sept.2013

M E H A R R Y M E D I C A L C O L L E G E

P U L S EN E W S L E T T E R

6 WHAT SHOULD MEDICAL STUDENTS EXPECT FROM HEALTH CARE REFORM?

8 TO HURT OR TO HEAL?

4 “KI SA” : Reflections from a Meharrian Medical Missionary

2 A LETTER FROM THE FUTURE:Thoughts from a not-too-recent Meharry grad.

Rows of nervous, fidgeting young students, bright-eyed and beaming with smiles, stood with their white coats draped over their arms lined up and ready to take a momentous step toward the execution of their dreams. This August 16th marked the White Coat Ceremony for the Class of 2017 for students at Meharry Medical College. Cameras flashed as each student was called to the front of the Kresge Auditorium, where they slipped into their seal-embroidered, name-emblazoned white coats. I can only speak from my own experience, but fam-ily members at the School of Dentistry ceremony seemed more restless and eager than their own children. Adorned with that white symbol of the jour-ney toward a dentistry degree, students were sa-luted by President Dr. A. Cherrie Epps and Dr. Cher-ae Farmer-Dixon, the interim dean of the School of Dentistry. Family members cheered, offered

advice, and shared encouragement in spades. The speakers urged inductees to remember that with the white coat comes great responsibility and privi-lege. A recitation of the Student’s Oath was lead powerfully by the 2014 Class President, Christina Quarterman. The ceremony culminated in a picture of the freshly robed class smiling bright enough to reflect the future.

Carmen Blunt, DSI

a letter from the futureL. B. Adair II, MD

PULSE NEWSLETTER: AUGUST 2013

Dear Class of 2017, I recall vividly the intensity of the days leading up to my white coat ceremony in the Summer of 2002. I was just completing the post baccalaureate program at Meharry Medical College and was excited and nervous about the future. For many of us, the joy in these moments may be overshadowed by the anxiety of our first medical school biochemistry class. Perhaps the cries of congratulatory well-wishes and “good-lucks” that your family and friends bestow upon you are muffled by the recurring thoughts of financial dilemma. Adding to some of the confusion is that now we are hearing more and more about the Affordable Care Act and what it means for the future of healthcare and physicians. These are all very real concerns and I can appreciate them, both from your perspective and from the perspective of a physician who has finished training. You are probably going to tell yourself that I will now go into a diatribe about persis-tence. Yes. However, I find it far easier to be persistent when you know that victory is imminent if you keep doing the right things. That is why I am now writing this letter to you; written from the perspective of someone who has finished training in Nashville, Tennessee, and who is now

practicing radiology in Honolulu, Hawaii, a feat that once seemed unimaginable. I am not writing to give you the blueprint to passing your first Gross Anatomy test or acing Physiology. I just want-ed to simply outline a few suggestions that I wish some-one had given me. Please humor me by practicing an ex-ercise that I was introduced to during my internship year

at Harvard. Write yourself a letter about your commitments, not your goals, for first year and mail it to yourself. Goals are but wishes that depend on a myriad of extraneous variables while commitments are driven by your pure desire to succeed and are intrinsic to you. Commitments are what got you to medical school. Do not open the letter immediately, but wait until after your first year is completed and use it to measure your progress. This is important and will give you a true test of your ability to fulfill a promise to the most important person on this journey, which is you. Let us begin with the essentials. My father’s best friend from medical school gave me a 3-point outline to success in medical school the summer before I began the post-baccalaureate pro-gram. He said pray, read your “you know what” off, and stay out of the limelight. It was the third thing that I have recently come to understand. All of us have been leaders, team captains, class presidents, and valedictorians accustomed to excelling beyond the norm in some way or another. However, in medicine there are no heroes and the training of medicine is a good place to practice learning to conform. What he meant was that conformity is your friend.

...pray, read your “you-know-what” off,

and stay out of the limelight.

Simply put, stay within the bell curve. For example, if your classmates are reading before a lecture you probably should too. This will be particularly useful in residency and as a physician. As Denzel Washington’s character exclaimed in the movie Training Day, “Stay off of the rover.” Reading before the lecture produces “ah hah” moments rather than “!@@#??, zzZz” moments. A wise man once told me that the key to getting an A in medical school was to see the same material over and over again. Each time, he postulated, would allow a different level of detail to be observed from the previous visit. Hence the reason cramming is not a great way to learn and retain material. Finally, medical school is training day for the rest of your lives as medical professionals. It is where you will set the stage for how you will deal with adversity. It’s about realizing new fears and conquering them. It’s about not mistaking pain for pleasure or pleasure for pain. It’s about realizing that after 15 years of formal education, your mother is still smarter than you (you’re an outlier for this reason). It’s about realizing that there is a higher power and knowing that He will have faith in you when you don’t have faith in Him. It’s about realizing that medicine is an ap-prenticeship and you will learn the most in training by actually doing it. The skills you obtain can and will be monetized later – even the seemingly most insignificant ones. Dream big and give back once those dreams are realized. Welcome to Meharry.

