, we triaged our own exposure to an unfamiliar virus.

But the most delicate triage was that of words.

I remember phone calls with families asking if they should travel to say goodbye – asking me to be the voice of certainty amidst all the uncertainty. I learned how to choose my words with precision, because what I said could shape the hardest decisions someone would ever have to make.

It was a time that felt like war – not in a way that minimizes the reality of combat, but in the sense of shared survival, of duty, of vigilance, and of a certain emotional resilience we had to develop just to keep going. We knew what it took to show up the next day but we all did it for our patients. What truly stood out to me was how we all looked out for each other too, and it was interdisciplinary. You saw it in the eyes that welled up and in the pursed lips that quietly acknowledged them. You also saw it in the nurses’ break room, to which we now had unprecedented access, in the ultimate gesture of solidarity.

This collective experience helped me learn that the heart of medicine isn’t just in knowledge or systems. It is in patient advocacy.

It is in recognizing that while policy and protocol provide structure,

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they should never be the limit of what we strive to do for our patients. It is in speaking up, even when you don’t yet feel ready to. It is in not losing your humanity when everything around you demands efficiency. The ICU was where I learned that you may not always have the right infrastructure or answers, but if you center the patient, if you lead with heart, you can move the needle. My newfound voice allowed me to advocate for my patients, even as, especially as, a resident.

I would not be the physician I am today if it weren’t for that season of medicine. And now, whenever I feel the pressure of limitation – whether it is time, beds, staffing, or systems – I return to that truth: as long as the heart of medicine is beating, we’re still making a difference. + Parul Sarwal, MD Associate Medical Director of Hospital Medicine, TeamHealth at St. Vincent Hospital Assistant Professor, Department of Medicine, UMass Chan Medical School

Spring 2025

WORCESTER MEDICINE

The Heart of Medicine

President’s Message Alwyn Rapose, MD

Dear Colleagues, Hope you are settling well into 2025! It will be Spring when you read this message. A time full of fresh life and new beginnings.

We are sorry about the unexpected cancellation of the Annual Oration in February, but our speaker had a medical emergency. However, our agenda at WDMS is still jam-packed with exciting events in the early part of the year with the Annual Business Meeting (ABM) in April, followed by the excitement of the in-person Annual Meeting of the Massachusetts Medical Society (MMS) in May (with the many associated committee and caucus meetings). I strongly encourage our district delegates to register early for the meeting and take advantage of the MMS-sponsored overnight stay at the Westin Hotel on Friday, May 16, so you are up bright and early for our caucus breakfast discussions on Saturday morning.

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I truly believe that volunteering our time and energy is a way we can combat burnout…

Please also make every effort to attend (and bring along your colleagues and students) our ABM scheduled for April 15. It will be held at the conveniently located Beechwood Hotel. In addition to formalizing your officers and chairpersons of various committees for 2025-2026, we will also present the Community Clinician of the Year Award.

The evening will be rounded off with a wonderful talk from guest speaker, Dr. Stephen Ko, who I can guarantee will touch our hearts and lift our spirits as we continue caring for our patients in an everevolving and challenging environment. This will continue the theme of our presentations and speak to the heart of our calling as physicians.

Along these lines, I would like to take this opportunity to increase awareness of many community organizations: local, national, and

international looking for medics to serve sick people without having to think of office schedules, insurance coverage, Epic documentation, RVUs, and productivity reports. I truly believe that volunteering our time and energy is a way we can combat burnout and other negative feelings we experience in our practices. An entire issue of Worcester Medicine (Volume 92, Number 3, Fall 2023) was previously devoted to this theme. Look back to that issue for inspiration and feel free to contact me any time so I can put you in touch with our Worcester physician colleagues already volunteering at local organizations like the free clinics at St. Anne’s and St. Peter’s (part of the Worcester Free Care Collaborative), Clearway Clinic (a Crisis Pregnancy Center), Visitation House (a temporary home/shelter alternative to abortion for mothers with unplanned pregnancies), UMass Memorial Health’s Ronald McDonald Care Mobile (for Worcester children and their families), Indian Society of Worcester Health Stop, as well as international medical missions conducted by organizations like Christian Medical & Dental Associations (CMDA; different countries), Optum, One World Surgery (Dominican Republic), Agape Global Health (Haiti), CRCA (Liberia), Cape CARES (Honduras), and Asaprosar (El Salvador).

This is not a comprehensive list but could be a starting point for your curiosity and enthusiasm.

In this edition of Worcester Medicine, I would like to give a special shoutout to our Secretary Dr. Justin Maykel. Despite his busy schedule as Chief of the Division of Colorectal Surgery at UMass, he has demonstrated great commitment to our Society activities, even registering his department colleagues as new WDMS members. He is a Worcester son-of-the-soil and we have used his connections to establish relationships with local businesses willing to support the mission of WDMS. Thank you, my dear friend, it’s been truly awesome working with you.

Let me end by wishing you a great year ahead. Please email me with your thoughts and feedback on our meetings, journal, or any other topics. It will be great to hear from you.

Sincerely, Alwyn Rapose, MD, FACP alwyn.rapose@reliantmedicalgroup.org

Spring 2025

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The Heart of Medicine

Doctoring in Tortoise Mode Heather Finlay-Morreale, MD

S

ome days as a clinician are challenging and test our limits. Many of us find comfort in flipping through a saved folder of treasured thank-you cards or in my case, children’s drawings. The visible gratitude of the patients we have helped strengthens the call to this caring and demanding profession.

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My life has evolved into a new calling.

