By Danielle Gonzales

Every time he went into a new patients room he would say, “I am Dr. X and this is Danielle, we work together.” Dr. X answered all my questions, showed me different scans, I would look up the different diseases on the computer while he was inputting notes and we would discuss them and he made me feel as if we were a team and I wasn’t imposing on him.

Furthermore, every time I volunteer in express care, I am reminded more and more of how important it is to become bilingual.  Anytime I go into a patient’s room and they are Spanish speaking they talk to me because they think I am the translator.  Every time I have to tell them that I don’t speak Spanish, I feel worse and worse.  Not only have I learned through my experience at SCVMC that it is important to be able to speak another language from a medical point of view but it has become more and more important to learn, personally.  I feel this way because the Spanish language is part of my culture and I feel as though I am not being true to my heritage until I am at least able to speak the language.

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By Janet Chu

Currently, there are 47 million Americans without health insurance, which limits their ability to seek and access care.  For them, the way that they receive healthcare is through free clinics or more commonly, the Emergency Room (ER).  Using the ER as their primary form of healthcare is expensive and they do not receive regular or preventative care. This perpetuates the vicious trend of driving up the cost of providing healthcare in America, which then makes health insurance more expensive, leaving more people without health insurance.  It is a health policy issue that needs to be addressed. While the death toll itself is a staggering burden, it is only a part of the picture. The rest of the picture is filled with individuals who deal with the complications of both infectious and chronic disease. I find purpose in the day-to-day struggle that physicians encounter in providing individualistic and comprehensive care for their patients.

At the end of my day of training as a Vietnamese Interpreter, I went on a face-to-face interpretation in the E.R. with a staff member from interpreting services.  I was excited because this is the exact environment in which I will be working.  We interpreted for an older woman who came in with pain because she could not pass urine.  She had the urge to urinate, but physically was not able to; the plan was to put a catheter in for her because her son told them she was in terrible pain.  When we arrived, we checked in with the doctor who had asked for the interpreter service.  Upon entering the room, the flustered son was demanding that we help his mother. While the doctor was asking routine questions, the patient kept complaining of the pain, continuously asking for a way to enable her to pass her urine.  Dr. X was trying to take control of the situation, asking the patient to pay attention and answer the questions.  However, she could not because she could not ignore the pain.  When the doctor reached over to touch her, the patient screamed “Don’t touch me!”  When the doctor heard the interpretation, she was clearly offended.

This made me think of how doctors constantly deal with such patients on a day-to-day basis; they must maintain composure and a sense of professionalism even under such situations.  Because the patient was unwilling and unable to answer the doctor’s questions, this created a barrier to providing care.  While I agree that the patient should be made comfortable, I understand that the doctor felt the need to understand the symptoms before doing anything so as not to exacerbate the situation.  Being a physician means more than understanding the science behind diagnosing and treating disease. The practice and art of medicine requires a holistic approach and understanding of the patent’s physical and emotional needs.

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By Xochilt Borja

During my first shift training as an interpreter, I felt truly immersed in my own culture. I remember Dr. X spending a lot of time informing me that many of the patients we see are immigrants, sometimes illegal, and that they are vulnerable because this is a new system, a new culture. This vulnerability sometimes leads them to accept any service they may get, even if it may not be the best. Dr. X said that the ER serves as a safe place for them, providing someone to whom they can relate and express themselves freely. If we do our job right, we can clearly get the doctor the information they need so that the patient is fully served and satisfied. He also said that as interpreters, we have a great responsibility because we act as referees between the doctors and the patients and it is on us to make sure that both patient and physician are well served and satisfied.

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By Dr. McCullough

Four Quads (Quadriplegics)

During a recent trauma shift I met John (name changed) (quad #1), a vibrant C5-6 quadriplegic with a wonderful new wife, a brand-new van (now totaled), and recent baby he had conceived in the “natural way.”  Since his diving accident in high school John hadn’t missed a beat of the drum of life.  His eyes and smile lit the room from the trauma gurney where he recounted the funniest story we had heard in some time in the ER.

