ACPNJ's 2019 Scientific Meeting: Meeting and Exceeding All Expectations.
Special Thanks to our Exhibitors & Sponsors!
Sincere thanks to the exhibitors and sponsors who made our 2019 Scientific Meeting such a great success!
- Akcea Therapeutics
- Compassionate Care Foundation
- Mid Atlantic Resource Group
If you are interested in sponsoring or exhibiting at future ACPNJ events, click here to contact us.
2019 STORY SLAM
The following are transcripts of the stories presented by New Jersey physicians at the Story Slam held during the 2019 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.
By Dr. Aram Srapyan
A 49-year-old man was sent to urology clinic by his primary care physician for right sided flank pain evaluation and incidental finding of hematuria during regular check up. During the work up CT scan detected right kidney complicated cyst. Per Bosniak classification complicated stage four renal cyst is almost one hundred percent compatible with malignant tumor.
Upon his first appointment he was alone, even though he told me about lovely wife and children. After complete work up we scheduled him for surgery, possible radical nephrectomy. I won’t go into much more detail here other than to say that the cyst on it’s grossly presentation was cancerous like and further pathological study confirmed the diagnosis of stage two renal adenocarcinoma. This means that the cancer was only limited to the kidney without any lymph node involvement.
After the surgery was successfully completed, I was asked by my attending to meet with the patient’s family. He was in a happy marriage with a wife and two children, boys ages 14 and 16. I explained them that fortunately the cancer was caught on it’s early stages, the primary care physician did a great job. The surgery that we performed is considered radical treatment with excellent prognosis.
I made a pause. I saw the tears of happiness on her face and the mother hugging her two sons so tight. This scene in a waiting room will stay with me forever.
I was 14 years old when my father was diagnosed with kidney cancer. It was similar scenario: incidentally diagnosed base on chronic flank pain. Unfortunately it was end stage renal cancer and medicine was unable to save my father. He spent his last days in his bed in our apartment surrounded with his lovely wife and two sons.
Being a 14-year-old boy who was fond of reading fiction literature and spending time with his father, I made this disease as an enemy in my thoughts. I was looking for revenge. I studied very hard for two years to enter medical school and was able to get it with a scholarship. Another six years of determination and hard work in medical school and I entered residency program in Urology.
Currently I’m board certified urologist back in my country and I participated in multiple radical nephrectomies but this one has a separate place in my memories. That was my first participation in radical nephrectomy, the first face to face encounter with the enemy from my childhood years. The scene of that family, mother hugging her two sons after I told them the outcome of the surgery.
The scene that changed the feeling of revenge to something more valuable. I started to understand that life creates the greatest humans by breaking them first. Truly, it’s the painstaking journey of falling apart and coming back together that fills their hearts and minds with a level of compassion, understanding, and deep loving wisdom that can’t possibly be acquired any other way. I realized that although it was the darkest period of my life, if I had not struggled through, and beaten, so many years of studying, I would not be here now smiling so appreciatively at my colleges with whom we are fighting for life on our daily bases trying to make happy many families, trying to keep families compete, trying to keep the loved ones together. You right in some cases we fail and got defeated but what else if not medicine give you the unique opportunity to fight and to go through challenges to spread love and kindness. Our experiences in the hospital sometimes are brutal. Some of them knock us down hard and keep us down for a while. But when our time of mourning is over after each misfortune, we need to press forward, stronger, and with a greater understanding and respect for life.
Stories like mine hold many lessons, but one lesson they collectively share is the fact that hard times don’t just break a person, they can also make a person. Hard times are like strong storms that blow against your body and mind. And it’s not just that these storms hold you back from places you might otherwise go. They also tear away from you all but the essential parts of you that cannot be torn, so that afterward you see yourself as you really are in the present, without the needless attachments and crutches you’ve been clinging to. In all seasons of life, your goal shouldn’t be to seek a perfect and pain-free existence, but to live an imperfect and sometimes painful one in radical amazement.
Everything is extraordinary in its own right. Every day is a gift. Never treat life casually. To be spiritual in any way is to be amazed in every way, even when things don’t go YOUR way.
By Farnoosh Farshidi, MD
Capital Health IM Residency Program
It was March 21, another Persian New year had made its way to us. Streets filled with glowing faces, most certainly excited to see what auspicious events would bless them in the year to come. Families, friends, strangers, all rejoicing together, no matter what differences may be, celebrating the way Iran knows best. At the time, I was thinking how unfortunate I am being 3 hours away from my home, in a rural area hospital. I solemnly watched my colleagues leave, to go enjoy the sweets and smiles of New Year’s Eve. I sat in the physician’s lounge, by the window; a beautiful blanket of snow covered the streets of the town as the white snow so effortlessly fell to ground. I was gazing at the dark skies, that would soon fill with robust colors, and I couldn’t help but think how badly I’d wanted to be home and not here.
