SAVE THE DATE FOR ACPNJ’S 2019 Scientific Meeting!


ACPNJ’s 2018 Scientific Meeting was a tremendous success!

More than 260 colleagues, undeterred by brutal Nor’easters, gathered together on March 9-10 in Princeton for our 2018 Scientific Meeting, and were treated to a outstanding conference.

Congratulations to St. Francis and RWJ, winners of the Resident and Student Challenge Bowls, along with the winners of the abstract poster and oral presentation competitions.

Thanks to all the internists, residents, students, presenters and exhibitors who made this year’s Scientific Meeting a tremendous success!

Enjoy these video highlights from the meeting.


2018 STORY SLAM

The following are transcripts of the stories presented by New Jersey physicians at the Story Slam held during the 2018 ACP-NJ Scientific Meeting.  Please check back as more stories will be added as they become available.

You may view the videos of these wonderful presentations in the playlist above.

 

“FRIENDLY FIRES IN THE NIGHT”

By Dr. Yesinia Galan
PGY-2
Saint Peter’s University Hospital

‘Attention please, attention please…’ My ears perk up as all ears do when on call overnight as the ICU resident. ‘Rapid response team to room 1426…’ I was already on my feet by the time I heard the word rapid. It’s a singular feeling walking down a hospital corridor toward the unknown a little after 3am. Kind of like what I envisioned when studying the fight or flight response in medical school.

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As I near the stairway entrance I can almost hear my amygdala whisper to my hypothalamus ‘someone is in distress, get her moving’. My hypothalamus then shouts to my autonomic nervous system ‘all hands on deck!’  As I round the next flight of stairs, I am buoyed by the burst of extra oxygen to my brain. ‘Hey wait up…’  I turn and see my junior resident running down the last flight after me. I am grateful to see him. He didn’t have to come, but his curiosity on this otherwise quiet night was appreciated. ‘Grab a cow, get me the latest labs, and be ready with the attending phone number please’. Computers-On-Wheels are those marvels of technology that are never around when you happen to need them most. As I entered the 1B corridor I was surprised to see a nursing aide standing outside of the patient’s room with her hand casually resting on the mobile blood pressure stand. Either there were too many people inside or worse, she was the last important person who was missing. ‘Let’s go’ I gently prodded her as I stepped in to see to our patient with only her nurse by her side. ‘Hi there Mrs. G,’ I said as I simultaneously flicked her wrist to read the name on her ID bracelet, noted that she looked at me when I talked, motioned to the nurse to give some relevant background. I slipped the blood pressure cuff onto her right arm after noticing that the other was in a sling.

As I triaged her, the subtleties of her humanity crept in. She was so thin and her wiry limbs reminded me of story characters described as ‘spindly, lanky, or gangly’. Her left arm was in a frayed sling and cradling a badly bruised shoulder. I can’t remember the last time I saw such a bruise. It was one of those sprawling splotches of pinks, blues, greens, browns. Her skin was deeply lined and her gray hair curled shortly around her head in one of those frozen grandmotherly styles. She was 95, a nonagenarian. I remember having looked up the term just last week after attending to a 97 year old.

I leaned in to ask her if she was in any pain. She was hard of hearing I had been told and didn’t have her hearing aids. Her eyes were what drew me in most. They were large and round and out of proportion to her small, withered face. They darted around curiously at the rest of the rapid response team who buzzed around her. She had the distinct look of an inquisitive child I thought as I stared.

The brown of each iris was flecked with gold. When she smiled and said ‘I’m ok’ I was transfixed. Simply lifting the corners of her mouth had lit wondrous fires deep inside her eyes. Friendly and warm, they kept me close. I actually leaned in for another millisecond longer really kind of amazed at what I saw.

My hands were still under the command of epinephrine. Tilting her neck to look for JVD. Feeling for PMI as the words ‘altered mental status’, ‘persistently tachycardic’ ‘known Afib,’ were spoken in pressured cadence by my junior resident.

Her heart sounds were irregular and dancing a jitterbug anywhere from 150 to 200 beats per minute. I made my way from her neck to her chest to her back with the stethoscope. I only paused over her belly to be sure it was the hard rim of her bladder that I felt just under the umbilicus.

