logonj2017 ACPNJ Scientific Meeting Highlights

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

Check back often for highlights, photos and videos from the 2017 Scientific Meeting.

And stay tuned for details on the 2018 ACPNJ Scientific Meeting!

Photo Highlights
2017 Scientific Meeting


 

2017 STORY SLAM

The following are transcripts of the stories presented by New Jersey physicians at the Story Slam held during the 2017 ACP-NJ Scientific Meeting. You may view the videos of these wonderful presentations below.

Bring your parent to work day.

By Dr. Roozbeh Ghavami
Capital Health Residency Program

We all tell stories each and every day when we present a case to one another or during the rounds.  The story of an ailment, a discovery or a cure.  The story of hope, luck, laughter or loss.  Many of these stories are routine part of our daily life.  We forge personal bonds with our patients and we often hear their stories.  Some of these stories have a familiar tone, some strike close with our own experiences and some are too far to grasp.  Many years back I heard a toast at a dinner party that stuck with me.  The toast was simple, sweet and for many of us true.  Here is to health, wealth and happiness.

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Wealth and happiness is easy to part with, but health is the one wish that our profession wrestles with each and everyday.  Perhaps we have grown immune to the suffering of the patients or their families; side effect of our career one may say.  But this immunity is rapidly washed away when the patient is a loved one.  Now the statistics of mortality or immortality takes a different twist, does a crazy dance across the paper and gets a life of it own.  Now we quickly speed through the charts and data, battling the percentiles for another tenth or the hundredth, try to find flaws with the data, all in the wish for everlasting health.

Many of us have lost a loved one, and by no means I am alone in this crazy dance of life.  But the story telling of our day, takes a different road when the patient we are presenting is our parent or child.  Now the story is personal, it feels more real than anything else, and the patient is not just another name on our list.  The feeling of hopelessness is an unavoidable void.  I may be a young physician with little experience in life of medicine.  I may have not grown immune to the suffering, but that does not make this feeling naive.

It has been too often that I had to make a defeated patient comfortable in his or her last pages of story.  I have found the family vulnerable, hopeless and defeated.  But mostly I have found myself vulnerable and defeated just as much.  I begin to think of the moment that I will be THAT family member, and the defeated patient is my loved one.  I find myself sharing a tear with the family, exposing my vulnerability to them and becoming a part of their story.  But in that moment of loss, I feel the silver lining, again I find joy in my work, that the life goes on, more work is to be done, more battles to be fought and more stories to be read.  You wipe your tears of defeat, put on your assuring smile, and grab another story to read.

Randy Pausch, the mesmerizing Carnegie Mellon professor who lost his battle with pancreatic cancer said on his last lecture: that in life we cannot change the cards that we are dealt, just how we play the hand.  I may not be able to change the cards of my mothers’ health, but I can change how I play the hand.  Every patient is my loved one, and every patient’s story is my story.  Our book of life is filled with such stories.  Some have a sweet taste of victory, some are marred with defeat, some are filled with joy and some are empty with sadness.  But this is the book that I would never sell, stop writing or stop reading.

As a Persian poet Sepehri said: our job is not to discover the mysteries of the red rose, but to swim within it.

Here is to health, wealth and happiness.

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A Bridge to the Other Side

By Dr Aparna Daley
Capital Health Residency Program

It was a day like any other ‐ the early morning rush through traffic to get to the hospital, queuing in line to get signout on patients from an exhausted overnight intern, the smell of Starbucks wafting through the passages and the regular organized chaos of morning activities typical of a teaching hospital. I was three months into my internship. I had packed up my possessions, my memories, my dog (and eventually my husband, too) neatly into the designated parameters of shipping boxes and airline carriers and set off to explore a new dream.

I had been endlessly occupied settling into my new role as an intern, clerking patients, examining them, responding to calls of a vociferous and active pager and surreptitiously yet inadvertently entering the lives of patients. It was on one such morning that I saw her. We were gathered on the round. I was listening to one of my colleagues present her history to the attending. She was about 60 years old. Her delicate face bore furrows of one who has known hardship but has persisted with steely determination and yet there was a gentleness about her as though the fragility at her core, usually hidden from the world, was now evident. She had long, thin black hair, soft skin and weathered palms – those of someone who had known a hard life. My colleague mentioned “pancreatitis”, “gallstones”, “cholangitis” and then it all came back to me and I was taken to another continent, to a time barely two years ago and I saw her again; this time… my mother. I was taken back to the time, not too long ago, when instead of being the health care professional receiving the history, I was providing it; when instead of getting consent for procedures, I was signing consent for those procedures; to I time when I was waiting outside the operation room in the lobby, on a couch somewhere looking at the ceiling and waiting, wondering, hoping…

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My mother was diagnosed suddenly with cholangitis, about two and a half years ago. She had come for a national education meeting and despite feeling unwell, she insisted I drive her an hour away so she could hand in her papers for the meeting before allowing me to take to the hospital for admission. She had a gallstone obstructing her bile duct and required an ERCP.