But a calling can evolve. After 10 years of clinical practice, I got sick. Really sick. I spent two years bedbound, undiagnosed, and incompletely treated. My delayed diagnosis was in part due to dismissal and disbelief while I experienced mistreatment. This period was full of pain, frustration, and grief at my loss of function. It would be understandable if I pulled away from my medical peers in disillusionment. But, I haven't lost faith in the goodness at the core of most physicians. Once diagnosed and treated, with new lessons learned from the patient's side of the bed, I returned to share my journey and perspective with the medical community.

In my new life, I had to unlearn some of physicianculture's central tenets. My view of my quality of life as a now-disabled person is not diminished by my inability to do some basic tasks. I work to live the best life I can within the strict limits I have been dealt with.

I learned to rest before hitting overload status. Now,

due to my myasthenia gravis, I literally and symbolically walk through life slower. My husband affectionately calls this "power tortoise mode". I take time to enjoy the smaller and slower moments and observations. My new mantra is described well in Ron Bell's poem, "Walk, Don't Run", "But walking, which leads to seeing, now that’s something. That’s the invitation for every one of us today, and every day, in every conversation, interaction, event, and moment: to walk, not run. And in doing so, to see a whole world right here within this one."

My life has evolved into a new calling. Rather than treat patients one by one, I speak to physicians and trainees about mindfully treating the disability, chronic illness, and undiagnosed community. Although my new road is challenging, and I travel slowly, it brings me joy and satisfaction to bridge the patient and doctor worlds. + Heather Finlay-Morreale, MD is a patient, physician, writer, artist, and advocate. She is an assistant professor of pediatrics at UMass Chan Medical School. Email: finlaymorreale@gmail.com

Meet the Author Series May 21, 2025, 5:30p.m.

UMass Chan Medical School Facilitator: Lucia Knoles, PhD, Professor of English at Assumption University and a Board Member/Summer Instructor to the Worcester Clemente Program With a panel of contributing authors

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The Heart of Medicine

In Memoriam

Spring 2025

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The Heart of Medicine

Older Adults Read the Obituaries Gary Blanchard, MD

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had long witnessed this behavior from my father, who had set up multiple email and text message alerts on his phone, encompassing seemingly every Eastern and Central Massachusetts newspaper. He was often, as a result, the first to know when someone from his Barnstable High School class of 1966, or an old neighbor, or a fellow parishioner, had sadly passed away. He said he did this because… well, I was never quite sure. He said he just wanted to know.

In the days after March 31st, when my dad died from a cardiac arrest in the evening of Easter Sunday, and I took possession of his iPhone, it was truly as if he had died a second time when he – or, well, I – received the email notification of his own passing. Normally, I knew he would have been the one to see this first. There was an added finality to this Legacy.com email alert.

We had a beautiful Easter celebration – he watched his granddaughter and grandson scavenge and claw each other for Easter eggs, attended church as a Eucharistic Minister, and presided over the ham and turkey at dinner. It really was a beautiful day. I remember him saying as much to me on the deck in our backyard.

In a sense, my father’s passing was, by definition, very sudden. In another sense, it wasn’t sudden at all. He had suffered his first heart attack on the day I was starting my medical school orientation in August 2000 at Tufts. At age 51, he was in the CCU after his major heart attack while I was set to attend lectures on the floors below. He used some memorably colorful turns of phrase to tell me that he had worked too hard for me to miss my orientation to med school. I knew that was an accurate assessment, even if it was not easy to focus on the terms of my financial aid repayment later that morning.

My dad’s 24 years of ischemic heart disease certainly influenced my own practice style over time. But this is not mostly about that (although I do always fondly remember how he was the favorite patient of every nurse who ever took care of him: he was consistently appreciative, kind, and quick to tell how proud he was of his son and daughter to any member of the interdisciplinary team). I was his healthcare proxy, and he had shared, multiple times, with me what his goals were and how he would want me to make medical decisions on his behalf. I genuinely found that those parts were never the hard parts.

I went back to work at Saint Vincent Hospital in mid-April. And it turned out that older adults do indeed read the obituaries.

As a geriatrician, I have the privilege to regularly talk to my patients about loss and grief. There can be lots of losses associated with aging, but to be present with a patient after they’ve lost a spouse, a sibling, a friend, sometimes even a child, is humbling. I’m usually the one inquiring, leading, trying to listen. Only, after my father’s passing, I found something unusual happening: many of my patients were inquiring, leading, trying to listen. All of which was a bit hard to know what to do with, and how to choreograph. I knew they were trying to be helpful because they had read my father’s obituary. Many patients had even come to my father’s wake – including some patients in their 90s, and many of whom were caregivers

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who either brought their spouse or arranged coverage for their spouse. They met my mother, my wife, my sister, and my children. I know I had shown the newborn nursery photos of our daughter, now 15, and our son, 12, back when I first met some of them.

We are taught that we are not to be friends with our patients. The doctor-patient visit is most certainly designed to not be about us, and our own troubles, or losses. And yet.

“How are you doing, Dr. B.?”

For some patients, I found I would reflex into a narrative that I was gradually forming when other people would ask me that question. It’s not possible to function and finish a day if you were to actually answer that question every time it is posed. And, with my patients, after all, I also see them on a schedule.

So I would usually stick to my evolving script, one that didn’t require any new emotions to be shared or previously unformed thoughts to be expressed. I did certainly appreciate their asking.

But I found that sometimes, for some patients, I did not always stick to the script. I even found myself saying things that I hadn’t quite said before.

There is a line. Of course there is a line. But having relationships with patients who I’ve known for 15 years, I found the contours of that line to not always be as easily demarcated for me as when the line was first neatly sketched out during my orientation at Tufts (I remember my mentor, Dr. Joel Popkin, explaining the dilemmas of the line to me during my residency about some patients for whom he had known for 40+ years).

