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Medical Education, Medicine and Literature

The book that made me go to medical school – and other good reads

The book that made me go to medical school - and other good reads

books - 560

Editor’s note: Over the last several months, numerous young Scope readers have inquired about which books they should be reading to prepare for a potential future in medicine. We asked medical student (and SMS-Unplugged contributor) Natalia Birgisson to offer some suggestions.

“In my business, you can lose big, but sometimes you win big, too.” So begins page 87 of the book that made me go to medical school. It was the summer after my freshman year of college and I was volunteering in an outpatient pediatric ward. In the span of a week, I had seen two babies die. A newborn died of complications from seizures right in front of me, and a two week old baby died of malnutrition as we watched him wither away in an incubator.

I couldn’t stand the feeling of being a part of a system that was cumbersome and ineffective, I couldn’t stand my heart breaking, and I wanted to want to be anything other than a doctor. I lay in bed the next day and looked around my rented tropical room for distraction. On the night table was a book left by the last guest, The Soul of Medicine: Tales from the Bedside by Sherwin Nuland, MD, and what I found in his collection of stories was solace, companionship, and hope. It is a compilation of stories, each chapter written by a doctor in a different specialty discussing his or her most memorable patient. If you’re interested in medicine, the reality of it, then I suggest taking Nuland up on his offer to glimpse the mark that medicine leaves on a doctor’s soul. I keep it next to my couch in case a lost friend ever happens upon it the way I did.

Mountains Beyond Mountains by Tracy Kidder was the next book that strongly influenced me. A detailed glimpse into the life story and accomplishments of Paul Farmer, MD, PhD, who not only serves as a role model for anyone interested in global health, but who has changed the world for the better in a tangible way. What I remember from this book is a short scene in which we learn that, at least during the time the journalist was shadowing him, Farmer saw his daughter only once a month. They say that part of a teenager’s angst is realizing that her parents are not perfect and being angry at them for their flaws. Well, Dr. Farmer, I’m still angry with you for missing out on your daughter’s childhood the way my dad did. And for the rest of my life, when I think about changing the world by saving peoples lives, it will be with the caveat of improving on the model that he lived by. Because to me, there’s no point in helping strangers if I’m hurting the ones I love.

Blue Collar, Blue Scrubs and Hot Lights, Cold Steel by Michael J. Collins, MD, were two medical memoirs that resonated strongly with me. I read these the summer that I was writing my medical school applications. Somehow, the application process has a way of making everyone feel incompetent or mediocre at best. And here was a guy who decided to take post-bachelor classes as a construction worker, carpool to medical school, and marry the love of his life before starting residency at the Mayo Clinic. Almost every page of his books had me laughing or crying as I rooted for him.

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Events, Medicine and Literature, Stanford News

For group of Stanford doctors, writing helps them “make sense” of their experiences

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At a Stanford Pegasus Physician Writers Forum last week, psychiatrist Shaili Jain, MD, told the 40-or-so attendees that writing and practicing medicine are synergistic. Medicine and motherhood: not so much.

“As one of my mentors once said, it’s called ‘juggling the joy,’” Jain said. “People who don’t think it’s a challenge are either in denial – or someone else is doing all the hard work.”

Jain was one of five authors who shared their work. She read an essay, called “The Trimesters,” that she had written ten years earlier about her initial struggles coping with her duel roles as doctor and to-be mother. During her pregnancy, Jain suffered from intense all-day sickness. “Panic set in; was this what life was going to be from now on? I feared I had entered a no-man’s land of perpetual dissatisfaction,” Jain wrote. She had to tell her patients, some who suffered from severe mental disorders, she would be off work — a situation that left her uncomfortable with the blurring of roles. Pregnancy was personal, yet it impinged on her professional life.

Yet patients have no choice but to share their inner secrets, fears, goals, what medical school alum Ward Trueblood, MD, called their “heart songs” in the poem, “Cancer Doctor.”