‘Hmmm’ I said to myself as epinephrine took over again. ‘Start the oxygen’. ‘I need that EKG’. ‘Recycle the blood pressure’. ‘Call her daughter’. I listened again carefully at her neck before starting massage and said, ‘Ready the adenosine’ as my hypothalamus continued to orchestrate my steps.

Her heart rate settled down nicely after one IV push as only the most amenable of AV nodes do. I found out from her daughter that she had slipped while getting into her modified shower early that morning. She said that the sound of Mrs. G’s shoulder against the linoleum literally made her sick to her stomach.

Mrs. G had not been herself over the last two days. ‘How so?’ I asked. ‘Cheerful’ her daughter responded quickly. I smiled at that. It was an appropriate adjective I thought. One that I haven’t heard used to describe even the most pleasant of patients in my short career.

Over the next half hour our stress responses seemed to subside simultaneously. Mrs. G gradually settled back into her usual Afib at the same pace it took to get her tucked into bed. I settled back into my usual state of expectant calm for these shifts and reviewed her medication list for a clue as to what made her retain the liter of urine she drained after catheterization. The likely culprit of her troubles. She was in one of the rooms that had ambient lighting and a single yellow bulb burned over a sink with fancy backsplash . ‘Better now huh?’ I said peering into her face again so that she could hear me and read my lips. ‘Much’ she said and smiled again. The fires burned brighter now as the shadow of distress was gone. We held gazes until her bony hand reached up to touch my cheek. ‘You’re really sweet’ she said. I pressed her hand to my cheek and said, ‘Thanks, so are you.’ The warmth of those fires again kept me close. I watched her for the next couple of minutes as she dozed off. I then walked back to the nursing station for a copy of the ACP Hospitalist my junior resident finished earlier and rounded back to Mrs. G’s room. I pulled up the corner chair to her bedside. As I shifted in my seat and opened the magazine I thought about how I must look. It felt like I was settling in by a cozy fireplace with a great read. A friendly fire in the night.

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“GLORIA THE GLORIOUS”

By Dr. Roozbeh Ghavami
PGY-2
Capital Health Residency Program

I always thought that in your journey of life, there are events that define you, change you, defeat you, raise you and make you the person you will become.

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I met Gloria on my first day of clinic, practicing as a resident. She had a calm and collected voice of the ocean, soft hands like the calm Caribbean water, deep sparkling brown eyes like the sun and a soothing smile like the cool breeze of the ocean. I didn’t know where to start. I am sure that the terrified and scared look on my face was by no means the calming or assuring look of a doctor.

I went back to the basics to calm my nerves. After all, it is always easier to start with the familiar. So I started with “tell me about you.”

Then came the first wave, swiftly knocking me off my boat. Cancer. I felt flushed. But her sweet Caribbean island voice, somehow made the wave feel more warm than cold. Then came the rays of sunshine. She said: breast cancer, but I’ve been cured, that was many years ago. I gave her an assuring smile, more than anything, I was happy to hear that she was cured. Then came the second wave. “But now I have cancer in my liver and pancreas.” I felt flush again. This time, she saw the fear in my eyes. It was so obvious because now she is asking me, the doctor, if I am ok? I managed an assuring smile and lied. Yes, Yes, I’m ok. Being a mother, I am sure that she had read right through my lie.

I wasn’t. I was fighting a battle of my own, against the waves of cancer. My own mother is struggling with cancer and my family are all on the same boat, sailing against the waves of this rough sea.

I pushed away the fears, gathered up the little courage that I had left, smiled and asked her to continue. Gloria was here to manage her new onset of diabetes due to her pancreatic cancer.

Toward the end of the visit, I gathered a bit more courage, assured her that there is hope and that my own mother is fighting the same waves as her. Asked her to smile and stay strong. All along, realizing that I was really telling myself to smile and stay strong.

With each monthly visit, our relationship grew. We became friends and our visits were more social than medical. We shared experiences, news about the families, her grandkids, her and my mom’s struggles with the chemo. But none of that mattered. I was getting copied on each test and scan, notified of each hospital admission. I am sailing a drowning boat with no land in sight. But like a good captain, I sailed the course and assured the occupants of land in sight.