I walk into a room and try to ask myself, ‘What can I do to try to be most helpful for this person today?’

Oftentimes, that involves mostly listening, and trying to understand their perspective, their worries, their struggles.

And, in these moments, it felt at times as if what I could do to be most helpful to my patients was to share a bit about myself and how I was doing. It seemed to be therapeutic, and cathartic, for both of us. It reminded me of the value in our patient-physician relationships, rather than just our patient-physician visits.

I worried about the line during these visits. I still do. But I also know that I was glad that older adults read the obituaries. + Gary Blanchard, MD Director, Geriatrics and Palliative Medicine, Saint Vincent Hospital Kelley House, Head of House, University of Massachusetts Chan Medical School Email: Gary.Blanchard@stvincenthospital.com

WORCESTER MEDICINE

The Heart of Medicine

A case worker from my office, Jane, was equally creative. She found ways to help Juan meet his basic needs. She was not going to tolerate the squalor, however. She insisted that we set up a meeting with his case worker, their boss, the landlord, and whomever else could make change to his setting. This was unacceptable.

Juan used opioids. This meant that people looked at him differently.

His needs were looked at as questionable. Afterall, he was high most of the time, wasn’t he? Would he even notice the ceiling stains, water damage, and sagging panels? Jane was having none of it. She knew he deserved better. She would see that his conditions were improved. How could he heal in such an unsanitary situation?

We met with all the people who could make decisions. We were assured his situation would improve. The toilet would be fixed, as would the ceiling. A wireless doorbell would be installed that week.

Six months later I ran into Juan’s brother. He came to see me at the mobile van I now worked on (Road to Care), where we provided care for people who are street homeless and often with substance use disorder.

Nothing had changed. Juan’s brother was distraught.

“You said they were going to fix it.”

How could I explain? Jane and I had been reprimanded for our efforts

by our employer. She quit. Soon after I was let go.

The meeting with human resources had listed a slew of infractions including all the efforts to help Juan – meeting with housing leadership without approval, taking medications and supplements to the patient’s house, visiting patients at home. I had shown signs of depression too. That was the final draw. The termination letter from the CEO of family health center read: Based upon the nature of the conduct, there is no option to “cure” under these circumstances.

I was immediately cut off from Juan. What would happen?

Now I knew. Nothing.

I assured Juan’s brother we would re-engage even though he was housed – someone had to. Juan was in the hospital. After our care was severed, he had become worse, and his bowel became infected.

This is not a story about me. This is a story about Juan and the thousands like him in Worcester County.

They receive inferior care. And when we turn on each other as providers, even less.

There is no option to cure Juan and those in the same situation based on the current nature of our conduct. We need to work together. We need to support providers who care deeply about the homeless.

We need to help those at risk for burnout. More importantly, we need to create more very affordable housing, that comes with wrap-around services including primary care, mental health, social services and peer support.

We also need to offer our respect for everyone in Juan’s situation. He does not receive the same care I receive when he enters the emergency room or hospital. My adult daughter recently joined our team to help with some evaluation. After a few days she said, “I will never look at someone who is homeless the same way again.” We can’t all get to know people who are homeless or have substance use disorder. So, you will have to take it from me, and my daughter: the vast majority of people who are homeless have suffered from many traumas – from before birth, in their childhood, and throughout their lives: rape, incest, violence, poverty, war, mental health disorders, and more. Trauma leads to self-harm, substance use, homelessness – and it becomes a vicious cycle. Society adds to it by staring, pointing, and neglecting. Our Supreme Court has added to it by saying it is illegal to be homeless and arresting people who have nowhere to go. And we, the health care industry, make it worse when we abandon people or treat them differently than everyone else. Layer upon layer of trauma.

We can do better. Let’s treat each other better and treat those we don’t know with some curiosity,

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An Option to Cure Hugh Silk, MD, MPH

“Dr. Silk, you have to come help me, man. I can’t live like this.”

Not a call that a physician wants to receive.

Juan had been living in supported housing after being homeless for years. His situation was still dire despite now having housing. He had recently had multiple surgeries with drains and an ostomy bag. He needed daily wound care, nutritional supplements, and antibiotics. His apartment had been neglected by the landlord. The ceiling was caving in. The toilet was no longer working. He did not have a doorbell, so nurses and supplies could not get to him. I had known Juan since we first met at a food pantry years earlier. He was struggling with opioid use, but he sincerely wanted to get better. He came regularly to see me. We formed a bond, and I was able to get him to come to our office to receive primary care at Worcester Healthcare for the Homeless.

My attempts to see him at home were to try calling when he had a cell phone, and when it worked. Other times, I would call at his window from the backyard or toss pebbles gently against his window to get his attention.

He would come to the window, eventually let me in, and I would do my best to tend to his wounds. I brought him medications, Ensure that I purchased, and supplies that I acquired through donations.

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Those moments of respect and care – just may be the cure.

WORCESTER MEDICINE

The Heart of Medicine An Option to Cure Continued compassion, and patience. Maybe we can’t cure this problem in its entirety. But there is an option to cure. We have to choose that option. And all along the pathway to cure is where good things can happen. Those moments of respect and care – just may be the cure.