Sincerely,Luther B. Adair, II, MD

C/O 2006

Cover Photo : Joshua Anthony

“Ki sa li genyen?”That was my first question to a slender young man who appeared to be in his early 30s. He sat next to what looked to be his mother who was lying on the floor writhing in pain. “What happened and when did it start?”He slowly placed his hand on his mother’s shoulder to help calm her down. “Deux moi de sa li di dan’l ap fel mal...epi e konsa li vin plus mal...” “Two months ago her tooth started hurting. A month later she began bleeding from her gums and it got worse and worse…”Her neck was severely inflamed and reddened with the rubor that signaled an infection deep below the superficial layers of skin. The right side of her jaw was swollen to about the size of a golf ball and it was obviously difficult for her to breathe as the inflammation and bleed-ing compressed her airways. A few beads of sweat fell into my eyes and I fumbled for a nap-kin in the front pocket of my medical scrubs. As he continued to talk, I translated his responses from Haitian Kreyol to the nine other Meharry medical and dental students. Surrounded by what appeared to be undis-rupted illness and chaos, I looked to Dr. Ber-thaud, one of the two faculty physicians that led our trip, for guidance and some semblance of order. Every single bed was full and the emergency room had standing room only. Dr. Berthaud had the calm, seasoned demeanor of someone who has lived and breathed the management of all types of uncommon and rare tropical diseases. He called one of the nurses over and had the patient switched to an antibiotic regimen that would treat the likely bacterial agents.

I flipped through a review book I had in my bag and looked up “Ludwig’s angina”. In the States it is considered a potentially life-threatening in-fection that requires urgent surgical manage-ment. The son said they brought her from a vil-lage located about 8 hours outside the capital, but for them it had turned into a two-day trip across the island. This was our first day at the General Hospital of Port-au-Prince, Haiti. The following day we met a 27-year-old mother-of-two who had come into the HIV clinic to refill her antiretroviral medications. One of her complaints was severe abdominal pain when taking the medications on an empty stomach. This complaint echoed the daily di-lemmas many patients face. Anti-retrovirals (among other medications) can cause severe abdominal pain if taken on an empty stomach, leaving many patients who are both sick and poor to decide whether they will spend the lit-tle money they have on food or medication. Sadly, she told us she often skips the medica-tion to avoid the pain.This brought to light one of the many prob-lems these health care providers face in their patient management. Often times behind the mirage of what initially looks like an easy fix stands a myriad of challenges.On our fourth day, we had the opportunity to visit one of the only major Tuberculosis clinics in Haiti. A clinic founded and pioneered by Dr. Berthaud himself. We unloaded 12 fully packed boxes of luggage with medication, syringes, n95 masks, and countless other medical sup-plies. Seeing first hand the patients who need-ed those supplies for me was one of the many highlights of the trip.

Patients admitted to the TB clinic are often suffering from the worst stages of TB infections and what we witnessed was a testament to that. There was a young man who could not have weighed more than 100 pounds, battling a chronic TB infection; a woman who’s X-Ray showed severe dissemi-nation of the disease throughout her lungs; a mother wearing a protective n95 mask with her six year-old toddler coughing up speckles of blood as she sat on her mother’s lap.While each patient’s condition seemed daunt-ing, a ray of hope shone through the darkness of illness. Young and old Haitian doctors sur-rounded by a team of Meharry Medical Col-lege students serving patients of the same color, background, and race, allowed for a greater sense of comfort and relationship between patients and clinicians. This was a good reminder of an oft-quoted Haitian prov-erb, “Anpil men chay pa lou…” meaning “many hands make the burden light.” Being a first generation Haitian-Amer-ican, I know that the island is a beautiful gem of the Caribbean, and I was glad to share it with my fellow Meharrians. One night we were invited to dinner at the mansion of a Haitian-American diplomat and ate plate after plate of gourmet Haitian dishes. She shared with us all the pleasures of Haitian culture, which, in retrospect, was a shocking juxtaposition to what we had experienced earlier in the day. At dinner that night we spoke at length with her about the state of the Haitian health care