C5-6 ‘quads’ (cervical transaction between the C5 and C6 vertebrate two levels below Christopher Reeve’s injury) can actually control part of their arm and shoulder, not a complete quad as we think it.  The higher you transect, the more you lose.  Christopher Reeve breaths with help of a ventilator. Two levels lower, at C8-T1, you can use your hands.  Spinal injuries almost come in clubs because the deficit patterns are so specific, depending almost entirely spinal injury level.

In sum, at C5-6 one can pull but not push, with no finger movement.  But if notched into a steering knob on the right hand, and a modified throttle and break on the left, a quadriplegic at C5-6 can, barely, but safely, drive an adapted car, usually a van.

Years ago, my uncle Ted (real name) (quad #2) let me drive his van in college when he wasn’t using it, so I am personally familiar with the controls.  He had broken his neck being active too, as a helmeted motorcyclist enjoying the Oregon countryside where I grew up.  Like John, my uncle Ted’s injury ignited his spirit and appreciation of life.  Ted taught me medical lessons long before medical school, especially about spinal cord injuries.

For John, getting his new van was Christmas and a birthday rolled together.  Freedom.  An open road.  Less dependence.

John was out for his second test-drive, on a local highway when his throttle jammed.  55, 65, 75, 85, 95mph.  Quite a powerful engine, more so than the brake which shortly ground through after dropping the speed to 40.  The engine overpowered the brake.  Back up.  45, 55, 65, 75, 85…….

John is quite a storyteller, even from the gurney; his facial animation makes up for his lack of coordinated arm movement, even imitating the 8-cylinder engine noise accelerating back toward 100mph.

John’s wife gazed glowingly as he came to the climax of the story.  “I figured I better get off the highway or I was going to die.”  Sure enough.

Off-ramps can’t take those speeds, so John just jumped it.  Through a perimeter fence, traversing an open area, piling an inner fence, smashing a barrier, over a curb.  Each obstacle absorbing some speed.  Down to zero, stalled in the dirt.

But the only reason to have such an open space in the crowded Bay area was that this was Lockheed’s military research wing.  And all the security guards saw, or at least what they reported to the S.W.A.T. team, was that a white windowless van has just penetrated all their defenses at 80mph.

Helicopters.  Sirens.  M16’s.  Laser sights.  “I was lit up like a Christmas tree.”

“Step out of the car.”  The megaphone boomed.

“Hands over your head.”  Came the second request.

Neither of which is really possible with a C5-6 injury.

“If I still had my goatee, I think I would have been toast.”  John proposed.

Certainly, the post 9/11 anxieties accented the whole affair.

Eventually, the laser sights lowered; an ambulance was called (just to be safe).    This brought John’s pleasant story, and happy conclusion, to the tail of my long shift during which two others had died in unrelated illnesses.

I admitted John to the hospital just to be sure his sore neck was ok.  It was — CT scan negative — and he went home today.

 

I never learned the name of Quad #3; I will call her Julie.  We briefly met in the hall one fresh Sunday morning near the spinal rehab which is in the same wing as the ER.  Her injury was fresh, as evidenced by the back brace she wore.  Hands flat, electric chair movement controlled with her chin — a C4-5 injury at best.

Julie’s mischievous grin and presence in a main hallway made it clear she was playing hookie from the rehab unit.  I enjoyed Julie’s smile so much that I circled back around a parallel hallway for the privilege of greeting her smile again.

A study on quadriplegia and happiness showed that, within 2-3 years, following the initial shock and regrouping, that quadriplegics usually return to their baseline levels of happiness.  Julie didn’t seem to want to wait that long.  Her smile radiated so deeply from within that it seemed to be formed more by her spirit than her lips.

Although I’m usually happy, Julie’s grin and playful laughter as she hid from the nurses and basked in the morning sun, made me wonder how long, with all this medical education, it had been since I had smiled and laughed like Julie did, so fully consumed in the moment.

Sometimes, people ask those who work in the trauma center and public hospital how they work around such pain and suffering.  Good question.   I think the acuity of events often stirs a sleeping authenticity we seldom get to enjoy from others.

