Thursday, August 11, 2022

Palliative Care: Healing beyond the operating room

This July, marked a new chapter in my formal education as a healer, when I began a year-long fellowship in Hospice and Palliative Care Medicine. I'm thrilled to have the opportunity for this training and hope to someday join the ranks of those board certified in both Surgery and Hospice and Palliative Care Medicine. While the combination of surgery and palliative care seems to surprise many, it was actually a Canadian surgeon and urologic oncologist, Balfour Mount, who first forged the concept of "palliative medicine." Surgeons including Geoffrey Dunn, Robert Milch and Anne Mosenthal have spread the ideals surgical palliative care in the United States, by espousing their importance through the ACS and other surgical organizations. I'm grateful for visionary surgeons Red Hoffman, Pringl Miller, Buddy Marterre and founding the Surgical Palliative Care Society.

With hopes to inspire more synergy in surgery and palliative care, I share my personal statement:

My interest in Palliative Care has always been deeply interwoven in my dream of becoming a surgeon. As a first year medical student, I understood doctors to be professionals skilled at making patients “feel better.” I believed surgical training would provide the broadest skillset to relieve patients’ suffering. As a third year medical student however, I quickly realized the misdirection of my perspective. I was initially perplexed to witness modern medicine’s prioritization of curing disease and prolonging life over the amelioration of suffering. I didn’t understand why costly interventions were performed without a moment’s consideration for the discomfort they inflicted, when low cost treatments for symptom management and pain control weren’t even considered.

Then I learned about palliative care. The interdisciplinary, patient-centered nature and focus on comfort and relief of suffering made sense to me. Addressing “total pain”, inclusive of physical, emotional, spiritual, and social realms enables the ease of suffering that had been intuitive to me. My only question was why these goals and skill set would be limited to palliative care physicians. In fourth year, I spent two weeks with the palliative care service. It was encouraging to observe how services provided by the palliative care team facilitated treatment of the whole patient. I found the privilege of guiding patients and their families through end of life decisions on par with the privilege of operating to return patients from the brink of death. Still I remained steadfast in my pursuit of becoming a surgeon and aspired to be equally skilled at alleviating suffering and enabling dignity when death is inevitable. 

Three years into general surgery residency, I am that much closer to realizing my dream. The exhilaration I feel each time I hold the scalpel reaffirms my career path. Poignant moments in patient care strengthen my aspirations to treat total pain and support patients and their loved ones through the passage of death. I will never forget intern year and the patient brought in by EMS with a nonpalpable pulse after a motor vehicle collision. Our heroic efforts in CPR brought her back multiple times during the primary trauma survey. When she finally maintained a pulse long enough to complete the CT scan, an obvious discontinuity in her cervical spine explained her lack of sympathetic tone, rendering her demise unavoidable. As soon as we showed her parents the CT scan and explained her prognosis, they asked that we cease resuscitation. With the medical team no longer surrounding all sides of the patient, her family was able to hold her hands and kiss her cheeks as they each took their moment to say goodbye.

It saddens me not every death I’ve witnessed has played out so peacefully. At present, primary palliative care is not a proficiency required of trauma and acute care surgeons. I find this paradoxical in light of the deep surgical roots of palliative care. Fifty years ago, it was a urologic oncologist, Balfour M. Mount, MD, who introduced and championed the field of palliative medicine. The American College of Surgeons established a committee on surgical palliative care in 2003. Yet the implementation of palliative care principles into trauma ICU care and an alliance between surgeons and palliative care clinicians has been slow to non-existent. The potential for synergy at the intersection of surgery and palliative care inspires me to become a trauma surgeon trained in palliative care. I can imagine no greater honor than to operate on trauma survivors and support their loved ones through their time of crisis. 

Training in palliative care will provide me the tools I need to palliate my patients both before surgery, and after. Surgical treatment is unique in that it often causes significant pain and suffering before patients experience long term benefit. It is imperative I have tools to minimize post surgical suffering and pain. It is equally important I am facile in supporting patients and their families in making medical decisions reflective of their goals and the richness of their life experience. Whether it be the 94 year old woman with intracranial hemorrhage secondary to falling while on anticoagulation, or the 30 year old construction worker who fell from the second story, the decision to discontinue artificial life support is never easy or straight forward. In the words of Cicely Saunders, “How people die remains in the memory of those who live on.” As a future trauma and critical care surgeon it is an unachievable goal to cure every disease or traumatic injury; my goal as a surgeon is to heal patients and their loved ones, in life as well as death.