It started when he slowed
to ask about a grandson’s picture
or fetched a cup of ice
for the bed-bound, listened to
talk of a fishing hole, heard about a dog
that licked a woman’s morning eyes…

They were sharing heart
songs rarely whispered.
He grew softer, invited
in this open window
of each one’s brave longing.

Medicine is a privilege, Trueblood went on to say. “As a cancer doctor, one shares soul with their patients… so here I am, 76, and I’m still going into the hospital,” he said.

And for Jain, writing is an essential part of her job as a physician. “I have a compulsion to make sense of what I’m experiencing,” she said.

The Pegasus Physicians Writers group meets regularly.

Becky Bach is a former park ranger who now spends her time writing about science or practicing yoga. She is an intern at the Office of Communications and Public Affairs. 

Previously: On death and dying: A discussion of “giving news that no family members want to hearWhen death comes rapping at the chamber door: Writers inspired by crises and medical emergencies and “How cancer becomes us”: A conversation with author and anthropologist Lochlann Jain
Photo by annazuc

Events, Medicine and Literature, Medicine and Society, Patient Care, Stanford News

Abraham Verghese discusses stealing metaphors and the language of medicine at TEDMED

Abraham Verghese discusses stealing metaphors and the language of medicine at TEDMED

Abraham Verghese TEMED

Few of us pay close attention to metaphors used in the language of medicine. Instead, our focus is typically on words relating to symptoms, test results and diagnoses. But as Stanford physician and author Abraham Verghese, MD, explained last week at TEDMED in San Francisco (which was co-sponsored by Stanford Medicine), metaphors, particularly as they relate to medicine, are significant because “they explain our past… [and] share our present and, perhaps most importantly, the metaphors we pick predicate our future.”

Verghese took conference attendees through a “grand romp through medicine and metaphor” during a session titled “Stealing Smart,” which featured seven speakers and their stories on how stealing something from another field, such as the principles of video game design, could improve medicine. As a child with “no head for math,” Verghese was drawn to the written word and developed a love for metaphors. His physical and metaphorical journey into medicine originated with his childhood reading and, as he sheepishly admitted, his reading list “had a certain prurient bias.” In fact, he selected the novel that set the course of his life, Of Human Bondage by W. Somerset Maugham, because the title “had great promise.” Despite it’s lack of salacious content, the book made a lasting impression on Verghese.

He recalled reading about how the protagonist, a boy named Philip who was born with a clubfoot, overcame great adversity to become a physician. The character was intrigued at the variety of patients he meets in the wards of the hospital and marvels at their willingness to open up about their personal lives at a time of distress. In describing the doctor-patient relationship, the author writes, “There was humanity there in the rough.” Those words spoke deeply to young Verghese and “implied to [him] that not everyone could be a brilliant engineer, could be a brilliant artist, but anybody with a curiosity about the human condition, with a willingness to work hard, with an empathy for their fellow human being could become a great physician.” He added, “I came into [the profession] with the sense that medicine was a romantic passionate pursuit. I haven’t stopped feeling that way, and for someone who loved words anatomy was such fun.”

Verghese reveled in the abundance of medical metaphors throughout his training. The prevailing metaphor in anatomy was that of a house, while the overarching metaphor of physiology was that of a machine. When it came to describing symptoms, there was no shortage of metaphors: the “strawberry tongue” associated with scarlet fever, the “peau d’orange” appearance of the breast in breast cancer and the “apple-core” lesion of colon cancer. “That’s just the fruits – don’t get me started on the non-vegetarian stuff,” he joked.

But all of the metaphors noted in his talk are 60-100 years old, and when it came to naming one from more recent times Verghese was at a loss. He said:

In my lifetime, and I suspect in yours, we’ve seen so many new diseases – AIDS, SARS, Ebola, Lyme… We have so many new ways at looking inside the body and scanning the body, such as PET and MRI, and yet, strangely, not one new metaphor, that I can think of… It’s a strange paucity because we are so imaginative. The amount of science that has been done in the last 10 years eclipses anything that was done in the last 100 years. We’re not lacking in imagination, but we may be lacking in metaphorical imagination.

