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Events, Medicine and Society, Stanford News

Anna Deavere Smith explores “crossing the line” of being sick and dying

Anna Deavere Smith explores "crossing the line" of being sick and dying

ADSThe New York Times has written that Anna Deavere Smith, playwright, actress and professor, is the “ultimate impressionist. She does people’s souls.” It was Jonathan King’s soul that Smith summoned up at the Jonathan King Lecture on campus earlier this week. The lecture series, celebrating its 25th year, honors King, who earned a master’s degree and PhD in computer science at Stanford and who became an advocate for patients’ rights after his cancer diagnosis in 1989. The series was created by friends and family to honor King’s memory and to carry on his message of “walking in the shoes of your patients.”

The event opened with a video of King during his life and battle with cancer, including portions of a talk he gave to medical students in which he said, “There is a line that divides people who have passed over to the condition I am in from everybody else.”

Smith weaved those words throughout her performance, as she brought to life patients she had interviewed in the course of her research for her landmark one-woman show “Let Me Down Easy.” Those real life patients included Hazel Merritt, a diabetic patient who had compelling reasons to refuse dialysis treatment; Ruth Katz, former associate dean of administration at Yale Medical School; Ann Richards, former Governor of Texas; and Eduardo Guerro, a patient who said, “You can’t turn dying into a picnic.”

What medical professionals CAN do however, Smith said, is recognize the whole person in the patient. “Take in everything they are, and that starts when you walk in the room and touch the patient,” Smith said. She then echoed King’s advice saying, “Get as close to your patients as possible.”

Smith also addressed the “line” that King referred to. “There is a matter of, of… aloneness for those who have passed over that line, and we can do better as humans and as a society to work to get over it. We need to imagine crossing that line, because we are all human, and we are all going to die.”

In the Q&A portion of the lecture, medical student Arunami Kohli thanked Smith for her moving performance and asked her how she got patients to speak so candidly. Smith’s answer: “I have found when people are in crisis, they want to restore their dignity, and when they do, they are so eloquent, they sing. Just remember to give patients that opportunity, to restore their dignity.”

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics. The center hosts the Jonathan King Lecture.

Previously: Actor Anna Deavere Smith on getting into and under the skin of a character

Global Health, Pediatrics, Stanford News

Stanford Medicine magazine tells why a healthy childhood matters

Stanford Medicine magazine tells why a healthy childhood matters

cover 560 450
I’ve forgotten most of my childhood experiences – which is perfectly normal. But apparently my body remembers many of those experiences – and I learned while editing the new Stanford Medicine magazine that’s normal too. The fall issue’s special report, “Childhood: The road ahead,” is full of stories of researchers realizing the impact early experiences can have on adult health. Some of their discoveries are surprising.

“Some people think kids are protected by virtue of being kids. In fact, the opposite is true,” pediatric psychiatrist Victor Carrion, MD, told writer Erin Digitale, PhD, when she interviewed him for her story on the long-term effects of childhood trauma. Other writers found the same goes for other types of early damage: Kids are resilient but they also carry hidden scars.

The report also includes a Q&A with former President Jimmy Carter on discrimination against women and girls, which he considers the most serious human rights problem on Earth. The online version of the magazine includes audio of the Carter conversation.

Other highlights of the magazine’s special report include:

  • Go to bed“: An article on the devastating toll inadequate sleep takes on teens, with an update on efforts, including a Stanford project, to fix the problem.
  • When I grow up“: A report on the growing need for support of chronically ill children making the jump to adult care, and on the progress that’s being made.
  • Beyond behavior“: A story about a high school student’s return to health after an assault, and the new type of therapy that helped her.
  • Rocket men“: A feature about three rocket-combustion experts teaming up with a pediatrician to analyze the breath of critically ill children at warp speed.
  • Warm welcomes“: An article on blending Western medicine into traditional culture to reduce newborn mortality in the developing world.
  • Bad for the bone“: A quick look at a new way to study the toll of childhood disease on bones.