system and the role we young student doc-tors would be expected to fill. Meharry urges students to uphold a commitment to service. It cannot be overstated that this principle de-fines who we are. Hearing this phrase is one thing, but seeing it embodied in the faculty that teach us and lead us is an entirely differ-ent experience. Dr. Berthaud told a story that he says stuck with him from his first days as a doctor in Haiti. He described walking into the clinic to see a beautiful 14-year-old girl who lay dead on a hospital bed. When he asked the nurse for her history she told him the girl’s father went to his home village to borrow the $15 US dollars it would cost to purchase the neces-sary antibiotics. The girl died before he could make it back. The reason why, Dr. Berthaud explained, he would always carry extra cash with him to the clinic. The next time I ask a patient “Ki sa ou ge-nyen?” or “What brings you into the hospital today?” I will be prepared for the response, thanks to Meharry Medical College and my experience on the Haiti Medical Missions trip.

"Ki Sa"E l v i s F ra n c o i s M S I I I

Pictured Above L-R: Chantelle Ceasar MSIII, Jenny Ousley MSIII, Christina Hardaway DS IV,

Elvis Francois MSIII, Michael Paul MSII, Jeffery Pascal MSIII, Joshua Anthony MSIII,

Monica Buckner MSIII Credit: Joshua Anthony

To the uninitiated, these are merely three liberal arts courses and a medical chore. But we are the initiated, aren’t we, Meharrians? The most valuable tool in the clinician’s arsenal is the history. The story rather—the narrative, if you will. This year, we at The Pulse have renewed our commitment to this part of medical practice. Through written word and carefully curated visual media we hope to raise the bar of medical narratives and challenge the rest of Meharry to do the same. The definition of such a narrative is no longer limited to a boring personal statement sub-mitted during the height of application season. It now includes artwork and videography, oratory and medical journalism. Even medical mixtapes will be considered. We want to hear about Me-harrians at TED-Med, veganism as a way of life, and the non-traditional path to medicine. We want to hear from you.August 28, 2013 : 50th Anniversary of the March on Washington

Dr. Martin Luther King Jr. and Henry David Thoreau occupied two different spaces, walked in two different worlds, breathed in two different centuries, and followed two different paths. But one thing they both sought, and one thing I live deliberately for is balance, which I believe to be an essential fact of life.Thoreau’s search for balance led him not only to the woods of Concord, Massachusetts, but to the woods of his soul to discover life distilled to its basic elements, devoid of materialism, and “unnatural” states of being. Troubled by the possibility that it would be only at the end of his life that he realized the seemingly meaningful elements of his life were in fact meaningless, Tho-reau challenged himself to find this balance, and shed the cloaks of his modern world so that he could connect to a world without the unnecessary tangibles of his daily life.Similarly, Dr. Martin Luther King Jr.’s search for balance led him into the woods. Dr. King’s woods, however, contained no trees; there was no bark, there were no leaves. In his woods, Dr. King sought to balance a system that for too long had been oppressive to a people. A system upon whose limbs a crow named Jim made his bed, and upon whose branches strange fruit had been hung and plucked. Dr. King’s woods shook from the roars of civil disobedience, swayed from the breeze of peaceful resistance, and rang with demands for justice and equality. He had a vision that he realized could only be achieved if he removed himself from the reality of the unjust world in which he lived, and went into the woods with dreams of overturning the myth that his life, the life of his wife, children, and African-Americans would forever be tainted by de jure segregation. And so I reflect on my own woods, which I have discovered in the recesses of my soul, and where my quiet spirit often plays hide and seek. I cannot ignore this inner calm that foretold about my eventual arrival to these Meharry woods, at a time in my life when all I desired was for the seesaw of life to just...stop...tipping. I heard the whisper during a period of stillness and quiet in my life, and all of the sudden, the seesaw sat still on its fulcrum. Peace.That experience taught me the importance of living deliberately for balance, knowing that it is only then that my next steps become clear. Balancing has meant saying no in order to take the time to grieve from loss. Balancing has meant saying goodbye to toxic relationships, habits, and thoughts that have worn out their welcome in my life. Balancing has meant carving out a piece of my day to silence the chatter, unplug, and just...be. For what good am I to serve and heal others, when I have neglected to care and seek healing for myself?Most importantly, going into the woods and finding balance has meant drawing upon a strength that is greater than myself and establishing a connection with God who is always present, al-ways on time, and with whom I do not need an appointment or middle man to reach.I do not have a pond upon which I can contemplate life like Thoreau, nor have I led the crowds to march like Dr. King. However, like Thoreau and Dr. King, I have sought balance, and I have found it. It is only with this balance that I can fulfill my greater calling to worship God through service to mankind, and follow the path on which my feet have been set.