This dearth of metaphor has two consequences, he said. The first is that Congress isn’t funding biomedical research to the level that is necessary to advance new discoveries and treatments. The second is that patients are “not as enamored with our medicine and our science as we might think they should be,” he said. Verghese implored the audience to “create metaphors befitting our wonderful era discovery.” He encouraged those in the crowd and watching the livestream online to accept this challenge, saying, “I want to invite you to name things after yourself. Go ahead! Why not?”

As he closed the talk, Verghese shared the metaphor that has guided his life by saying:

It’s the metaphor of a calling. It’s the metaphor of a ministry of healing. It’s the metaphor of the great privilege we’re allowed, all of us with anything to do with health care, the privilege of being allowed into people’s lives when they are at their most vulnerable. It’s very much about the art of medicine. And we have to bring all the great science, all the big data, all the wonderful things that we’re going to be talking about [at this conference] to bear one human being to another… We have to love the sick. Each and everyone of them as if they were our own. And you know what? They are our own, because we are all humanity there in the rough.

Previously: Abraham Verghese urges Stanford grads to always remember the heritage and rituals of medicine, Inside Abraham Verghese’s bag, a collection of stories and Stanford’s Abraham Verghese honored as both author and healer

Medicine and Literature, Orthopedics, Patient Care, Pediatrics, Stanford News

From post-WWII Russia To 7-year-old Giana Brown, a limb-lengthening method evolves

From post-WWII Russia To 7-year-old Giana Brown, a limb-lengthening method evolves

young patientGiana Brown is one tough little girl. When she was 7 years old, an orthopedic surgeon, Jeffrey Young, MD, from Lucile Packard Children’s Hospital Stanford, placed a brace called a Taylor Spatial Frame on her lower left leg that would help lengthen it about three inches to match her right leg. To accomplish this, the brace would require adjustments of about one millimeter a day for more than six months.

Her parents could have made those adjustments, but Giana insisted on doing it herself. She used a little wrench to turn the knobs that would lengthen the struts on the brace according to a computer-generated, color-coded prescription sheet.

Sculpting Bones,” the story of Giana’s rare bone disorder, her surgery and her recovery, is featured in this summer’s edition of Stanford Medicine magazine. An animated graphic illustrates in detail how the brace and bone biology work together to lengthen limbs. The story focuses not only the remarkable method of cutting a bone and slowly lengthening the gap to allow it to grow — called “distraction osteogensis” — but also on the unusual history of the “external fixator” device that makes this growth possible.

The device originated in a remote region of Siberia, Russia, nearly 70 years ago, where a young doctor, Gavriil Ilizarov, MD, cared for a patient population that included soldiers returning from the front lines of World War II with a vast array of bone injuries. Ilizarov discovered his method of distraction osteogenesis by accident, and a revolutionary method of bone lengthening was born.

Several decades later, orthopedic surgeon Charles Taylor, MD, and his brother, engineer Harold Taylor, modernized the device, changing the angle of the struts for more flexibility, and creating a computer program that generated prescriptions, “accurate to within a millionth of an inch and a ten-thousandth of a degree,” for adjusting the struts daily.

Although Giana’s dad, Greg, accurately describes the device as “draconian-looking,” her surgeon, Young, hails it as an ideal tool for healing his pediatric patients. “I really like how the technology allows me to basically sculpt the bone,” he says. “It’s the perfect blend of engineering and art.”

For Giana Brown, the accuracy, simplicity, and artistry of the device has paid off: She’s back to running and playing with her friends the way a healthy, happy kid should. Read her story – and her tips for making life a little easier in the frame -  here.