The issue also has an article on a surprising role for viruses in human embryos, as well as a report from India on how vision, investment and medical know-how has brought about an ambulance system — now 10 years old and one of the most important advances in global health today. The online version includes a video showing the ambulance system in action.

Many thanks to Lucile Packard Children’s Hospital Stanford, which helped support this issue.

Previously: This summer’s Stanford Medicine magazine shows some skin, Stanford Medicine magazine reports on time’s intersection with health and Stanford Medicine magazine traverses the immune system
Illustration from the cover of Stanford Medicine magazine’s fall 2015 issue by Christopher Silas Neal

Events, Patient Care, Stanford News

At first-ever Stanford Medicine 25 Symposium, a focus on bedside medicine and a call for community

At first-ever Stanford Medicine 25 Symposium, a focus on bedside medicine and a call for community

Stanford 25 event attendeesOn his first day as an attending physician at Stanford, Abraham Verghese, MD, noticed something unusual. “I was struck by the fact that the house staff were spending a great deal of time wedded to their computers,” he recalled. “And it was not their doing. They didn’t sign on to do that.”

His experience reflects an increasingly common trend in modern medicine: With the introduction of new medical technologies­­, physicians today find themselves spending more time at the monitor and less time at the bedside.

Verghese recounted his story to a packed room of physicians and clinical educators who had traveled to Stanford from places as far flung as Brazil and Australia to attend the inaugural Stanford Medicine 25 Symposium.

The two-day event provided attendees with the tools to foster and encourage a robust bedside medicine culture at their home institutions.

The time is right, said Verghese. Today, many physicians and educators are advocating for a more hands-on approach to medicine. At the same time, an increasing number of bedside medicine programs are popping up at universities and hospitals worldwide: “I’m hoping that this is the moment when we all come together, and we stay together and connected in this effort to take what we all believe are fundamental and important skills – important to the welfare of the patient, important to practice cost-effective medicine, important in choosing wisely – and we form a community with solidarity around that theme.”

Throughout the symposium, participants learned the basics of evidence-based physical diagnosis from Steve McGee, MD, author of a textbook of the same name and a professor of medicine at the University of Washington. They learned how to schedule and program consistent teaching rounds, and how to incorporate technology without losing connection with the patient. They also heard from Andrew Elder, MD, professor of medicine at Edinburgh University and Junaid Zaman, MD, a postdoctoral researcher at Imperial College London and Stanford, about the MRCP PACES examination – a high stakes clinical exam that all medical school graduates in the UK must pass to continue their postgraduate education, an exam run and administered by Elder.

During an afternoon panel, experts from Johns Hopkins, Stanford, the Seattle VA, and the University of Alabama, Birmingham discussed ways to create a bedside medicine culture. Ideas included inviting master clinicians to teach at the bedside and hosting regular workshops. But, the panelists agreed, the support of community is critical. “It’s really hard to build a bedside medicine experience,” noted Brian Garibaldi, MD, of Johns Hopkins. “Community is key.”

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Pediatrics, Public Safety, Stanford News

A reminder to parents to be careful of open windows

A reminder to parents to be careful of open windows

7867279958_6d74bdf4f7_z croppedPreventing falls from windows may not be something that’s on the mind of every parent – especially this time of year. But as the Indian summer continues here in the Bay Area and elsewhere, windows in homes may be left open, leaving kids vulnerable to accidents.

Over on the Healthier, Happier Lives Blog yesterday, Daniel Imler, MD, assistant professor of pediatric emergency medicine, talked about injuries caused by falls, noting that the most common kinds are extremity fractures, traumatic brain injuries, and damage to the cervical spine. After saying that “window screens only offer minimal help,” he also outlined some preventive tips for parents:

Move furniture away from windows and prevent children from climbing over. Locking all closed doors and windows is a great preventative measure as well. If you do open a window safety locks can help keep the window open only 4 inches for safety. Some families choose to install windows that open from the top down on floors above the ground level.