I have come to enjoy helping trauma patients, not for the blood, nor even for the trauma at all, but because, for windows of brief lucidity, the entirety of humanity, decency, and compassion sometimes emerges.  Priorities are set right.  Bonds of family and friendship are polished and reinforced.  I like medicine for this, emergency medicine in particular, because it reminds me, as it reminds the patients, of the echo of the meaning in their lives.

_

 

Quad #4 was a lesson in assumptions.  Drunks and drug addicts often arrive in cervical collars to protect against potential neck injury (as do about half the ambulance patients).  Recently an ambulance arrived with a patient (I will call him Brian) for transfer to ‘rehab.’  He appeared disheveled.  At first glance, this garnered a homeless appearance.

One of the ER nurses asked the paramedic “which drug,” which is a fair question as someone enters drug rehab.  The sober patient piped in, “I just broke my neck at C6.”

Spinal rehab, not drug rehab.  We all took a breath.  For us, a little collective humility; for Brian, a new life trajectory.

I walked over, laying a hand on his shoulder, looked Brian directly in eyes and told him we would do everything we could, meaning that rehab would.  I tucked a loose blanket in.  My Uncle Ted had taught me long before my medical school that quadriplegics have problems with heat regulation; perhaps Brian was already too cold and didn’t know it.  With complete lucidity, he just said “thank you.”

In the past hour since the injury, Brian had clearly lived a year — obviously, visualizing his new life, or trying to.  He stared straight up, watching the ceiling go by as the paramedics whisked him off to spinal  rehab.

I hope he gets to work with Julie during therapy.

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By Peter Ballard

Dr. X and I have a laugh each time I remind him that the word of the day is “ageusia” from a patient we saw that had a history of acromegally and was now experiencing loss of taste sensation. Another Dr. X patient led to my doing a tremendous amount of research on Diabetic Keto-Acidosis.

Dr. X taught me to always ask a patient what you can do for them and to never settle for blindly following procedures. “Use your brain!”

Dr. X taught me to always encourage patients to stop smoking.

Dr. X modeled the importance of addressing the personhood of the patient.

Dr. X displayed how to make each patient feel that they are the only one that matters, even if it is only for a moment.

Dr. X taught me the importance of a sense of humor and to always anticipate how an ER patient may physically harm you and prepare for it.

Dr. X showed true humility.

Dr. X spent time explaining how to make career decisions in medicine.

Dr. X displayed some of the best bedside manner I have seen in emergency medicine.

Dr. X taught a no-nonsense approach to medicine.

I have never enjoyed learning so much.

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By Ann Leu

The nurse was obviously really annoyed and rightfully so.  It was a hard procedure to watch, as the patient was very obviously very uncomfortable.  But the surgeons were determined and made multiple attempts– with her hand inserted, with one forcep, with two forceps, by injecting air inside with a large syringe, nothing worked.

The nurse can really serve as an important advocate for the patient.  Communication between all members of the healthcare team is so important to bring the best quality of care to the patient.

On a completely different note, it has been such a great experience shadowing doctors in the ED.  I have learned so much and it has made me that much more excited to start medical school.  I am sad to leave, but I shall return!  How cool would it be if I were to come back to Stanford for my residency?  It would be so great to be able to come full circle.  I started at SCVMC as a volunteer in the information desk, which provided such a great foundation for my knowledge of the hospital as a whole.  I started to build my confidence, to practice talking to patients , and to communicate with people of all backgrounds and tempers.  Cora and Kathleen have had the pleasure to watch me grow and to progress to SCOPE, and it has been wonderful to share that experience with them.  I will miss them!  I also feel I have made some friends in the ED, some techs, RN’s, registrar, and lastly, MD’s.  There are a number of doctors and residents that I’ve really enjoyed working with and feel that I could really see myself fitting into the culture.  Though I hadn’t really considered emergency medicine, it is now a definite possibility in my mind.  Who knows what the future holds?  Maybe I will be back in 4 years!