Wednesday, April 7, 2021

Social Media, Solitude, and Survival

Conversations and advice on intern year tend to focus on surviving, the implication being that thriving can come later. Indeed, this is how intern year has felt for me (twice!)--endless patient care “checky boxes” in the hospital with limited time at home consumed by family life and studying squeezed between requisite personal hygiene, nutrition, and sleep to sustain human life. For interns of the 2019-2020 academic year, surviving meant not only adjusting to 80-hour work weeks and learning to respond when referred to as “doctor”, but doing so in the midst of a once-in-a-century global pandemic. Just when I’d made peace with being too busy to attend family events, much less make a dentist appointment, I found myself geographically separated from my husband and children for 8 weeks, with all dental offices closed for the foreseeable future.

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My family was blessed with the option of staying with relatives nearby; the sacrifice for this safety and seclusion being I saw them solely through a video screen for 8 weeks. I was especially grateful for this convenience, weeks into the separation, when I spiked a temp of 102 less than 24 hours after my immediate co-worker tested positive for COVID. Thankfully I did not require hospitalization. Even still I have never felt so profoundly ill in all my life. As I mindfully adjusted by breathing to alleviate the burning sensation triggered by air passing through my bronchi, I was especially comforted to know my family was safely secluded, miles away. Thankfully, I was able to return to clinical duties 14 days after I came down with symptoms. I survived largely unscathed, though I did experience weeks of alopecia a few months after recovering, and noticed a post-viral tremor--something which I’ve seen scarcely discussed in the literature. 

As someone who leans on my closest friends when stressed, I disengaged from social media as a means
is of survival. I continued the virtual solitude when my second year schedule was unwittingly front loaded with the most difficult rotations packed into the first 6 months. Now with my critical care rotations, months of nights, and the ABSITE behind me, I have space to reflect on the last year and a half. What strikes me is that while I may have been on a social media hiatus, the spirit and positive energy of the SoMe community were with me every surgeon-paced step of intern year as well as every moment immobilized on the couch, while I willed the air to stop burning my lungs. I am so grateful for each and every social media connection and memory; I can’t wait to return to the community--to meet the newcomers, and catch up with old friends.

I close with two quotes by the poet, Rainer Maria Rilke, that capture my experience of solitude from social media, as well as my excitement to return.

“But your solitude will be a support and a home for you, even in the midst of very unfamiliar circumstances, and from it you will find all your paths.”

“I am so glad you are here. It helps me realize how beautiful my world is.”

― Rainer Maria Rilke

Wishing you health, happiness, growth, and connection in 2021.

Thursday, August 23, 2018

Six #ProTips for a Successful Departmental Social Media Presence

by Heather Logghe, MD

More and more surgical departments (and departments of all medical disciplines) are realizing the value of Twitter and other social media to build their reputation, promote the treatment offerings and research of their department, and connect with potential patients, residents, and faculty. Given the recency of social media, particularly as a critical component of a department’s public presence, there is much uncertainty and limited research to guide best practices. The tips and resources shared here are based on my presentation at the 2018 Association of Program Directors in Surgery (APDS) Surgical Education Week.

#1: Be Likeable
Just as with in person interactions, niceness, gratitude, and positivity go a long way. The book Likeable Social Media by David Kerpin offers a useful pyramid representing the building blocks of a likeable business on social media. It should come as no surprise these qualities are a recipe for successful departmental social media accounts as they also align with the characteristics of a kind, empathetic, and impactful physician.

#2: Be visual
Bar graph by Buffer showing number of retweets that tweets with images get compared to tweets without imagesEye-tracking studies on internet readers show users spend more time looking at relevant images than text: visual content generates increased engagement over posts without. Tweets with images receive 150% more retweets than those without and Facebook posts with images generate over 2x engagement than posts without. Visual abstracts (graphic representations of research studies and findings) are particularly effective in increasing visibility of research findings.1

#3: Be educational
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Vikolian et al. found that tweets containing educational content2 generated more engagement than tweets with promotional content. Their article also details their use of a Twitter journal club to compliment their traditional in-person journal club, providing a unique opportunity for residents to serve as moderators. Lamb et al. at the University of Connecticut used Twitter to disseminate ABSITE questions, significantly improving ABSITE improvement compared to those who did not participate.3 Such efforts strengthens resident learning and contribute to program branding and international influence.

#4: Be listed
Twitter has an under-utilized list function that allows accounts to create multiple lists of users that can be viewed and followed by other users. These lists are an effective tool to showcase faculty, residents, and alumni of one’s department. For example, @JEFFsurgery has designated lists for all three. Thus, with just a few clicks, prospective faculty, trainees, and patients can see abbreviated profiles and easily follow of all users in the list. Note that lists appear more polished and welcoming when all users have a photo and completed profile as seen here.