The cure may not be getting 100% better. A famous Jazz musician once said, “all the way to heaven, is heaven.” The cure may be the route to getting better: being treated better, feeling better, trusting better, living better. I have faith that we can do that, together. + Hugh Silk, MD, MPH, FAAFP Vice Chair of Community Health and Professor University of Massachusetts Chan Medical School, Department of Family Medicine and Community Health

A Covenant

Raphael A. Carandang, MD To do the best With what We know And have To offer With all our knowledge And skill To communicate Not our biases But To give Time And space To explain Honestly Sometimes painstakingly The details And reality Of the disease Of the likely course Of treatment Of prognosis And possibilities To acknowledge The unknown To inquire

With true interest About the person In the body In the bed Before us To sit In the space Of uncertainty To be Present With Openness As together We seek To understand The impact Of illness On the individual And ultimately Know As best as we can What it is To live

Raphael A. Carandang M.D. Associate Professor Departments of Neurology, Anesthesiology and Surgery University of Massachusetts Chan Medical School A Covenant was originally published in The Pharos and is republished with permission.

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The Heart of Medicine

Are Some of My Best Students Some of Your Difficult Patients?

Lucia Z. Knoles, PhD

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y heart sinks when he walks into the classroom. His scowl makes me fear for my safety. I’ve had difficult students before, and I don’t like the way they make me feel: ineffective, distrusted, disliked.

So, I understand why articles in medical journals sometimes focus on patients described as “difficult”, “heartsinks”, “frustrating”, and even “hateful.” Like my difficult students, these patients make doctors feel helpless to help.

But I learned what difficult really means from the participants in my Clemente course, Storytelling our Way to Health Equity. In one section of this Mass Humanities-funded project, medical professionals shared stories of their experiences working with members of historically marginalized communities.

In the other, members of Worcester’s Clemente program shared their stories. Clemente offers free college-level courses for low-income adults. Many are immigrants, people of color, members of the LGBTQ+ community, substance users, or people with serious persistent mental health issues or disabilities.

They are the most inspiring students I have ever encountered. They are passionate about learning and committed to making a difference.

Yet the stories my students told helped me understand why your heart may sink when one of them comes for treatment. After struggling with poverty and other social risk factors all their lives, these people suffer from multiple health problems, mental health issues, and chronic conditions that defy easy—or any—cures. They may be noncompliant because they cannot afford medications or no-shows because they lack transportation. They are sometimes demanding because they are desperate.

They expect not to be heard.

That’s why my students’ hearts may sink when they see you walk into the exam room. Life has taught them people and systems will fail them.

Here is Dukroa Owens describing her childhood in The Sun Rose & Mama Roared: “Moving from foster home to foster home, I dealt with sexual assault . . . [by] people who were getting paid to care for me . . . When I noticed the same thing was being done to my little sister, I made complaints to my social worker and the supervisor and . . . the District

Attorney. Nothing ever happened to that family.”

In his story, If It Was Up to Me, A. J. remembers: “I am eight years old when the state takes me away from my mom because they think she's abusing me. . . After I move in with my father . . . my stepmother hits me and throws me around. She calls me fat and tells me I'm not worth anything. She shouts that my mom and I are both stupid bitches. My sister ends up in pretty much every mental hospital in Massachusetts because her biological dad is sexually abusing her. She tells me that hospitals are . . . a place to escape and be safe where people won't hurt you. Later she changes her mind. She tells me: ‘Be careful with that because I got hurt in the hospital’. It seems like nowhere is safe.”

When Theresa Buccico’s grandmother was hospitalized, the young teenager was left to survive on her own. In See Me Through My Grandma’s Eyes Theresa writes: “No one would be coming to help me. My biological mother was in a treatment facility for her lifelong substance use disorder. My father . . . had no contact with me. My brother was incarcerated.”

Theresa slept on couches, got a job, kept up her grades, and eventually became her grandmother’s caregiver. No system supported her.

Laura DiCaronimo also felt alone when her mom was hospitalized. In The Best Day she reflects: “Not once were we offered outside resources for families of people with traumatic brain injuries. Not once was it suggested that we find a support group. Not one mention was ever made of the myriad nonprofits and social service agencies that could've helped us. I felt hopelessly adrift in a world that would simply chew my mom and me up and spit us out. The bills were already piling up . . . I paid her rent, which I could not afford . . . and cried.”

You are only human if you think: I can’t possibly solve all these problems. But these authors aren’t demanding that you fix everything.

They are asking you to see and hear them.

Consider the conclusion of Lost in a Labyrinth of Pain, Ana Herrera’s story about the months of agony and financial distress that resulted when her concerns were ignored by her specialist: “I will always remember the moment when my (new) oral surgeon said: ‘Trust me, I'm not leaving you alone.’ I finally felt heard. . .

Thank God for the work of good doctors like these who care about and listen to their patients. They are true heroes.”

And George Odomako concludes his story about experiencing a heart attack in the inhumane conditions of a shelter, From MA to NYC: “I am grateful to the people at Bellevue Hospital whose attention made me feel seen and heard. And I am grateful to the primary care physician and case worker who saw me as a human being. They helped heal more than just my body.”

Sadly, few medical professionals have time to listen to each patient’s life story. But reading See Me through My Grandma’s Eyes, the anthology

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The Heart of Medicine Are Some of My Best Students Some of Your Difficult Patients? Continued produced by the Clemente storytelling project, allows you to see inside the lives of people who face unimaginable difficulties every day.

Each time we listen to someone’s story we are better equipped to understand those who need our help. The scowling student turned out to be incredibly gentle. I hadn’t realized autism made it difficult for him to understand facial expressions. I have been similarly wrong about the “lazy” students who were working forty-hour jobs, driving family members to immigration hearings, or suffering from depression. Their stories taught me that difficult students have difficult lives.

I suspect the same may be true of many difficult patients. + Lucia Z. Knoles is a Professor of English at Assumption University and a Board Member/Summer Instructor for the Worcester Clemente Program.

