The Gift of Time

A little over one month ago, I graduated from medical school. Losing the title of “student” for the first time in my life prompted me to reflect on what I’ll miss most about being a medical student.

Without a moment’s hesitation, I know unequivocally the answer is time. From the first day of my clinical rotations, it was clear to me that more than anyone else on the team, as the medical student I had time. And time has the power to heal.

I took advantage of this gift every opportunity I could. The resultant conversations often impacted the patient’s trajectory. For example in talking with an overweight patient who needed a lung transplant, I learned he had recently lost over 80 lbs in six months. Prior to this realization, the team had feared he was unable to lose enough weight to qualify for a lung transplant. In a one on one conversation with a gang member who was demanding his own room upon transfer out of the ICU I learned he had been molested by a man as a child and was fearful his PTSD would worsen sharing a room with another man. We arranged for a private room.

There were also heart touching moments. Watching the eyes of an 80 year old woman with dementia light up as she sang every verse of her favorite Sunday school song with the palliative medicine team. Or watching a previously paralyzed man surprise his wife by standing up to greet her after his successful spine surgery. I can only hope these moments were as healing for the patients as they were educational and inspiring for me.

It saddens me to know that as a resident, I will no longer have the unstructured time I had as a medical student. I find solace in knowing med school memories of patients will forever be close to my heart. In residency I will strive to be efficient with my duties so when a patient remembers “one more question” as I walk to the door, I will have time to truly listen. Time may not heal all wounds, but it’s in these unscripted moments with patients that I find my inspiration.

Addendum: After writing this post, I came across a great blog post by Dr. Robert Centor titled, "Why do we expect productivity from physicians" arguing that we must continue to value time in the physician-patient relationship. I couldn't agree more.

Survivor as Physician

8/17/2017: Sharing this again. Inspired by all the courageous women and men of the #MeToo movement. 

8/2/2015: In light of the recent New York Magazine article in which 35 women share their stories of being assaulted by Bill Cosby and the #TheEmptyChair hashtag that followed, I am retweeting my own story in honor of the female surgeons and physicians who have privately shared their story with me and sit daily in #TheEmptyChair.

Yesterday I had the tremendous honor of receiving the UCSF Chancellor's Award for the Advancement of Women. As difficult as it is, I would like to share with you my acceptance speech. I have thought long and hard about "coming out" as a physician and in the end I have decided that if I can share the message of hope and healing with just one survivor, it will be worth it.

As a rape survivor and domestic violence advocate, I have shared my story with dozens of audiences. The majority of those times, I have relayed the lessons of my experience with minimal emotional investment or consequence. However last night, when I sat down to write this speech, I realized that this time is different. In less than two months I will be a doctor. Since getting my acceptance letter from UCSF, in the back of my mind I have always wondered how I would someday reconcile my new physician self with "Heather the survivor." Being chosen for this award has given me the courage to accept that "Heather the physician" will forever be inseparable from "Heather the survivor."

Preparing for this day, I debated how much I wanted to talk about my own story. Then I remembered how lost I felt picking up the pieces after the assault, how I yearned for the stories of other survivors. I wanted to know that recovery was possible.  I wanted to know how I could possibly heal from an invisible wound so deep the only way I could describe it was so say that “my soul was bleeding.”

15 years later, I can tell you that the healing never would have been possible without the commitment and support I received from the faculty and administration at my alma mater, the University of Wisconsin, Madison. From start to finish, my undergraduate degree took 8 years. Whether it was counseling support, excused late assignments, or weekly meetings with the dean and special test accommodations when my PTSD-induced exaggerated startle made it difficult to take my exams in a crowded room, the University of Wisconsin gave me the time and space I needed to heal and the support I needed graduate.

When it came time to choose which medical schools to apply to, I knew I would need a school that could provide me that same kind of support. Against the better wishes of all but my closest friends, I only applied to only one medical school. I literally decided upon UCSF based upon the impression I felt from their website. I did make a few campus visits to confirm my intuition and I made a special UCSF binder with paraphernalia of evidence as to why I felt at home at UCSF. I’d like to share with you two pieces of outreach materials I collected. One is a Sexual and Relationship Violence Resource Guide and the other is a guide for how managers can support faculty and staff dealing with the challenges of domestic violence. It was essential to be to be at an institution that had mechanisms in place for supporting survivors of me sexual and domestic violence. And I knew I had found that in UCSF.