Oluwatoni Aluko MSII

balance

the new narrative

Spoken Word • Haiku • Photography • HPIJulian Hinson MSIII

Sign up for the 12 South Student-run Clinic

www.timecenter.com/12southclinicStudents with repeated volunteering sessions will be included in the Dean’s letter.

When compared across a five-year span (2009-2013), the change in positions-of-fered (between years) has grown six fold (from a 382 position difference to 2,400 position difference); the largest bump observed when stratified by specialty was in Internal Medicine. Though the infusion of 2,400 more residents may seem miniscule – in a time crunch, ac-cented by both a provider underage and the impending demand of larger patient panels, it proves to be rather significant. Moreover, it supports the notion that medical students are shifting into a workforce repository tailored to the ACA; it’s as if a primary care space is being

carved for wearers of short white jackets while their longer coats are still being measured. By virtue of fact, medical students should be heavily involved in the ongoing conversations surrounding resource allocation.

What should medical students expect? Current medical students should be sensitive to open enrollment and consumer in-formation campaigns (led by government of-ficials, community organizations, and advocacy groups), lending special attention to indica-tors of early adoption. If the enrollment sta-tistics in the first three months demonstrate a significant growth rate, it is likely that reflex opportunities will emerge, in both short and long-term forms. Generally, medical students should anticipate that the increasing patient pool will drive residency programs, in particu-lar – primary care residencies, to increase the quantity of available positions. Likewise, medi-cal students should expect an increase in ser-vice corps positions to match the structured training of a primary care workforce; in fact, expansion of loan-repayment and scholarship awards for service has already been under-written by the ACA (extending from 2011 to 2015).

Amidst the incentivisation, it is important to keep perspective – the developing health care

system is far from perfect, and will require the collaborative efforts of all stakeholders to achieve sustainability within the first 5 years of implementation. In that vein, the greatest expectation, and in some regards – the great-est privilege that students should own is the opportunity to pioneer health reform. Great-er responsibility will be placed in the hands of oncoming primary care providers as they reshape the face of modern care delivery in America.*

*Originally published on Kevin MD, June 5th 2013, and the RWJF blog, June 18th 2013

what should medical students expect from health reform?

Italo M. Brown, MPH, MSIII More residency match data can be found atpulsemmc.wordpress.com

In an ad-hoc poll among classmates,I recently inquired about the most important date (in 2013) to a 2nd year medical student. The overwhelming majority cited their respec-tive USMLE Step 1 exam dates as most impor-tant, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses all are worth their respec-tive weights, the one date that should bear the most gravity in the minds of medical students across cohorts is October 1st.

This October marks the launch of open enrollment for health insurance exchanges, a much-anticipated provision of the Affordable Care Act (ACA). The ACA seeks to reduce the number of nonelderly uninsured Americans by half; in other words, a projected 20 million new patients will be infused into the health care system over the next 18 months. With the burgeoning demand for care set to spike in 2014, the opportunities for frontline care providers seem abundant. And though still in training, budding physicians should be cogni-zant of the impending care demand and its implications. Further, it is paramount for stu-dents and health care stakeholders to share open dialogue about the unique role medical students fulfill as valued assets to the evolving health care system.

The stakeholders For years, the health care workforce has struggled to meet the service demands of pa-tients; in some respect, this has been attribut-ed to a disproportionate patient-to-provider ratio. According to the American Medical As-sociation (AMA), trend data projects a work-force shortage of roughly 63,000 providers in 2015 (interestingly, this is when most 2nd year medical students will be graduating). Naturally, stakeholders (i.e. providers, chief executive of-ficers and board members at respective non-profit and for-profit hospitals) are engaged in dialogue to develop new models of resource management. Many have speculated that this dialogue will yield innovative strategies to in-centivize primary care providers and support-ive staff. However, the role of medical students has yet to be fully elucidated, and therein lies a tremendous opportunity. The National Resi-dent Matching Program (NRMP) recently re-ported that, for the 2013 cycle, about 26,400 medical students were offered positions in domestic residency programs; 45% of the po-sitions offered were primary care-oriented. A year prior, roughly 24,000 medical students were successfully matched to programs; in 2011, that number was 23,400.

Miss Black & goldcommunity service court.