Email: lknoles@assumption.edu To reach the website where you can download See Me Through My Grandma’s Eyes, click or tap here or on the book cover below:

Book Review

Thoru Pederson, PhD

The Elements of Marie Curie: How the Glow of Radium Lit a Path for Women in Science by Dava Sobel. 2024. Atlantic Monthly Press, NY. ISBN 978-08021-6382-0

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arya Sklodowska, born Nov. 7, 1867, was without doubt the most famous woman in science in her time and remains so to this day.

Those who do not recognize names like Rosalind Franklin (DNA) and Jocelyn Bell (quasars) have heard of Marie Curie. An excellent biography by Susan Quinn appeared in 1995 and now comes another, by a writer as luminous as Marie’s radium - Dava Sobel. Her previous books include The Glass Universe: How the Ladies of the Harvard Observatory Took the Measure of the Stars and Galileo’s Daughter , among several other publications.

Sobel charts out Curie’s life along three lines. One is the strictly biographical one, powerfully engaging on its own. The second of course is her pathfinding work on radiation and radioactive elements, resulting in two Nobel Prizes. But the third is the author’s clever design of the book. The reader discovers that the “elements” in the book’s subtitle are of two kinds. On the one hand, these are the various atomic elements with which Curie worked, most famously radium and polonium but also others. But the other “elements” are, one by one, the many gifted women scientists who came to Curie’s lab and whom she trained and mentored into successful careers of their own. This was a brilliant stroke of the author, as was “naming” each chapter for an element in honor of the Curie lab trainee described therein.

For a review in Worcester Medicine (or in any other place with a medical readership) it is worth thinking about Curie’s radiation exposure. The energy from radium and polonium is not strong enough to penetrate human skin, but one decay product of the former, radon-222, itself radioactive, is a gas, and thus upon inhalation reaches the lungs. Curie did suffer respiratory distress most of her adult life. But the more telling scenario is her X-ray exposure.

Well after the zenith of her fame, during World War I, she got the idea that if mobile X-ray machines could be driven to the front lines, battlefield physicians and surgeons could make immediate treatment decisions, long before the wounded soldier could otherwise be transported to a hospital.

She constructed and deployed these mobile X-ray machines and, near the end of her life, speculated that it was this X-ray exposure, not her work with radioactive elements, which had caused her aplastic anemia, the cause of her death. Always a champion of peace and justice, she had put her life on the battlefield on behalf of her adopted country, France. Thus, possibly putting her life in danger—a noble act for a twice Nobel laureate.

The radical Abby Hoffman, who in his early years lived less than a mile from where I am writing this, said “Buy or steal this book.” I suggest considering the former. + Thoru Pederson, PhD, is the Arnett Professor of Cell Biology and Professor of Biochemistry and Molecular Biotechnology at UMass Chan Medical School.

Email: thoru.pederson@umassmed.edu

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The Heart of Medicine: Running Toward, Not Away Arunava Saha, MD

T

he shrill ring-tring started from one corner of the room, reverberating in a circular crescendo as one buzzer after another joined in a deafening symphony. The sound could mean only one thing—a rapid response.

I had barely settled at my workstation after an exhausting hour-long family meeting. It was a sweltering summer afternoon on the wards, and I was drowning in paperwork, notes, and pending admissions—the unholy trinity of a resident’s life. Being on call only amplified the chaos; any problem anywhere in the hospital fell squarely on our shoulders.

I glared at the pager in my pocket with a mix of contempt and resignation. Hunger gnawed at me, my to-do list loomed large, and every fiber of my being was screaming for rest. But as I glanced at the screen, my frustration dissolved, replaced by a chill that coursed through me. The small, dimly lit screen displayed eight letters that every doctor dreads: CODE BLUE. In an instant, I shut my desktop, grabbed my stethoscope, and bolted out of the room. A few of my colleagues sprinted ahead, others followed behind, as we rushed toward the source of the alert. The procedure suite—almost halfway across the hospital—had become a theater of urgency. Bystanders stepped aside as we dashed through hallways, their curious stares blending into the periphery.

As my feet pounded the floor, time bent. Each frantic step transported me back to the most fateful day of my life. Every code blue run carries with it an echo of that day—a memory that is as vivid now as it was nine years ago.

My final year of medical school was tumultuous, shadowed by the relentless decline of my mother’s health. Diagnosed with decompensated liver cirrhosis, she endured four hospitalizations in six months, including a grueling 30-hour train ride from Kolkata to Vellore. She was tethered to a central line throughout the journey, and I was her only doctor, clutching a handful of life-saving medications and an overwhelming sense of responsibility.

Her final battle was fought in a world-class ICU during a grueling 21-day stay. Despite their best efforts, the medical team told us there was nothing more to be done. I was just 20 years old, the only child of a mother who had been my everything, and the first doctor in the family. Yet, I had to make the decision no child should

ever face: to stop fighting and focus on comfort. My family deferred to me, likely because they knew I wouldn’t have accepted any decision that wasn’t my own.

“Keep her comfortable,” I said, not fully grasping the weight of those words.

I spent my days attending classes, preparing for my final exams, and my nights at her bedside, managing her encephalopathy and agitation. On one such night, she briefly regained clarity. She looked at me, her eyes heavy with fatigue but filled with love. “I’m not trying to be difficult,” she said softly, “I just can’t help it. I love you.”

I held her hand and whispered back, “We’re doing everything we can, Mom.” She squeezed my hand, and in that moment, I understood a profound truth: medicine is not always about the answers we give but the comfort we provide when there are none.

The fateful afternoon, sitting in a pediatric lecture, I got a frantic call from my dad. By the time my brain had registered what he howled over the phone, I had already started running. That was the fastest I ever ran in my life, from a 6th-floor lecture hall at one end of the hospital campus, across multiple corridors, down the stairs, and back up to the 8th floor on another wing, my heart racing faster than my legs could carry me. I remember thinking with every stride, that every second lost was another second she wasn’t receiving oxygen to her brain.