I thought perhaps calling my friends and family to wish them a Happy New Year would help. And it did. Hearing their excited voices, though made me long to be with them more, it also elicited a sense of gratitude of actually always having my support system cheering me on.
As I lay on the semi-comfortable ‘on call bed’, contemplating what new adventures lie ahead, my thoughts were suddenly startled when my on call phone began to ring. It was one of our midwives, her voice full of helplessness, “Dr. Farshidi, we have 35 year old female who had been in labor for 24 hours, she’s delivered the baby, but has a retained placenta and is bleeding profusely! The family is unable to bring her to the hospital due to unrelenting snow fall. We will send our ambulance now.” The thought of this woman stranded in an area where no medic was present, bleeding half to death, made my heart sink. I knew very well that she would breathe her last breath before the skies lit up with the fireworks celebrating the year she was supposed to live raising her newborn. The next thing I knew, I was on the ambulance, reciting tiny prayers to make it to her in time.
My heart was doing somersaults with each bump on the road, reminding me how much my superiors tried to stop me, owing to the severe weather conditions. I could feel the driver pushing down on the breaks, skidding across the once what seemed, beautiful blanket of snow. Stopping then starting up again. My fear was rising, ‘is this it? Is this how it ends?’ But I knew at this point what mattered. One thing and one thing only, as I clutched the units of blood, I whispered to myself, “I have to make it to her.”
After a painful 3 hours we arrived at the small health center where patient was. The pungent smell of blood was apparent from entrance of the building. My heart began to sink a bit more. I ran inside to find a young, feeble woman, lying on what seemed like a bed, pale, exhausted and lethargic. I stared at her, my eyes full of hope and despair all at the same time. The words “I’m Dr. Farshidi, I’m here to help you” stumbled out of my mouth. “I have to deliver your placenta manually, it’s going to be painful but it’s the only way. Her tired eyes, and what seemed semi-lifeless body looked at me, her dry lips parted, and breathlessly said, “my baby?” At this point, there were streams flowing from my eyes, but I knew this is not the end.
Gowned and gloved, I said my prayers, and I was more determined than I had ever been in my entire life. I successfully removed the placenta. The severe uterine atony had my hands working like a machine, but I still knew this was not the end. After 6 grueling hours of uterine massage, hope began to fill the room, in the form of sun rays arising from the horizon. Both the mother and newborn were transferred to the hospital. They survived, and went on to living the life they were meant to.
It was the first day of the New Year, and I had no idea that it would be preceded by such a life turning event. A story that will have forever changed the perception I have of hard work, determination and faith. Perhaps we should remind ourselves, that as physicians, our sacrifices are merely a means to “save the endangered, heal the sick, the comfort the dying.”
By Shuvendu Sen, MD, MS, FACP
December nights are cold in Edison. I was a third year resident back then. As MRD, I was in charge of all admissions in the hospital. Hospital nights are a different world. Silence takes the pedestal. Corridors are hushed into obedience. Groans, moans, even labored breathing emerge from the darkness. The daylong overhead pages like ‘Code Blue’, ‘Code Sepsis’, ‘Code Stroke’ inexplicably dwindle in frequency. When they do occur, they scream out of vacuum. There is no space for any discussions. Time is tackled by the hour. Treatment is swift, objective, and decisive. Patient care becomes personal. Nurses and doctors bond fiercely.
I got a page one such nights for a certain Gloria Sanchez. She was in ICU Bed 5. I did not know her personally. Nurse reported that she had been having labored breathing since the evening. Despite putting her on a V mask, she has not been saturating optimally. A full-blown AIDS, she was riddled with multiple opportunistic infections. Twelve years from today AIDS medications were just about taking a firm shape. People still fell in heaps to the wrath of this disease. Not wanting to involve my two junior residents assigned for the night before taking a firm decision, I went upstairs to intensive care unit by myself. Gloria was in a state of semi coma. A quick look and I thought I had the cause. Gloria’s breathing problem stemmed not from any respiratory issues but from a growing Ascites. She probably had a liver failure that might be causing her semi coma state.
Nonetheless, I had little option but to relieve the ascites, and I instructed my ICU nurse to prepare the kit for paracentesis. There was very little scope to take any written permission from Gloria as she was not in a state of mind to offer any decision-making capability. Besides, it was to my mind an emergency procedure.