Unfortunately, the ERCP triggered pancreatitis and over the next eleven weeks, as I sat by her bedside, I witnessed everything that pancreatitis can do to a 63 year‐old woman. Each day was a new trial – one step forward, then two back. A little improvement followed by deterioration followed by prayers, calls, communication, followed by improvement followed by deterioration… On and on the cycle went. I found myself in a unique position with a different perspective, speaking to her doctors and understanding the scenario in an entirely different light – truly understanding the complexities of the situation and finding myself, when my mother was unable to, signing consent for her procedures.

It was particularly difficult for me because just eighteen months before that, I had lost my dad in a similarly protracted and painful situation. He had collapsed at the airport. I was 1000 kilometers away at the time. This was nothing less than total anarchy to my world. My father, my mentor, the man who had taught me everything I knew about life, a man who had the rare quality of being both brilliant and kind, had fallen. He had extensive coronary disease; he was unstable for a cardiac bypass. The cardiologist inserted a balloon and spelled out to me that my father had suffered significant hypoxia and prognosis was grim. Over the next seven weeks, we had encountered multiple challenges in his care and a limited number of options in terms of transferring him to another hospital due to his unstable condition. When he eventually passed away seven weeks later, he had suffered so much that I had no option but to let him go. We buried him overseas, in the town where he grew up; where he ran down the streets as a little boy.

Due to my experience of losing my dad, somehow, when I took my mother to the hospital that day, I knew. I just knew that we were precariously close to treading down a similar path and though my mother had a wonderful team of health care professionals who truly did their best to save her; it seemed to me that perhaps God was more adamant to have her.

Those days of waiting as a daughter instead of a healthcare professional have changed me in so many ways. While I pride myself in always striving to maintain empathy for my patients, I can say I have seen the other side. I know what it is like to place your life in somebody else’s hands, what it is like to wait outside the operation theatre; what it is like when you have only one patient’s results that you need to follow up on and when that one patient feels like the most important patient. My parents taught me many things in life but they taught me through their deaths too. And while those are lessons that I sometimes wish I never had to experience, I cannot deny that those lessons too, have been valuable. I have learned that when family members don’t want to sign code status forms even in futile situations, that often it’s because they are hoping for a miracle that even they know may never come. I have learnt that what I may take for granted as routine in my working life is a unique experience for every patient. A trip to radiology, a physical examination, a history when the clinician doesn’t seem to hear you – all of these are so important and such different experiences for patients and their families.

My mother did not make it. She died to complications related to pancreatitis. After eleven weeks of suffering, all her joys and sorrows, her victories and defeats culminated on that day. It still is a very painful experience for me and losing my parents like that has probably been the biggest challenge of my life.

My mind was diverted back to the patient before me and she began to cry. A part of me wanted to cry with her, to cry for my mother but in the white coat, I realized I had a different role in that story. When we lose those we love; when we have walked on the other side with patients, it gives us a new perspective and perhaps a slightly new direction too. This patient did recover. She made it. I do not know her name but I see a little of my mother in her and I remember her.

Today is another day in the hospital. The same early morning bustle and I have patients waiting for me but I have crossed a bridge to the other side and so, I see so much more.

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Friendship

By Dr Leanne Jafar
Capital Health Residency Program

It was few months into my second year as a resident that I met her, a patient that has changed me.

It was the last hour of my shift when I had a new admission, a patient with disability and mental challenge, coming from a group home with shortness of breath and fever. I look at her and I see sad tired face and a bruised knee with what seemed to be old fracture that did not heal well among other comorbidities. But the worst part is that my patient did  not have a voice!

She understood my words but was unable to communicate, later she pointed to her bag, were we pulled out an I Pad.  After a struggle,  she was able to call someone, her sister Barbra, who told me about her medical history and the fact that she is afraid her sister was not well treated in the group home setting she was living in

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As the resident on the case I saw Sheila, every morning and I learned how to talk to her via her I Pad app and I talked to her sister too through the same device. It was fascinating, but more importantly to me it did its job of  giving Sheila her voice!

For most of the part however as my patient was not strong enough to pull the bed side device and ring the bell to ask for her pain medications, among other needs. It was hard to help her. I realized I cannot treat her like my other patients she is not like the text books. We need it to treat her differently.

Days went by and I became more familiar with her and more familiar using the  I pad app , one day her sister visited her and I get to see Barbara for the first time.  Despite 10 days of being her doctor, it was the first time we talked about her, not her disease. I knew about her favorite foot and how she did not like the hospital food, I knew about her favorite TV show and that she is in spite of her disability is happy because she is a woman of faith. I realized that a become fun of her and I looked forward to seeing her every morning until a bittersweet moment arrived and a new placement was found for her. It was the first time I had seen her afraid!