The four minutes it took to reach her felt like an eternity. By the time I arrived, the doctors and nurses were done. She left shortly after. It has been nine years since that day.

Her death shattered me, but it also illuminated the path I was meant to walk. It taught me that medicine is not just about saving lives; it’s about standing steadfast in the face of uncertainty, providing comfort when outcomes are beyond our control, and ensuring every patient’s dignity is upheld.

Now, as a fellow in Pulmonary and Critical Care Medicine, her legacy shapes my practice. I strive to see the person behind the ventilator, to honor the humanity in every interaction, and to bring not just skill but soul to every bedside. Her story reminds me to tread the delicate line between clinical detachment and emotional vulnerability.

Nine years later, I still run. Every time a code blue pager blares, I feel the same jolt of adrenaline, the same sense of urgency. But now, it is tempered by purpose. I run not only because it is my job but because I know what it means to be on the other side of the bedrail, clinging to hope, watching helplessly, praying that someone—anyone—will give it their all.

The heart of medicine, I’ve come to understand, does not beat in machines or flowcharts. It beats in the whispered reassurances, the unyielding compassion, and the quiet resolve to never stop running. Because once you’ve truly grasped what’s at stake, there is no turning back. + Arunava Saha, MD Pulmonary and Critical Care Fellow Tulane University School of Medicine Email: saha.arunava100@gmail.com

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Broken Steps, Unbroken Resolve: A Journey Through Adversity in Medicine Parul Chhatpar, MD

T

he air was brisk that day, a beautiful fall afternoon with golden leaves swirling in the light breeze—“a season of mists and mellow fruitfulness,” as Keats has so elegantly written. I was on my lunch break, halfway through the first day of my board exams. The season’s beauty was in stark contrast to the weight of the task ahead. As I glanced at my watch, I realized I needed to return to my station at the testing center. Hastily, I gathered my things and began to speed walk.

Flip-flops, the least sensible footwear for a medical professional-intraining, slapped against the pavement as I hurried back.

“

Medicine often teaches us determination—to navigate the unexpected and keep moving forward.

In my rush, I miscalculated a step. My foot landed awkwardly, and down I went into the grass. The pain shot through my ankle like a lightning bolt. Embarrassed, I quickly picked myself up; brushing off my clothes, I tried to convince myself it was just a sprain. Adrenaline carried me back into the building, into the test room, and through the rest of that exam day. However, the physical and mental discomfort was mounting with every hour. The stakes were high; I had to pass this board exam now, and failure was not an option. By the end of that day, though, it was clear this injury would not self-resolve. My initial instinct to push through—a hallmark of medical training— warred with the reality that this wasn’t something I could ignore.

I hopped out on one foot, dragging the other. I shifted my medical reasoning from the exam to myself, as the Ottawa rules came to mind.

Unable to bear weight and with bone tenderness at the base of the fifth metatarsal, I knew the situation called for more than rest and elevation. I needed an X-ray.

A few hours later, the urgent care doctor brought my X-ray in. My suspicion was confirmed: it was a Jones fracture. The irony was not lost on me. Here I was, studying to be a physician, and I had managed to diagnose myself halfway through a major exam. Keats’ words came unbidden to mind: “Do you not see how necessary a world of pains and troubles is to school an intelligence and make it a soul?” In that moment, I realized this trial was shaping me in ways I hadn’t expected.

It was time for the next test day. Armed with crutches, a bag of pretzels, and a growing sense of determination, I had returned. As I hobbled awkwardly into the testing center, the woman at the desk

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smiled warmly and nodded. “Welcome back, doctor,” she said with an encouraging tone. Her words, though simple, carried a sense of validation that bolstered my resolve.

Maneuvering through the testing center was an adventure of its own—balancing my backpack, managing the crutches, and fielding curious stares from fellow examinees. The locker system added another layer of awkwardness. Retrieving and returning items with crutches was a cumbersome dance that only drew even more attention. Each trip to the locker felt like a mini obstacle course, with my movements amplified by the echoing hallway. The stress of the exam, coupled with the throb of my injured foot, made for a uniquely grueling experience. Voltaren provided but limited relief from the pain. But each time I sat down at my computer to work on the exam, I found a sweet respite from the physical challenge. I focused on the task at hand which reminded me why I was there in the first place.

A sense of resolve took hold. Medicine often teaches us determination—to navigate the unexpected and keep moving forward. This time, the lesson wasn’t just academic; it was personal. It underscored the very heart of medicine—our ability to persevere, adapt, and find purpose even in the face of discomfort and challenge.

Looking back, I recognize this experience as a testament to adaptability and endurance. Keats’ words from Endymion resonate deeply, “A thing of beauty is a joy forever: Its loveliness increases; it will never pass into nothingness.” These words remind me that even in adversity, there exists an enduring beauty: a quiet, profound resilience that illuminates our purpose. That day, the exam wasn’t the only test I faced. I’m proud to say that despite the challenges, I passed my exam—a triumph that felt as much about overcoming adversity as academic achievement. And while I would have preferred to learn that lesson without a fracture, the experience serves as an important reminder.

Even in moments of literal and metaphorical missteps, we can find our footing again. + Dr. Parul Chhatpar is a PGY-2 preventive medicine resident at UMass Chan. She is passionate about addiction medicine, health equity, and evidence-based strategies to improve care for underserved populations.