As I suited up, I remember keeping my cell phone on the corner table attached to Gloria’s room. I marked the right flank of her abdomen as my point of entry. Gloria had her V mask in place, her eyes were closed and she breathed heavy. She flinched a little but remained unresponsive when nurse in a reasonably raised voice informed her about our procedure. I was about to insert the trocar when to my utter horror I heard my phone scream out. I had in the ongoing rush apparently did not remember to switch it off. I watched it helplessly as it started to ring. I was about to tell my nurse to shut it off when something happened for which I had the slightest anticipation.
That night was December 24. In tune with the auspicious moment, I had set the cell phone ringer to the timeless “Joy to the World, the Lord is come…”.
Midway to the tune, I noticed a movement from the corner of my left eye. Gloria’s eyelashes fluttered. The eyes half opened. Just about. Tired eyelids. She whispered, “Is it Christmas Doc?”
“Yes, Gloria, it is. Merry Christmas Gloria,” I answered, almost breathless.
“Merry Christmas doc,”
The phone stopped ringing. The music died.
Gloria Sanchez went back to her unresponsive state. I proceeded with my procedure.
10 years later…
Dawn Shilling was a 22 year old patient, admitted under my care with drug overdose after a fight with her boyfriend. She was in a state of complete unresponsiveness when she arrived. The Glasgow Coma Scale (the standard neurological scale to assess a patient’s conscious state) read 5.
Neurologist ordered MRI of the head that showed features suggestive of anoxia encephalopathy. She remained bed bound, on ventilation and essential comfort medicines. With no meaningful expectations, our hospital neurologist called her family members to explain future course of action. The idea was to get family’s opinion for either continued therapy or withdrawal of active care. Accordingly the Bio ethics committee was summoned.
All family members including her sisters and brothers agreed to the futility of further care. It was explained in painful details how she would remain bed ridden and tied to the ventilation with nil to minimal chance of recovery. All agreed except John, her father. A retired construction worker who had bent himself backwards to raise his children. Dawn being the youngest was the love of both the parents. After Dawn’s mother died in sudden stroke, she was all that John lived for. He refused to budge despite all efforts by social workers, clinicians, and other family members. He was a religious man who reminded me more than once that “doctors prescribe, god cures.”
Active management thus continued with eyebrows raised by the administration every passing day. I shifted her to a quieter room, a bit away from the hustle bustle of the central nursing station. I saw no reasons for the meaningless weather channels and TV soap operas in her room and advised gospel music much to the delight of her father who remained stuck day and night besides her bed, half reclined on an arm chair. I told him to talk and read scriptures to Dawn as if she was listening. He did just that, in unfailing devotion.
Nothing happened, nothing moved. The same ventilation management, the same peg tube feeding, the same IV fluids, the same gospel music. Till one day John called me late one evening, his voice trembling
“I think I saw Dawn’s eyes rolled over. And her fingers trembled by itself. May be she is communicating?” I did not have the heart to tell him that those could be natural movements, periodic and involuntary reflexes. Yet, the following morning as I rounded with my residents, I tried something different. I lowered my voice, and with my ungloved index finger slid within her half crumpled palm whispered to her “If you can hear me Dawn, you can squeeze my finger.” After what seemed like an age, Dawn’s fingers quivered, subtle, and slight, almost in protest. I looked up at John who stood at the other end of the bed, his lips trembling, the eyes like a river in raging flow. I knew then the battle was far from over. I wanted nothing to change, wanted traditional medicine to stay back. Only Gospel and John sustained.
Dawn recovered. Muscle by muscle. Motion by motion. One morning her eyes danced to my wishes. One afternoon she had her first liquid diet in two months. A month later she wheelchaired out of Room 516 followed by 20 other joyous family members.
Did Dawn recover naturally? Was she an exception to the rule? Did John’s soothing words day in and day out unplug her clogged brain? Did the relentless gospel music awaken her comatose brain?
We will not know. We do not have answers to anyone of the questions. Yet we do know that Dawn turned around against all medical dictations. We do know that other than ventilation management and peg tube feeding nothing medical was done or offered. And we do know that the room was flooded with music of the most profound depth and demeanor. We will do well to keep our perspectives right here. The worst we can do is to drag Dawn’s personal experience, place her among other coma patients, play the gospel music and search for statistical significance.
We over glorify facts and figures, while the magic of personal healing gets demonized as exceptional and coincidental.
More objectively, music becomes that unseen bridge through which memories, dead and defunct, tread across to become recollections, viable and visible.