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By Patrick Lee

Everyone has that particular song that can alleviate bad moods and make even the worst of days more bearable. But why is it that music has this effect? And how does music promote wellness? Recent neuroscience research has provided many answers. Here are three key ways that music is beneficial:

1. Music and Mood: Music is a timeless pick-me-up. Create specific playlists for particular emotions.

The most basic benefit of music is its ability to alleviate stress and pain. The sounds and words of a song can calm and soothe listeners, but these palliative effects can be much more concrete than expected. An emerging field called music therapy seeks to apply music to aid recovery from physical and mental illnesses. From emotional to physical ailments, music helps to speed up patients’ recovery and reduce stress and pain. Cancer patients have been shown to exhibit decreased anxiety and nausea after chemotherapy when listening to music.[1] However, music therapy is useful not only for severe diseases but also for general wellbeing and happiness. A 2001 study by Anne J. Blood and Robert J. Zatorre reveals that music activates the same area of the brain that is associated with reward and pleasure.[2] In this way, music can naturally produce the feeling of happiness associated with an intrinsically rewarding activity such as eating. Through this lens, music can be seen as a brain food, and a daily dosage will go a long way in promoting happiness. A 2011 paper from Nature Neurosciencereveals that listening to music is often associated with increased dopamine activity in the mesolimbic reward system, one of the major dopamine-containing pathways in the body.[3] Dopamine is a major neurotransmitter that plays a vital role in feelings of happiness and pleasure. Therefore, an easy, effective tip is to create a pick-me-up playlist of inspiring songs or personal favorites for those moody days. This is a simple way to get more dopamine flowing along the mesolimbic pathway and quell moodiness and depression and is completely healthy and harm-free as well.

2. Music and Exercise: Music strengthens endurance, and different types of songs can be matched to maximize the efficiency of different types of workouts.

No one can deny the burst of energy experienced when their favorite song comes on during an intense workout, and neuroscience is shedding new light on this phenomenon. Adding music to a workout can make people feel like they’re exerting 10% less effort than they actually are.[4] Moreover, listening to music during a bike ride reduces by 7% the amount of oxygen needed to complete a workout[5]. However, only certain types of songs will maximize endurance. Dr. Karageorghis, a music and exercise expert, describes how he has correlated different types of songs with different stages in a workout. He proposes three ways to use music:

1. Pre-task: inspiring, slow-tempo music for warming up.

2. Asynchronously: regular background music with an upbeat tempo, suitable for when the heartbeat around 120-130 beats per minute.

3. Synchronously: music that perfectly matches the rate of workout. For example, each

footstep on a treadmill should be in sync with the beat of the music. This maximizes endurance and workout efficiency.[6]

A continuing theme in these three guidelines is the manipulation of tempo to enhance the workout. At the beginning, the beat of the song should be slower to allow for a gradual buildup of one’s heartbeat. As the exercise becomes more intense, the more upbeat songs should be played, in accordance with the pace of the workout and the increased heart rate. In this way, it is easier to adjust the intensity of the exercise routine. Just as musicians use metronomes as a reference for correct tempo, exercisers can play a very fast-paced song if they want to accelerate the rhythm of the workout, or a more calming, slow-paced song to initiate the cool-down period. In this way, making music the framework for an exercise routine promotes efficiency and simply makes the workout more enjoyable.

3. Music and Cognition: Music can improve auditory skills and promote mental longevity and well being by keeping the brain active.

Music also has the incredible ability to enhance auditory skills and sustain long-term mental health. People often say that listening to classical music improves test-taking skills or that music improves math skills, and although it is unclear how true these correlations are, there is no doubt that music plays some beneficial role in the brain. For example, a 2007 study at Northwestern University shows that musicians have faster brainstem responses to auditory stimuli than those who don’t play music, ultimately suggesting that musicians have more advanced auditory and audiovisual processing.[7] In addition, Nina Kraus, director of the Auditory Neuroscience Laboratory at Northwestern University, notes that through music, “the nervous system makes associations between complex sounds and what they mean,” and thus, music can help to improve communication skills.[8] Ultimately, these enhanced communication abilities can help people with personal interactions and relationships, leading to increased happiness. Moreover, such musical skills can provide sustainable mental health benefits. So how can this particular benefit of music be harnessed? Try learning to play an instrument. Although this method is a bit more involved and time-consuming, it is perhaps the most rewarding and long-lasting. As the aforementioned studies indicate, it will enhance and fine-tune the brain’s auditory center, and just the simple process of learning a new skill keeps the brain active and increases longevity. A study by Dr. Robert Friedland even indicates that people who play a musical instrument are much less prone to developing Alzheimer’s disease in the later stages of their life.[9] A musical hobby keeps the brain active and engaged and thus helps to prevent neural decay due to inactivity. So whether it’s the piano, guitar, or oboe, learning an instrument can promote long-lasting mental wellness and happiness.