Email: drparulchhatpar@gmail.com

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Curbside with Dr. Baker Christopher Baker MD, UMass radiologist/contributing cartoonist to Cartoonstock.com

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t sat on my shelf, creased just so, the slim spine a reminder of what I thought medicine could be — a journey of discovery, resilience, and the skill of managing uncertainty. My mentor and writing professor gifted it to me, a nod of encouragement for my journey as both a medical student and a writer: Siddhartha Mukherjee’s The Laws of Medicine . One passage from the book has lingered in my mind, depicting a legendary surgeon, Dr. Castle, whose presence in the operating room (OR) was nothing short of commanding. His mastery of surgery, so formidable “that he allowed the students to do most of the operating, knowing that he could anticipate their mistakes or correct them swiftly after,” left an indelible mark on those around him. And then, as if to hint at his humanity outside the OR, Mukherjee snuck in a one-sentence mention of Castle’s weekend retreats to the sea, where he sailed on a vessel aptly named “The Knife”.

The imagery of Dr. Castle, both in the OR and his leisure time on the water, fascinated me. This was the archetypal surgeon: skilled, composed, and confident in every facet of his life. It wasn’t long before the seed planted by the story of Dr. Castle took root in my mind.

I found myself drawn to the sailing club on the lake, perhaps yearning to give reason to the model yacht holding such a prominent position in my room, or perhaps conflating my desire to be the man written on the pages with the need to be a sailor. Either way, and on a whim, I made the decision to sign up for sailing classes during the summer of medical school.

As I stepped onto the deck of a sailboat for the first time, a sense of apprehension quickly enveloped me; my sense of stability rocked with each small wave. The terminology was entirely foreign – “it’s time to raise the halyard”, “don’t forget to tighten the boom vang”, or “we’re not ready to gybe yet” – but beneath the surface lay an undeniable allure: a promise of childlike adventure, a

Above it on my shelf sat a model of the 1992 America3 sailing yacht, its mast just barely avoided scraping the ceiling. It, unlike the book, was indeed a mere trinket; ornamental as a means to suggest refinement of taste. Years later, I thought back to these bookshelf items while watching the sailboats on the lake from the seventh-floor conference room of my medical school. From that vantage point, I observed the sailors, occasionally glimpsing moments of struggle as they grappled with the lines, trying to tame the luffing sail. It felt like a serendipitous sign.

chance to learn something new without the responsibility to be good at it yet. A fitting promise, as our adult class followed a summer camp of nine- and ten-year-olds learning the same things earlier in the day.

In the weeks that followed, I immersed myself in the world of sailing, learning the ropes — quite literally — and embracing the process of learning with a childlike curiosity that I hadn’t felt in years. Sailing was entirely

Learning the Ropes, Literally Sahil Nawab, BS

I

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The Heart of Medicine new to me, and with that unfamiliarity came a refreshing sense of freedom. There was no pressure to be an expert or even to be competent — just the joy of discovery. Much like the children in the camp immediately before us, I allowed myself to stumble, make mistakes, and, more importantly, ask questions without inhibition.

When I took that spirit of learning back to medical training, that same sense of awe and wonder became readily apparent in my studies. I found a renewed motivation to push through the challenges and rigors of medical school. As adults, we often shy away from admitting what we don’t know, fearing judgment or embarrassment. This is especially true in medical school. But in this new setting, surrounded by knots, sails, and terminology that made little sense to me at first, I let go. I was no longer concerned with how I appeared to my peers. I tapped into the openness of my inner nine-year-old, who wasn’t afraid to ask why the boom vang needed tightening, what would happen if the sail wasn’t properly trimmed, or what the clew was for the twelfth time.

In doing so, I rediscovered the beauty of learning like a kid — not burdened by the self-consciousness of adulthood, but driven by an insatiable curiosity. Every mistake was a lesson, every failure an opportunity to understand something new. Like the children who spent their summer mornings mastering the art of tacking and gybing, I approached each challenge with a willingness to fail, eager to see what the next lesson would teach me. In the seriousness of medicine, it’s a lesson that I often neglected.

Learning in this way also brought an unexpected joy. I found myself laughing at my missteps (and almost falling in the water at least once), celebrating small victories like tying a proper knot or gybing without losing control of the boat. With each outing, my skills grew, but more importantly, so did my sense of wonder and appreciation for the learning process itself. That summer of sailing, it turns out, was not just about mastering technique—it was about recapturing the fearless, inquisitive spirit of youth. Bringing that same fearless curiosity back to medical school, I’m reminded that the path to becoming a doctor isn’t just about getting things right; it’s about embracing each challenge as an opportunity to learn and grow, with the wonder and excitement of a child. + Sahil Nawab, BS, Medical Student, UMass Chan Medical School Email: sahil.nawab@umassmed.edu This article was originally published in Doximity as an Op-Ed on January 21, 2025, and can be accessed at: https://opmed.doximity.com/ articles/learning-the-ropes-of-medicine-literally

Feature Photo

Dr. J. Aaron Scott, anesthesiologist/intensivist at UMass, shares a goofy "3 roaring T-Rexes" moment with his 3-year-old daughter, Olivia, on her first time visiting the hospital.

J. Aaron Scott, DO, FCCP, FCCM, FASA Associate Professor of Anesthesiology & Perioperative Medicine and Surgery Program Director, Anesthesiology & Perioperative Medicine Residency Medical Director, 3 Lakeside Heart and Vascular Intensive Care Unit Department of Anesthesiology & Perioperative Medicine, Division of Critical Care Medicine UMass Chan Medical School aaron.scott@umassmemorial.org / james.scott@umassmed.edu

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Photo Corner

Healing Hands

Today's Class photo by Joel Popkin, MD

photo by Lisa S. Gussak MD

Greenwich Village Olympics photo by Joel Popkin, MD

photo by Joel Popkin, MD

The Pilot Got the Best View in the House

We'd love to feature your photography! Send your photo along with a short caption to mwright@wdms.org.