Previously: Stanford Medicine magazine opens up the world of surgery
Photo of Giana Brown by Max Aguilera-Hellweg

Medicine and Literature, Stanford News, Surgery

A surgeon battles her own unexpected complications

A surgeon battles her own unexpected complications

I first interviewed Stanford surgeon Sherry Wren, MD, a year and a half ago for an article about a course she taught to other surgeons on global health care. Based on her personal experience from medical missions to Chad, Congo and Ivory Coast, it was obvious the course was a labor of love. Here was a surgeon who was passionate about her work, and whose goal it was to overcome any and all obstacles to save patients – from using papaya paste for wound dressing to hand drills for relieving brain bleeds. She made use of a combination of her surgical skills, her physical strength and her love for her work to accomplish her goals. “You have no idea how physically hard it is to crank a six-millimeter pin into someone’s femur with a hand drill,” she told me then. “And I’m strong.”

When Wren mentioned off-hand that she was still recovering from post-surgical paralysis after her own neck surgery, I knew there was another story waiting to be told. Almost two years later, that story about Wren’s struggle to return to surgery following the partial paralysis of one of her most important tools, her left hand, has been published in Stanford Medicine magazine. My colleague Paul Costello referenced it here earlier this month.

This is a story about a surgeon experiencing what it’s like to be on the other side of the scalpel when something goes horribly wrong. In the piece, she describes what she felt upon waking up following neck surgery:

My left hand was like a claw. I couldn’t lift my left knee. Then my surgeon came to see me, and I recognized that ‘Oh shit!’ look on his face, because I’ve had that ‘Oh shit!’ look many times.”

Wren, who injured her spine following a deep-sea diving shipwreck, also talks of her struggle to return to the demanding, 10-14 hours surgeries that she excels at despite lingering damage to her left hand and the accompanying depression that blindsided her. I wrote:

It was the correct diagnosis. The correct treatment. There was no surgical error. And yet somehow, the veteran surgeon who makes a living with her hands woke up partially paralyzed. The unexpected complications included paralysis of her left hand and her left leg, and a weakened right hand. Already she thinks, Will I still be able to operate? Already she thinks, What am I if I’m not a surgeon?

This is Wren’s very personal story, one that she tells open and honestly. The experience of being the patient has made her a better physician, she said. And it’s a story that she hopes by telling, others can learn from.

“I thought a lot about whether I wanted to share this story,” Wren said. I, for one, am appreciative that she did.

Previously: Sherry Wren, MD – a surgeon’s road home, Surgery: Up close and personal, Stanford Medicine magazine opens up the world of surgery Surgery: Up close and personal and Stanford general surgeon discusses the importance of surgery in global health care

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Medicine and Literature, Stanford News, Surgery

The operating room: long a woman’s domain

The operating room: long a woman’s domain

In my recent story for Stanford Medicine magazine on the transformational changes in surgery, I reported that “women were once personae non gratae in the operating room.” An alumna of the medical school, Judith Murphy, MD, took me to task for my choice of words, for as she points out, women have long been the backbone of the OR.

“In fact, for decades, women outnumbered men in the OR – circulating nurse, scrub nurse, overseeing nurse, etc.,” she wrote to me. “So it is not that there were no women in the OR, but there were no women surgeons. No Women Who Count, although everyone knows these nurses are essential to successful surgery.”

When she was a medical student at Stanford in the early 1970s, she says female students and faculty had to use bathrooms and lockers that were labeled “Nurses,” whereas the men’s room was labeled, “Doctors.”

“We all laughed about it, but it did reflect the unconscious assumptions that your language still perpetuates, all these years later and after so much progress,” she shared with me. “The women who came after us were a bit more empowered and did not think it was funny; they complained, and the doors were changed to Men and Women.”

Murphy, a practicing pediatrician in Palo Alto for decades, says she might not have made note of the issue were it not for a recent encounter with a male acquaintance who, on learning she was connected to Stanford Hospital, said, “I never knew you were a nurse.”

“When he said that, I thought, ‘Darn, I can’t believe this is still happening.’ I gave him my usual response: ‘I have great respect for nurses and could never have done as good a job without them, but in fact, I’m a doctor,’” said Murphy, who is now retired.