Previously: A young child, a falling cabinet, and a Life Flight rescueCarseats save lives, but only if kids are buckled in and Rattled by one child’s injury, a whole family becomes accident-prone
Photo by Kalexander2010

Global Health, Health Costs, Health Policy, Stanford News

Pharmaceutical adventures in India

Pharmaceutical adventures in India

medication in IndiaIn the course of a recent trip to India, I developed some minor health problems and found myself doing what many locals do: consulting with a pharmacist. India’s cities are peppered with these modest little storefronts, some the size of a large closet, which sit along the street, the pharmacists stationed on a stool behind a counter awaiting customers.

The pharmacies are stocked floor-to-ceiling with a plethora of remedies for whatever ails the human body and spirit. My husband and I sought treatment for an affliction common both to travelers and local Indians, caused by contamination in food and water: diarrhea. Despite our best food precautions, we managed to contract a case of the runs after eating at a very elegant restaurant in Jaipur in the northern province of Rajasthan. When a dose of Lomotil did not prove entirely effective, we decided to turn to a pharmacist for advice, as my experience traveling abroad is that local practitioners often know best how to treat common local problems.

The pharmacist asked us several questions in perfect English: Did we have a fever? Any vomiting? Any stomach cramps? No to the first two, yes to the last. He radiated a sense of confidence. He then produced two sets of pills in silver and green packages. We were advised to take these twice a day. He also gave us an electrolyte replacement solution, to be mixed with purified water and consumed twice daily as well. The pills had names I did not recognize, so I largely took them on faith, explicitly following his directions. The total cost for both of us: the equivalent of $2.50.

“You actually behaved in many ways like a many locals would – like a person who doesn’t have easy access to a health-care provider,” Nomita Divi, program manager of the Stanford India Health Policy Initiative, told me recently when I related my experiences.

Divi took a group of Stanford students – one med student, one masters and two undergraduates – to India for 8 weeks this summer to study this very phenomenon: the role of pharmacists in healthcare delivery in India, where a dire shortage of physicians, particularly primary care physicians, severely limits access to care. These pharmacists often serve as first-line providers, she said. Some have formal training, but many do not and operate on the basis of experience, as the students observed this summer, she said.

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Medical Education, Medical Schools, Medicine and Literature, Stanford News

Tiger mother, tiger cub: A Stanford doctor reflects on his upbringing

Tiger mother, tiger cub: A Stanford doctor reflects on his upbringing

Tiger Child Pic JAMA PedsWhen Amy Chua’s book, “Battle Hymn of the Tiger Mother” was published in 2011, Jason Nagata, MD, was in medical school at the University of California, San Francisco. He caught on to the humor (which escaped some of the book’s reviewers), and the anecdotes resonated with him – reminding him of his own strict and intense upbringing. “It was very funny and very controversial,” he said. “A lot of that book stuck with me from the child’s perspective.” He started to share some of those memories with people around him and found that his fellow med school students had similar stories, too. He wrote about his experiences as a “tiger child” in a funny and touching essay (subscription required) published online today in JAMA Pediatrics.

When I connected with Nagata, we spoke over Skype because he was working in Ecuador as part of his global health residency. He noted that despite the negative press Chua’s book received, he believes that strict childhood training helped prepare him for medical school. “The tiger mentality is prevalent throughout medicine,” he said. “It was intense as a child, but it prepared me well for medical training – the hours and the intensity.”

But Nagata had to learn the hard way to make room in his schedule for rest. After a particularly intense time during medical school, he developed an ulcer that landed him in the hospital. His recovery took more than a month. He explored writing as a way to reflect and think through his experiences as a student and later as a doctor. When he came to Stanford, he attended the Medicine and the Muse writing workshops to hone his writing chops. His current essay is just the latest in a series.

Although he makes time for rest, he still has plenty of drive and intensity. He mentioned that he was planning a trip to the Galápagos Islands and to hike Mount Chimborazo, the highest mountain in Ecuador, the weekend after we spoke. After he completes his residency at Stanford, he’ll start a three year fellowship in adolescent and young adult health in July 2016.

Nagata describes his own mother’s unusual path from NICU nurse to graduate student in chaplaincy. “She exemplified the tiger mom and probably works even harder than I do,” he said. “I got a lot of my habits from her.” She doesn’t demand as much from Nagata these days, but her Tiger mom spark isn’t completely gone. When he told his mother about the upcoming essay, she quipped that she was planning to write a rebuttal to JAMA Pediatrics “in her own tiger mother vein,” he said.