Brotherly Love photo by Martha Wright, MBA

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2025 Berlin Award Winners The Gerald F. Berlin Creative Writing Award at the University of Massachusetts Medical School honors the poetry, fiction and essays of medical students, physicians, in training (interns, residents and fellows), graduate students and nursing students from the medical school. The award was established to encourage creative writing by health professionals-in-training and to honor the father of Richard M. Berlin, MD, who sponsors the award.

First Place: You Could Have Killed Me Today Jaslyn Kindel, MD, Resident, Obstetrics and Gynecology, UMass Memorial jaslyn.kindel@umassmemorial.org TO READ THE WINNING PIECE, CLICK OR TAP HERE

Second Place: First Patient Liz Irvin, UMass Chan SOM, M3 elizabeth.irvin@umassmed.edu Third Place: On Superficial Anatomy Rowan Magnuson, UMass Chan SOM, M1 Rowan.Magnuson@Umassmed.edu

Honorable Mentions Matryoshka (originally Three to five business days of Grief) Haruna Choijilsuren, UMass Chan SOM, M1 haruna.choijilsuren@umassmed.edu; Whale Tale Park Abigail DeNike, UMass Chan SOM, M2 Abigail.denike@umassmed.edu East Palm Avenue, 2025 (same author as First Patient) Liz Irvin, UMass Chan SOM, M3 elizabeth.irvin@umassmed.edu Reclaiming My Identity: My Path to Becoming an OB/GYN Physician Alysandria Wayne, UMass Chan, SOM MS3 Alysandria.Wayne@umassmed.edu Connections Michael Wilson, UMass Chan, PGY1 michael.wilson@umassmemorial.org

Medical Director(s) Needed for St. Anne’s & St. Peter’s Free Medical Programs After eight years of dedicated service, Dr. Jane Lochrie will be stepping down as Medical Director of St. Anne’s & St. Peter’s Free Medical Programs at the end of 2025. We are seeking a new medical director(s) to continue leading these vital community programs.

St. Anne’s Free Medical Program was founded over 20 years ago by Dr. Harvey Clermont, providing essential healthcare services to underserved populations. In August 2020, St. Peter’s Free Medical Program was established to further expand access to care. Our mission is to deliver high-quality, respectful, and free medical care to Worcester County’s underserved residents. The programs are entirely volunteer-run, supported by a dedicated team of healthcare professionals, medical students, residents, and longtime volunteers who are committed to serving the community.

Program Details: St. Anne’s Free Medical Program – Tuesdays, 6:00-8:00 P.M. | 130 Boston Turnpike, Shrewsbury St. Peter’s Free Medical Program – Thursdays, 6:00-8:00 P.M. | 929 Main Street, Worcester If you are interested in learning more or would like to apply, please contact Lisa Izzo at (860) 983-8943 or lisa.pinnow@gmail.com.

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In Memoriam

Joyce Zoe Cariglia

January 5, 1945 – November 18, 2024 WDMS Executive Director 1985 – 2018

P

ast WDMS Executive Director, Joyce Cariglia, passed away at home on November 18, 2024, at age 79 after a life well lived. We at the Worcester District Medical Society owe her much.

After graduating from the Salter Secretarial School and working for a physician’s office, she came to the Worcester District in 1985 as then-Director Charlotte Wilder’s administrative assistant. When Ms. Wilder retired in 1990, Joyce was named Director. In that time, she brought to her role a calling for the medical profession and the ability of our society to bring physicians together to better themselves and their profession.

I had the pleasure of working with Joyce for her whole career at WDMS. She was always thinking of ways to do more and to do better. She was a creative force that could bring an idea to reality quickly and with little attention being paid to herself. Her span at the Society included the move to computers as well as the internet which she immersed herself in quickly, computerizing the financial records in the early 1990s and establishing a website for the Society.

She had a knack for taking members’ ideas and turning them into reality. Beyond the usual dinners and programs, many innovations came to us during her years including our TV show (Health Matters), the Spoken History Project, the Women’s Caucus, and numerous innovative medical education programs. Perhaps most outstanding was the development of Worcester Healthcare Outreach (WHO) which involved outreach in our community to address those in need. She actively sought and won grants from the Robert Wood Johnson Foundation as was able to staff up and meet the strict requirements of this process.

When her husband, Samuel, went through cancer care and eventually died, she recognized the failings of our system in end-of-life and got involved with the hospice movement as well as working with then-WDMS President Brownell Wheeler to focus on end-of-life education for the membership.

In addition to being predeceased by her husband, Samuel, in 1995, she lost her life partner, David Williams, in 2023. She is survived by her sister Loria Gourouses of Worcester. In her final years, she received much support from her good friend, Kim McGhee, as well as Hospice and Visiting Angels.

We are the beneficiaries of her dedication, creativity, and hard work.

Rest in peace, Joyce.

B. Dale Magee, MD WDMS President 1995, member since 1979

The Interstitium The Interstitium is a multimedia and literary publication for the UMass Chan Medical School and Worcester community.

On the website, you will find personal reflections from students and faculty on impactful moments in medicine, heartfelt testimonials from patients navigating the healthcare system, photography from around the world, and more. We hope to capture the experiences of our diverse community through art and the written word.

Please visit the website, share the stories, and consider submitting your own work.

In the words of Lucia Knoles, Ph.D, “Authors write in the radically optimistic hope that if they tell their stories you will listen, empathize with their suffering, and respect their humanity.”

CLICK OR TAP TO VISIT: InTheInterstitium.com

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