Pictured L-R : Rhae Battles MSIII, Ashley Taylor MSIII, Jensine’ Norman MSIII

We cannot deny that many of us have had some hurtful things happen in our lives. These hurts for most of us have been private or have had a very limited audience. Some of us are very good at hiding our hurt, but the truth is pain cannot stay hidden. As medical professionals, we know that pain is a sign of being hurt. Pain can show up in our habits, our relationships with others, our level of faith, and our neglect to pursue our divine desti-nies. Unfortunately, many of us find haven in living under the mantle of hurt for too long. Yes, we will all go through the place where we feel dumpy, aban-doned, rejected, used, abused, guilty, and ashamed, but God does not want us to stay in that place. There comes a time when we must decide whether to hurt or to heal. It seems like the answer is obvi-ous. However, there is a continuous struggle be-tween hurting and healing, an inner-debate among the flesh and the spirit. Some people would rather live with the hurt, because they are waiting on the person who caused them this harm to suffer in the same way. The anger and disappointment associ-ated with the pain afterwards makes it difficulat to

let go of the hurt in order to start healing. Some-times hurt can be so deep that a person convinces himself or herself that healing can never take place. A person in this situation lives believing that they can never be forgiven or that they can never be worthy of becoming a whole person. This simply is not true. We must ignore the thoughts that creep into our minds convincing us that we cannot heal. We can heal from addictions, from any type of abuse, and even from the most difficult experienc-es of suffering and loss. We can only experience healing if we come to a place where we can admit that we are in need of healing. Sometimes it is hard to reach to this place because we are so busy and focused on healing and helping others. We must also remember that a wounded healer also needs healing and help. As colleagues and peers we need each other as strongholds for support and for en-couragement; we cannot find strength and healing in isolation; and this does not come in the form of prescription drugs, surgery, or any manipulation of the body; its source is God’s grace and love. There is no sorrow that heaven cannot heal.

To Hurt or to Heal ?

Rev. Robin Harris Kimbrough

Freshly sharpened pencils, notebooks full of paper, and fully stocked backpacks mark the beginning of another school year. Unfortunately, many school children begin the year without the necessary supplies. The Miss Black and Gold Community Service Court seeks to change that. For the past two years, they have hosted a back-to-school bash at the Andrew Jackson Boys and Girls Club to get kids excited about returning to school. They also promote a healthy lifestyle by providing healthy snacks and interactive physical activity stations. The chil-dren made fruit kabobs with their favorite fruits and learned the importance of healthy snack choices. They also practiced teamwork while playing basketball and competing in an obstacle course. This year the Court got help from other Meharry organizations. The Pediatric Dental Club taught the children how to properly brush while having fun. The Family Medicine Group taught the importance of preventative care. Finally, boys were sent to school looking their best with haircuts sponsored by SOM Class of 2015. Everyone enjoyed the back to school bash and over 50 children were sent home with school supplies. A raffle provided over 10 backpacks filled with goodies. The Miss Black and Gold Community Service Court would like to thank all the Meharrians who dedicated their time, energy, and enthusiasm to get these kids off to a great start.

our Community gets served

Jensine Norman MSIII

The Meharry Court Presents:Women’s Week 2013 - The Seven Wonders of the World

9•22•13

LETTER FROM THE EDITOR

September 16, 2013: New Beginnings

Word,Christopher Salib, MSII

Editor-in-Chief, The Pulse

From my 9th floor apartment window I have a wide view of the Meharry campus, the surrounding neighborhood, and the tops of skyscrapers etching Nashville’s downtown skyline. A view such as this certainly puts things into con-text. I’ve been thinking lately on the nature of new beginnings, as it seems much is transforming around here at Meharry. With a new generation of students, mul-tiple new buildings being built, a new curriculum in effect, and many new rhythms driving our lives, a kind of rebirth seems to be taking place.

To be frank, many are concerned about our upcoming accreditation and whispering about what future changes might be in store for us as students and as professionals. I do not have quick answers to these questions, but I do know that the shape of our future will only be as great as our vision of it. We cannot wait for the world to impress us; we must first impress the world. Accolades and recognition will come only after we have proved that we have earned them.

So what really does this all mean? What this means is that at this point in time, we are collectively in a unique position to transform ourselves into the peo-ple or institution we wish to become; we must simply put our ideas into action—well thought-out and deft action. Undoubtedly, change takes much effort, but several minds working toward the same cause make things happen much more quickly and with much more force.

I don’t mean to belabor any one point, I only intend to encourage our greatness. To remind my fellow Meharrians that this new era is a chance for us to write out our futures, not to wait for them, idly, to come to us. Do not complain about what is wrong; find out what needs to be done and do it. We are all here, after all, to make life better for each other and for ourselves.

I am reminded of a saying (I confess I don’t remember where I heard it), paraphrased, “the thing about transformation is that it begins, but it never ends.” Let us do brilliant things together that makes us proud to say we are Meharrians, brilliant things we can look back on and say, “Yes, we were a part of the Meharry Renaissance.”

Submissions, questions, and requests may be sent to The PULSE at pulse@email.mmc.edu

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