But as I knew her. She was strong and always smiling and she told me if I don’t feel good I will be back and I will find you. I smiled at her as she was wheeled away and waved good bye.

Two days after that I run into her sister as she was picking up rest of her meds from our pharmacy.  I asked her about Sheila, she  gave me a  big hug and told me that Sheila said to her that I am her “ new friend “ since  the  being hospitalized two weeks ago .

As I walked back to the call room I began reflecting on her words.

“A friend “

I realized that caring for her, helping her find her voice and smiling each morning was the only part of my day that required little effort. It was also the only part of my care not mentioned in medical book. My attending was always  teachings us to make friends with our patients , but it’s the first time I understand how .

“Friendship”

I cherished the words and felt humbled with the trust she gave me.

I will always remember Sheila. She changed the way I see patients. Though I will always read and try to improve my skills as a clinician, I’ve already learned the most important aspect of being a physician – caring for the patient. I learn each day the  patients expect many things from their doctor – compassion , kindness , understanding and just simple look at them as human not pathology  which can be as helpful as our   guidelines driven treatments.

There has been nothing more rewarding than meeting patients, who despite suffering from multiple medical condition and disability, enjoy seeing me, their doctor.

I could reverse Sheila disability or help her speak but the impact she had in me I will carry to rest of my life. And I hope I always treat patients with the same reverence I gave Sheila.

It is possible, no matter what the outcome, to make a difference in someone’s life.

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Hollow Words

By Asim Khan, MD
​​Overlook Medical Center

The keyboard rattles, the mouse flies freely, and silence abounds,
Skillful attentiveness, fixated to the screen that rouses,
In the early hours while others rest in wide expansive houses,
While those in my infirmary are doused,
Words without meaning, words without healing,
Eloquence and mastery mean little to the one without seeing,
It means little to the one gasping for air and labored breathing,
The one who is absent of eating,
but is moribund to venous feeding,

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As the resident on theSir, your quality of life is without meaning,
Dear family, he has a terminal illness, are you not hearing?
Hello son, it’s simply end stage disease,
It has so many endless complexities,
It’s all here in our books, illustrated so marvelously!

But I cannot take a seat to spare a minute you see,
I will not hear your concerns, no second for empathy
My vernacular does not possess the word sincerity,
I only know meticulous efficiency and proficiency in this alternate reality
In which my allegiance is to the clock and the numbers of propensity,
The odds a sickness will happen, not how it will destroy a man’s sanity,
Hollow words and hollow oaths, what would he think, the great Hippocrates,

The keyboard, rattles, the mouse flies freely, and silence abounds,
In the deafening roar of thoughts unperceived ,
of conflict unrelieved,
The family from earlier? Peering from a distance, they stare incredulously.
Bewildered, they think how a man can speak with such audacity,
Oblivious to the suffering, their never-ending reality,

But for me,
I hear the two-toned printer convulse hysterically,
My notes, my notes! For all to see.
The day’s work is adjourned, but I will never, ever be free.

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How Times Have Changed

By Margaret Eng, MD
​​Barnabas Health

During morning report when I was a PGY2 there was a case presentation of a patient with an unusual purplish rash.  The resident was so excited and looked up various causes of this rash and was told that it was Kaposi sarcoma. We all pondered how this patient who was not white or of Mediterrean descent could have this. Within the next few months I admitted a homeless man with interstitial infiltrates that turned out to be PCP.  By the time I became a third year resident my large public hospital was inundated with scores of patients with an immunodeficiency syndrome that later became known as AIDS.

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I went into Infectious Disease because I enjoyed the opportunity to make a diagnosis and heal patients with the right antibiotics. Little did I know that as I continued thru my journey as an Infectious Disease physician that I would be dealing with dying patients- many with complicated social issues. I grew up in the civil rights era and felt strongly about the rights of the all but now I was caring for the ostracized, discriminated people that non care for. How fitting!  I became a hospice doctor and had to learn quickly how to break bad new constantly and deal with dying patients. This was never taught to me in medical school or during my residency.

As I look back, I do not regret my career decisions. I feel privileged to care for these patients and to see how the care of the HIV patient had changed from a lethal disease to a chronic disease is gratifying.  I ran into one of my former patients who was HIV + with Hep c and a drug user. She has clean up her act, has a beautiful 10 year son and has had undetectable HIV virus for years. She is about to embark on Harvoni this month.  She couldn’t express her gratitude for all we have done for her in the HIV clinic. I only wished we had those meds in the early days when we had nothing.

I saw a patient recently who was seen in the medical clinic with a nodular lesion on his foot- had a biopsy by a podiatry that turned out to be Kaposi sarcoma. The patient then was referred to an oncologist who immediately wanted the patient to be tested for HIV and then referred him to me- how times have changed.

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