Previously: For group of Stanford doctors, writing helps them “make sense” of their experiences
Photo of Jason Nagata as child, courtesy of Jason Nagata

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

Medical students and physicians share their writings on “becoming a real doctor”

Medical students and physicians share their writings on "becoming a real doctor"

louisewenreading_CROPPEDThe dilemma of being a medical student on clinical rounds who wants to help patients but can’t was captured by third-year student Raymond Deng in his essay “Performing Grief,” at a recent reading held by Stanford’s Medicine and the Muse Program and Pegasus Physician Writers group.

The event, titled “Becoming a Real Doctor: Writings on Medical Education and Training,” also featured a poetry reading by fourth-year medical student Lauren Pischel, a book excerpt by Cornell physician Matt McCarthy, MD, and essay readings by Emily Liu, a second-year medical student, and Louise Wen, MD.

The audience of medical students, physicians, residents, nurses and community members listened attentively as Deng described what it can feel like to be a medical student:

For a year or two, you will inch your way on the tightrope towards white-coated authority from diligently reproduced sham. What you lack in clinical knowledge, you will compensate for with the appropriate attire. Be meticulous. Put on your requisite, freshly-pressed white coat. Hang your stethoscope across the nape of your neck. Cram the pockets of your white coat so full of notes and reference guides that they sag. Ignore the nagging incongruence: the fact that you’re not a doctor but you look like one. You want to help patients, but will settle for watching… You will feel like a cardboard marionette, dancing to the steady rhythm of acting competent and acting ignorant of your acting.

For Wen, it was acting against the rules of eating in the area of clinical care that afforded her the opportunity to connect with her patient, Sara, on a personal level:

Hey doc, here’s a treat for you, I know you guys work hard… Here, try some Afghani bread.” She looks up, eager to connect, and my own yearning to know this women beyond her illness swells within my chest. I can recite numerous details and data points about her medical history and hospital course, but her life as a human being is a gaping void.”

Eating the homemade bread, with “the inside as soft as pillowy sponge cake,” led to a sharing of photographs of Afghanistan and a filling of the void for Wen.

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Aging, Medical Apps, Stanford News, Technology

Stanford Letter Project, which helps users have end-of-life discussions, now available for mobile devices

Stanford Letter Project, which helps users have end-of-life discussions, now available for mobile devices

Stanford_LetterFor many of us, the topic of how we want to spend our final days rarely comes up in discussions with our family members or doctors. And a big reason why is that we think of reflecting on how we want to die as highly emotional and unpleasant.

But there are some compelling reasons to take the time to clarify what matters to you most in your waning days of life: It can reduce stress on your loved ones and help your physician provide a better quality of care.

Earlier this year, VJ Periyakoil, MD, director of palliative care education and training at Stanford, launched the Stanford Letter Project, a campaign to empower all adults to take the initiative to talk to their doctor about what matters most to them at life’s end.

Recently, Periyakoil released mobile app versions of the Stanford Letter Project for both the iPhone and Android. The apps, which offer templates comprised of simple questions aimed at getting the end-of-life conversation rolling, are free and can be downloaded from the iTunes and Google Play stores. Templates are available in Spanish, English, Italian, Taglog, Russian and Hindi.

As Periyakoil explained in a recent 1:2:1 podcast, “2.6 million Americans die every year, and very few of them get to talk to their doctor about their end of life wishes.” She urges every adult to tell their doctors about how they want to spend their last days; she suggests engaging in end-of-life discussions each time you reach a milestone in your life such as getting married, having a baby or being diagnosed with a chronic illness.

Previously: How would you like to die? Tell your doctor in a letter, Stanford doctor on a mission to empower patients to talk about end-of-life issues, Medicare to pay for end-of-life conversations with patients and “Everybody dies – just discuss it and agree on what you want

Research, Science, Stanford News

How Bio-X is fueling the #NextGreatDiscovery

How Bio-X is fueling the #NextGreatDiscovery


The videos, images and stories of #NextGreatDiscovery share two things in common: 1) They reveal the lives and motivations of amazing scientists carrying out basic research, and 2) All the scientists are affiliated with Stanford’s pioneering interdisciplinary institute Bio-X.