Indeed, the benefits of music are endless, but these are three simple and especially effective ways to apply music towards achieving happiness in daily life. Just these three tips, creating personal playlists, using music to regulate exercise, and learning an instrument, provide innumerable benefits now and in the future. Music can provide both instant and long-lasting happiness, and it comes with no harmful side effects. In addition, these three tips don’t take much time, and many people utilize them to some extent already. However, making a conscious effort to consistently follow these three guidelines can provide quite a boost on the path to happiness.


[9] “Alzheimer’s Risk Factors and Prevention.” The American Health Assistance Foundation. 11 January 2011.  (Accessed 3 April 2011).

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By Patrick Lee

The renowned Renaissance artist Michelangelo once said, “A man paints with his brains and not with his hands.”[1] Though he said this long before the advent of modern medicine and neuroscience, current research indicates that there is a close connection between art and mental cognition. In fact, a psychological profession called art therapy seeks to utilize this close relationship between art and the brain to promote health and happiness. The American Art Therapy Association formally defines the practice as “a mental health profession that uses the creative process of art making to improve and enhance physical, mental and emotional well-being.” [2] Often, art therapists use art to alleviate symptoms of certain disorders or to help patients learn more about themselves and their psychological states. Though the neurobiological basis of how art therapy provides these benefits is not entirely clear, a host of experiments prove that it is nevertheless an effective treatment.

The most tangible benefit of art therapy is the alleviation of certain symptoms of a wide spectrum of physical diseases and mental disorders. In general, it tends to reduce stress, anxiety, and pain for patients who live in constant pain or discomfort. For example, in a 2001 study published in Medical and Pediatric Oncology, children with leukemia who were undergoing painful procedures showed reduced levels of anxiety and trauma when undergoing a consistent regimen of art therapy.[3] Methods such as free drawing, which allows children to materialize inner fears, or structured drawing, which promotes a sense of control over reality, had palliative effects and made the patients more cooperative going through the procedures.[4] A 2005 study in Psycho-Oncology yielded similar results. In the experiment, mindfulness-based art therapy, a combination of mindfulness meditation and art tasks, was shown to reduce symptoms of distress in a group of female cancer patients.[5]

Art therapy is also helpful in the treatment of mental disorders. It is especially effective in the treatment of trauma and other sorts of psychological abuse. In patients with post-traumatic stress disorder (PTSD), art therapy assisted with reconsolidation of memories and externalization.[6] In other words, through the medium of painting or drawing, people can confront painful, terrifying memories in a comforting and controlled environment. They have power over the art, and thus have power over their memories. Although these aforementioned physical and mental benefits are the results of specific studies, it is generally agreed upon that art therapy, at the very least, can be effectively used to learn more about the patient’s psychological state and how he or she perceives the world.[7] From a biological standpoint, researchers cannot prove art therapy’s efficacy, but thus far, the successes of these experiments signal a hopeful future for art therapy.

with a focus on therapy for traumatic events (http://www.ehow.com/videos-on_12071_art-therapy-activities.html). These activities are applicable to all because they address universal life experiences such as illness of a parent, divorce, and death. However, for those who wish to address more persistent mental health issues, there are many professional art therapists available nationwide who can help patients discover the sources of their issues or diagnose potential mental disorders.