After getting accepted, I looked up the UCSF’s resources for women and printed off the “Focus on Women” website. I took pride in joining an institution that visibly supported women.  I am even prouder today, knowing I will graduate from an institution with a female chancellor, Dr. Susan Desmond-Hellmann. Another document I printed off was Dr. Barbara Gerbert’s “Slow Steps to Change” report on the History of the Chancellor’s Advisory Committee on the Status of Women. I met Dr. Gerbert early on in my time at UCSF and Dr. Gerbert has been a tireless cheerleader and supporter throughout my medical education. Dr. Gerbert chaired the committee that proposed this award to Chancellor Martin in 1994. We wouldn’t be here today without her vision and hard work to make this award a reality.

If I can leave you with one message, it is that we need to provide increased support for survivors of sexual violence and foster a dialogue of healing. According to the National Intimate Partner and Sexual Violence Survey, conducted by the CDC in 2010 and was based on telephone interviews with more than 16,500 adults, more than one in three women have experienced sexual assault, physical violence or stalking by an intimate partner during their lifetime and the same is true for more than one in four men.

When I first began to deal with the emotional and physical health consequences of sexual violence in my life, I found some comfort in statistics such as these. Yet at the same time, I felt a deep sense of confusion—if intimate partner violence were so prevalent why didn’t my doctors know how to address my emotional pain? Why wasn’t anyone talking about healing? I couldn’t help but wonder if I were the only survivor who wasn’t able to quickly get over it and move on with her life.

As I became a vocal advocate, I learned most women and men suffer in silence. If you are a medical practitioner, I urge you to ask your patients about past and current sexual and domestic violence. Just acknowledging that intimate partner violence has an impact on our health can make a big difference. If you are a survivor yourself, I encourage you to share your story with others when it feels safe. My first month of medical school when I began to question if I had what it takes, a faculty member shared her own story of how being assaulted had impacted her medical education many years later. I held her story close to my heart and knew that I would be okay. Creating conversations of healing will allow survivors to know they are not alone and that healing and recovery are possible.

Thank you for this honor and thank you for your support.

Mentoring My Mentors: An unexpected opportunity in Twitter

Last year, when I needed a research project on short notice, my mentor, @BarbaraGerbert, suggested I do a “Twitter study” with her.  Dr. Gerbert had recently published PublicHealth Surveillance of Dental Pain via Twitter and she was certain I could find something of interest to research through Tweets. Only in hindsight can I fully appreciate how her suggestion would change my life and the endless opportunities and connections that awaited me in the vast “Twitterverse.” One of my favorite unexpected joys of Twitter has been the unique opportunity to "mentor my mentors."

While doing my lit review on Twitter, I stumbled upon @KentBottles' article, Twitter: An Essential Tool for Every Physician Leader and I started to wonder if perhaps Twitter had more to offer than just research data. As an experiment, I opened a Twitter account. It didn't take long to realize that Twitter was life changing. After discovering the far reaching opportunities at the intersection of social media and medicine, I wanted to share its virtues with everyone I knew. Thus when I emailed my general surgery mentor to see if he would have time to meet during the @AmCollSurgeons' Clinical Congress in San Francisco, I asked if he would be interested in "Twitter 101" tutorial. He graciously agreed.

Also at this conference, I planned to meet my first "Tweet friend", @AndrewMIbrahim who had invited me (via Twitter) to join his new national student group, acadsurg.org. As fate had it, both my mentor and Andrew texted me at the last minute to meet at exactly the same time. Even though I had never met Andrew in person, I figured it would work out fine--what a better assistant could I have to give a Twitter tutorial with than a fellow med student I met on Twitter? While we did not create an immediate social media convert out of my mentor, Andrew and I were able to convince him that Twitter was more than a passing fad and that its opportunities and applications in academic medicine were vast. Since that time, I have mentored many of my mentors in social media. I have introduced the Association of Women Surgeons to social media by starting and tweeting for their Twitter account @WomenSurgeons.

Ever since my first cup of “inspiration tea” shared with my biology professor during my undergraduate studies at the University of Wisconsin Madison, I have been hooked on the enthusiasm, support, and encouragement I receive from career mentors.  Through every step (and misstep) of my educational journey, my mentors have have been an invaluable source of inspiration and guidance. It has been a great privilege and honor to have the opportunity to "give back" to my mentors through teaching them how to Twitter. I am humbled by their commitment to lifelong learning.

I would like to give a special thank you to Dr. Vineet Arora @FutureDocs for her article, Twitter to Tenure: 7 ways social media advances my career, which has been a particularly useful tool in convincing my mentors that Twitter can benefit both their career and their patients. I would also like to thank the @MedEdChat community for teaching me the power and potential of social media to improve medical education.

Addendum: Since posting this I came across an excellent article on younger doctors mentoring older colleagues.