Almost 15 years ago, Stanford Bio-X was founded to support biomedical research with an interdisciplinary blend of X, which is to say all the fields across the street from Stanford University School of Medicine – engineering, chemistry, physics, biology, math and statistics as well as the professional schools of business, law and education. Bio-X later came to be housed in the Clark Center, located with crosswalks linking those schools and departments.

Two of the scientists featured in #NextGreatDiscovery recently won Nobel prizes in chemistry, and both discuss the importance of Stanford’s collaborative spirit in their research.

From Michael Levitt, PhD:

The university has the medical school and other departments very close to each other. This means that you can mix together all the sciences whether it is engineering and medicine, mathematics and medicine, statistics and medicine. All of these things are really close together so people are able to interact, groups are able to mix. I think it really is a remarkable environment.

From W.E. Moerner, PhD:

One aspect of research today is that our science has become more and more multidisciplinary. Exciting science occurs at the boundaries between conventional disciplines. Here at Stanford we have a spectacular environment for multidisciplinary work. That’s because in a very close proximity we have all of the humanities and sciences departments, the medical school departments and the engineering departments all close together, essentially across the street from one another right here close to my office.

In the series, scientists discuss the importance of funding for the basic sciences, as federal sources become more scarce. Both Levitt and Moerner have received Seed funding through Bio-X, which support new collaborations between scientists bridging disciplines. These grants are critical for promoting interdisciplinary research through funding at a time when federal resources for early stage collaborations are hard to come by, even for scientists whose research receives a nod from Stockholm.

Previously: #NextGreatDiscovery: Exploring the important work of basic scientists, The value of exploring jellyfish eyes: Scientist-penned book supports “curiosity-driven” research, Basic research underlies effort to thwart “greatest threat to face humanity”For third year in row, a Stanford faculty member wins the Nobel Prize in Chemistry and Stanford’s Michael Levitt wins 2013 Nobel Prize in Chemistry
Photo by Peter van Agtmael/Magnum Photos

Addiction, Behavioral Science, Genetics, Neuroscience, Research, Stanford News

Found: a novel assembly line in brain whose product may prevent alcoholism

Found: a novel assembly line in brain whose product may prevent alcoholism

alcohol silhouette

High-functioning binge drinkers can seem charming and stylish. The ultimate case in point: Nick and Nora of the famed Thirties/Forties “Thin Man” film series (you can skip the ad after the first few seconds).

But alcoholism’s terrific toll is better sighted on city streets than in celluloid skyscraper scenarios. At least half of all homeless people suffer from dependence on one or another addictive drug. (My Stanford Medicine article “The Neuroscience of Need” explores the physiology of addiction.) Alcohol, the most commonly abused of them all (not counting nicotine), has proved to be a particularly hard one to shake.

Alcoholism is an immense national and international health problem,” I wrote the other day in a news release explaining an exciting step toward a possible cure:

More than 200 million people globally, including 18 million Americans, suffer from it. Binge drinking [roughly four drinks in a single session for a man, five for a woman] substantially increases the likelihood of developing alcoholism. As many as one in four American adults report having engaged in binge drinking in the past month.

While there are a few approved drugs that induce great discomfort when a person uses them drinks alcohol, reduce its pleasant effects, or alleviate some of its unpleasant ones, there’s as of yet no “magic bullet” medication that eliminates the powerful cravings driving the addictive behavior to begin with.

But a study, just published in Science, by Stanford neuroscientist Jun Ding, PhD, and his associates, may be holding the ticket to such a medication. In the study, Ding’s team identified a previously unknown biochemical assembly line, in a network of nerve cells strongly tied to addiction, that produces a substance whose effect appears to prevent pleasurable activity from becoming addictive. The substance, known as GABA, acts as a brake on downstream nerve-cell transmission.

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