“The power of the cultural unconscious assumption remains strong, even here where we have come so far,” she wrote. “This has been happening to me occasionally for 40 years, less so lately. I had hoped it would become archaic.”

Murphy says her response may have been a bit testier than in the past. But she can be excused, for it is always good to be reminded of our unconscious biases about the role of women in health care, reflected both in our language and behavior.

Previously: Surgery: Up close and personal and Stanford Medicine magazine opens up the world of surgery

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Medicine and Literature, Stanford News

Stanford Medicine magazine in images

Stanford Medicine magazine in images

There were lots of oohs and aahs among my colleagues when we first got our hands on the latest issue of Stanford Medicine. The award-winning magazine always contains good stuff (kudos to editor Rosanne Spector), but we all agreed that the artwork in this issue was particularly strong. Above are some of the more striking images.

Previously: Stanford Medicine magazine opens up the world of surgery
First two images in first row by Max Aguilera-Hellweg; illustration by Gérard Dubois
Illustrations in second row by, from left to right, Jon Han, Tina Berning and Harry Campbell
Images in third row by, from left to right, Jon Han, Max Aguilera-Hellweg and Gérard Dubois

Anesthesiology, Medicine and Literature, Neuroscience

Exploring the conscious (and unconscious) brain in every day life

Exploring the conscious (and unconscious) brain in every day life

line of peopleThe first time I fainted, I was seven. I passed out while racing my fellow second-graders across the playground. One minute, I was leading the pack in the race; the next thing I knew, I was lying in the nurse’s office with adult faces hovering all around me. My parents explained to me that I’d lost consciousness – it was like falling asleep for a minute, they told me.

It frustrated me to no end- even as a seven year old – that I didn’t know where that time had gone. Why couldn’t I remember those moments where I collapsed onto the grass and got scooped up by a petrified teacher? I ended up fainting a handful of times over the next few years (luckily doctors chalked it up to nothing more than dehydration and a genetic propensity to faint), and each time I was reminded of that frustration of not being able to grasp what was going on in my brain during those lost minutes.

As a seven-year-old, I didn’t have the chance to call up scientists and ask them to explain the brain to me, so when I started working on a feature article on consciousness for the latest issue of Stanford Medicine magazine, I was thrilled that maybe I’d get that chance to finally answer those questions that had been lingering in my head for decades. What makes the brain go from awake and aware to such a blank state, and then back again?

But it’s not that simple, I learned: There’s no single switch that flips the brain from conscious to unconscious. In fact, consciousness isn’t an on-off switch at all; it’s a whole spectrum of states. Anesthesiologist Bruce MacIver, PhD, pointed me toward this handy chart that shows different levels of consciousness. Each state of consciousness has its own unique place on two scales: physical arousal and mental awareness. As I looked at it, I realized that my experience with altered consciousness wasn’t just limited to my childhood fainting episodes – we all go in and out of multiple states of consciousness on a daily basis, and not only when we fall asleep and wake up.

“If you’re an elite athlete and you get in that so-called ‘zone,’ that’s an altered state of consciousness,” anesthesiologist Divya Chander, MD, PhD, explained to me. I’m no elite athlete, but after talking to Chander, I suddenly started paying attention to those not infrequent times when I “zone out” while driving or exercising. And when I woke up to a noise in my house on a recent night, I immediately noticed my heightened senses – that alertness is an altered state of consciousness too.

“What I’m always hoping is that hearing about this kind of work makes people ask more questions about what it means when they themselves enter different states,” Chander said to me when we talked. Her message was not lost on me; I’ve become an active observer of my shifts in attention and awareness.

My Stanford Medicine story delves much deeper than these observations of daily life, to look at how and why anesthesiologists are probing what it means to be conscious – and how their research could lead to better anesthetic drugs. But I hope that in addition to conveying the science, it also helps readers realize that subtle changes in consciousness happen in your brain all the time.