#5: Be hashtagged
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When users search for, or click on a hyperlinked hashtag, they are shown tweets including that hashtag, regardless of whether they follow the associated accounts. Thus hashtags are a powerful way to expand one's audience. Useful hashtags in surgery include #SurgTweeting for tweets of general interest to surgeons; specialty-specific hashtags such as #plasticsurgery and #colorectalsurgery; disease-specific hashtags; education-oriented hashtags including #MedEd, #SurgEd, and #FOAMsurg (“free, open-access medical education” in surgery); and #ILookLikeASurgeon for tweets highlighting gender equity, diversity, and humanism in surgery. Finally most surgical conferences have a designated hashtag.

#6: Be smart, be respectful
Since the advent of social media, many have worried about physician professionalism and the potential for violation of patient confidentiality. It turns out that 1) physicians are as capable of conducting themselves professionally online as they are offline and 2) physicians have much to discuss without the inclusion of protected health information.4 That said, common sense and courtesy are essential. My advice is to consider whether something would be appropriate to share on a crowded hospital elevator. If not, it does not belong on social media.


1. Ibrahim AM, Lillemoe KD, Klingensmith ME, Dimick JB. Visual Abstracts to Disseminate Research on Social Media: A Prospective, Case-control Crossover Study. Ann Surg. April 2017. doi:10.1097/SLA.0000000000002277

2. Nikolian VC, Barrett M, Valbuena VS, et al. Educational content and the use of social media at US departments of surgery. Surgery. 2018;163(2):467-471.

3. Lamb LC, DiFiori MM, Jayaraman V, Shames BD, Feeney JM. Gamified Twitter Microblogging to Support Resident Preparation for the American Board of Surgery In-Service Training Examination. J Surg Educ. 2017;74(6):986-991.

Friday, January 19, 2018

#ILookLookLikeASurgeon is Catfished: #TimesUp

Since the inception of #ILookLikeASurgeon in 2015, many of us have taken great pride in the positivity of the movement. It is with great sadness that I share the article below, written by an individual* in the #ILookLikeASurgeon community, detailing how a single individual used the movement to harass and manipulate women surgeons for ulterior motives we may never fully understand.

Per request of the author, this blog post has been deleted. I apologize for the inconvenience and hope you understand.

The original post listed an email account that is no longer being managed.

If you would like further information, feel free to contact me at @LoggheMD.

Monday, March 27, 2017

#InspireSurgResearch: Connecting via Twitter to meet the needs of #SurgResearchers

By Dr. Angie Ingraham

"Passion is energy. Feel the power that comes from focusing on what excites you."
~Oprah Winfrey

Surgical research excites me. My pursuit of a career in academic surgery is inspired by a desire to better meet the needs of my patients, a love for lifelong learning, and inspiring and supportive mentors. Over the course of my career, the American College of Surgeons has fueled this passion through research opportunities, educational conferences, and access to world class mentorship. 

I am excited to share my passion for surgical research and the American College of Surgeons with like-minded residents and junior faculty as the Surgical Research Committee Liaison for the American College of Surgeons Resident and Associate Society (ACS-RAS). Initially, my top priority is connecting with residents, fellows, and junior faculty to better understand how the American College of Surgeons can support them in surgical research.
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The Surgical Research Committee (SRC) is a standing committee of the ACS that focuses on the progress of academic surgery and the funding, content, and direction of surgical research.

The SRC sponsors several educational programs including:

●      Symposia (Panel Sessions and Lectures) at the annual Clinical Congress
●      Profile in Surgical Research

The SRC is seeking input from the Resident and Associate Society of the American College of Surgeons (RAS-ACS) membership on the following research related topics:

●      Research in general and how RAS-ACS sees the College helping in the research mission
●      Research courses that RAS would like the College to develop (or modifications to the existing courses)
●      RAS’s opinion regarding the Surgical Forum and other research presentations and panels during the annual Clinical Congress

The SRC wants to design and redesign research and educational programs to meet the needs of the RAS-ACS membership in addition to that of Fellows of the ACS. To do so, the SRC needs the input of residents, fellows, and junior faculty.

Given the ease of social media for public dialogue, I would like to engage in an ongoing #InspireSurgResearch Twitter dialogue. Please use the hashtag to share how the ACS can serve you better in promoting and sustaining academic surgical research. 

I look forward to connecting with you via Twitter!

Dr. Angie Ingraham
ACS Surgical Research Committee Liaison