One day, Gloria’s daughter called me that mom is in the hospital again, and she wants to talk to you. I finished the long day and drove the other campus. There, lied my glorious Gloria. I had lived her decline over the past year and a half, but this was our boat capsized. Yet, she smiled, perked up in her ICU bed and assured me that she is doing well and well taken care of. She asked me about my mom and work. Told me about her holidays with all the grandkids. Laughed about how she didn’t watch her diet and that her sugars were likely running high on the next visit. All along, holding my hands and smiling with sparkles in her eyes, like the sun beaming off the calm ocean. Another great social visit. We planned for an office visit upon her discharge and kissed goodbye.

Today, among all my well‐wished birthday text messages and calls, came another message. My Gloria had passed. It took me a while to digest it. I could not decide if that was a joyous or a sad message. After all, I had seen her decline, and her passing was in‐fact peaceful ‐ My Gloria isn’t suffering anymore. I will miss our social clinic visits and her Caribbean calm. But then it hit me like that first wave on our first visit. Our last visit was her taking care of me, making sure that I was ok. It was her motherly instinct to show me that she is ok, and nothing to worry about, “it will be all right” as she would always say. Even though, she probably knew that was our last goodbye. Life will go on, we will sail another wave and an island is near under the sun. “It will be all right.” 

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“HOME IS WHERE THE HEART IS”

By Dr. Asim Khan
PGY-2
​​Overlook Medical Center

Home is where the heart is,
That’s how the old saying goes,
But where is home? Apparently No one knows.

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Feet perched up on the desk, the intern removes from her ears her brand new Bose,
The alarm of siren, a code blue – she sprints through obstacles high and low.
Pulseless, and they frantically rush without repose
Soundless, a vacuum of torrential medical prose,
And it all stops, pause – the strip is flat line it shows,
And they continue, lining up to take their turn in rows,
All on queue, a conveyor belt as far as the eye can go,
Compression after compression, it never slows,
Son and daughter arrive in the chaos and realize there is little hope,

He wanted to pass at home among loving hands he knows,
To die a wishful death, not in the drab room under a white throw,
He always used to say, you will reap the seeds you sow,
He didn’t want this, but he just didn’t know,
The doctor, she never told him he could silently go.
Instead he suffered one after one, painful blows.
Until the heart found its home, no more diastole to passively pour,
Into the cavity, motionless, absent of its rhythmic contour
The time of pronouncement: early morning four past four.

Her stethoscope extends on chest wall, only silence to hear,
Deep inside his heart she cannot peer,
She thinks made a mistake, she says never again for a hundred years!

Outside the dimly lit room,
Thunder strikes and they circle, all the crows
Forever more, forever more,
The tragedy more grim than the writings of Edgar Allen Poe.

If only the doctor had asked for more,
If only she had the courage gathered from her core,
She could’ve prevented what will become tragic lore,

To ask on that fateful night – before all of this – what are your wishes sir?
Would you like to to talk with family and stir,
I am not God, not a seer but with words sincere,
In this moment of pain, unknown, and hidden fear,
Together we will stay away from the heart ache so severe,
Together we agree to make you comfortable, so that you may reach the edge of the frontier,
Calm and serene, so your family may revere.

She sees the reality and awaits the anger and leer,
Of denial and frustration from family severe,
Of suffering she caused – it was her fault, isn’t so clear?

Instead, his daughter, exasperated and full of tears,
She whispers: Thank you my Dear,
You did all could, to make him reappear,
But surely it was his time, this second, this moment, this year,
Stay strong, for you are the vanguard of the weak and ill – far and near,
Stay strong, my darling, for my sake, I hope you can persevere.

The young intern, remembers the French saying ‘Garder Le Nord’
She says, keep steady and maintain the course,
For you, there is redemption, so you must rise above and soar,
Be wary of incessant guilt and remorse.

Looking back at the daughter, she too whispers:
My heart has found its home,
It is not in deep depths of misery and catacombs,
Like those that envelope the ancients of Rome,
But it is here, in this hospital, with you and all my patients: I choose not to suffer alone.

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2018 Scientific Meeting Highlights!
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