Even activities as simple as visiting a museum and viewing artwork can promote well-being. A 2005 New York Times article describes a program sponsored by the Museum of Modern Art that provides tours to elderly Alzheimer’s patients, who in turn demonstrated improved memory and verbal skills while participating in the program.[8] Amazingly, something as simple as a museum tour can, for a short time, counteract the effects of a devastating mental illness. It keeps the brain active and can be beneficial. Ultimately, art therapy covers a broad spectrum of methods that play an important role in promoting well-being.

Further Information Concerning Art Therapy:

1. The tools of neuroscience shine light on how art therapy can be beneficial to patients with dementia.

2. The American Art Therapy Association website provides an overview of the major aspects of art therapy, and it is an effective tool for exploring careers in art therapy.

3. This report of a 2006 experiment analyzes the effects of mindfulness-based art therapy on women suffering from cancer.

4. Cathy Malchiodi’s Handbook of Art Therapy presents several case study analyses of art therapy treatment and includes a chapter on art therapy’s relationship to neuroscience.

5. Explore how art therapy has been used to help minimize fear or anxiety in children with leukemia who were undergoing painful surgical procedures.

6. “The Pablo Picasso Alzheimer’s Therapy,” describes how art therapy, in this case, tours of the Museum of Modern Art, has helped increase alertness and cognitive functions in Alzheimer’s patients.

7. “Art Therapy and the Brain: An Attempt to Understand the Underlying Processes of Art Expression in Therapy” examines how scientists use brain imaging techniques to try to decipher the relationship between art therapy and the structure of the brain itself.

[1]. 2011. Accessed 29 April 2011. .

[2]. 2011. Accessed 21 April 2011. .

[3] . Accessed 21 April 2011. .

[4] ibid.

[5] Accessed 21 April 2011. .

[6]. Accessed 21 April 2011. [7] Betts, Donna J. “A Systematic Analysis of Art Therapy Assessment and Rating Instrument Literature.” 2005. Accessed 28 April 2011.

[8] Kennedy, Randy. “The Pablo Picasso Alzheimer’s Therapy.” The New York Times. 30 October 2005. Accessed 21 April 2011.

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Written by Anne Sophie Lambert

Somehow we are already five weeks into our time in Ghana! I am far from ready to leave and feel like I am just starting to understand how complicated child care policy is. When I told Dr. Stevens how stable and well-behaved the children at Mothercare seemed, he cautioned me to consider that such an observation does not necessarily correlate with their well-being, as their good behavior could be a product of fear. Grace gave me similar advice when I admired how Village of Hope has a meticulous filing system, as well as a dentist and social worker on site. The files report that many of the children were “rescued” from negative situations in which their parents sold or gave them away to work in the fishing industry without any hope of education. However, the orphanage itself punishes the children by making them weed large expanses of land with machetes. Therefore, orphanages obviously are not the panacea, but it seems that the Department of Social Welfare must address the parents and other relatives’ misguided views on child labor and the value of education before the reunification process can be successful. Also, while I was playing a game of memory with some kids at Village of Hope between interviews, one boy asked me what happens when their parents “divorce” their children, and whether he would be sent to live with a white family. It made me sad that he has to think about such heavy things at such a young age, and I was glad that there are so many competent and good people in the Ghanaian government working to create the best possible future for these children. It will definitely require a thorough understanding of Ghanaian structure and social norms and a sustained presence in the country, so I am glad that our role is mainly to just help maximize the government’s capacity.

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Written By Pao Jirakulpattana

The concept of happiness drives the outcome of most political and economic decisions in Bhutan. King Jigme Singye Wangchuck has clearly articulated his support: “I care less about the gross national product and more about the gross national happiness.”[1] Committed to this revolutionary notion, the King has instituted GNH as the guiding philosophy of Bhutan’s development policy, in an attempt to measure his people’s quality of life and social progress in more psychological and holistic terms. The pursuit of GNH calls for a multi-dimensional approach to development that seeks to balance and harmonize a variety of forces that influence human happiness. Therefore, the King grounds his policy of happiness in what have become known as the Four Pillars: sustainable and equitable socio-economic development, environmental conservation, cultural preservation and promotion, and good governance.[2]

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