As for the questions I had as a seven-year-old, they’re not fully answered, but I’ve only gotten more intrigued to know how the brain mediates consciousness, and more excited to follow where this research goes in the future.

Sarah C.P. Williams is an award-winning science writer based in Hawaii, covering biology, chemistry, translational research, medicine, ecology, technology and anything else that catches her eye.

Previously: Stanford Medicine magazine opens up the world of surgery, Your secret mind: A Stanford psychiatrist discusses tapping the motivational unconscious and Researchers gain new insights into state of anesthesia
lllustration by Jon Han

Medicine and Literature, Patient Care, Stanford News, Surgery

Surgery: Up close and personal

Surgery: Up close and personal

gholami - smallTens of millions of patients undergo surgery every year in the United States, yet very few have the opportunity to be on the other side and observe a surgical procedure in action.

I had that rare privilege recently in the course of writing a story for Stanford Medicine magazine about surgery and how far the field has come in recent decades. The operating room, I discovered, is a world unto itself. It’s governed by a strict set of rules to help safeguard patients, but within those strictures, there is an elaborate kind of dance and much artistry in the way clinicians work together and finesse the tools to help heal their patients.

Sepideh Gholami, MD, a six-year surgery resident at Stanford who is featured in the story, said it was in part this sense of artistry – the movement, rhythm and pacing – that attracted her to the profession. And like many surgeons, she found it gratifying to be able to use her hands to fix a problem to quickly restore a patient’s well-being. She describes one of her early experiences, assisting in a procedure to remove a life-threatening tumor from a young man’s colon.

“I remember going to the family afterward, saying that we were able to get it all out, and seeing the glow in their faces,” she told me. She said it was reminiscent of the experience of her own mother, who had a tumor extracted from her breast: “This is how it happened for my mom, who is now disease-free,” she said.

In the story, Gholami talks about her rather unusual path from an early childhood in revolutionary Iran to becoming a surgeon in the United States, as well as the changes in the profession that have opened the way  to young women like her. The story also explores the remarkable innovations in technology that have made the patient experience today far less invasive and less painful. Those innovations, as well as new workplace rules that limit trainees’ hours, have dramatically changed the way young surgeons like Gholami are being trained to become the independent, skilled practitioners of the future.

Previously: Stanford Medicine magazine opens up the world of surgery
Photo of Gholami by Max Aguilera-Hellweg

Medicine and Literature, Stanford News, Surgery

Stanford Medicine magazine opens up the world of surgery

Stanford Medicine magazine opens up the world of surgery

surgeon hands - 560

It used to be “big hole, big surgeon” — but no more, according to Stanford’s chair of surgery, Tom Krummel, MD, who’s one of the surgeons featured in Stanford Medicine magazine’s report on surgery and life in the operating room, “Inside job: Surgeons at work.”

During his career of more than 30 years, Krummel has seen a massive shift from open surgeries to minimally invasive procedures — major surgeries conducted with tools that work through small openings.

“We do the same big operation. We just don’t make a big hole,” he said in the article leading off the report.

In the same issue, CNN’s chief medical correspondent, neurosurgeon Sanjay Gupta, MD, talks about why he’s “doubling down” on his support for medical marijuana.

As the editor, I’m biased — but I think it’s worth a read, along with the rest of the issue, which includes:

The issue also includes a report on research on Alzheimer’s disease, and an excerpt from Surgeon General’s Warning, a new book by Associated Press medical reporter Mike Stobbe on the fall from power of the U.S. surgeon general. The digital edition offers audio interviews with Gupta, Stobbe, Stanford surgeon and humanitarian-aid volunteer Sherry Wren, MD, and photographer Max Aguilera-Hellweg, MD.

Previously: The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe, Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions, From womb to world: Stanford Medicine Magazine explores new work on having a baby and Factoring in the environment: A report from Stanford Medicine magazine
Photo by Max Aguilera-Hellweg

Stanford Medicine Resources: