Category Archives: Clinical

Tooth and Nail

Rami Shahrouri, DDS, BA Biology
Dentist, Great Expressions Dental Centers, Lathrup Village, MI

I still recall the feeling of frustration when my parents explained to me that our dental insurance had been cancelled, which resulted in minimal dental office visits. Having been 15 years old at the time, I was living in a home where receiving dental care was a luxury rather than a necessity. However, oral hygiene and a great smile were important to me. During a visit to my dentist office I explained to him my situation. He proceeded to give me his email and urged me to email him with any questions or concerns that I had. From then on, he taught me about prevention and finding affordable ways to maintain a healthy smile. My dentist had such a positive impact on me, as my family went through a tough financial time. I am grateful for this opportunity to maintain my dental care. Moving forward, I wanted an opportunity to influence lives the way that my dentist influenced mine. I looked up to my dentist as a role model of adequacy and he sparked my initial interest in the field of dentistry.

By the time I started my undergraduate degree, the memory of what my dentist had done for me became less vivid. While thinking about possible careers one day, I recalled the enthusiasm I once had for dentistry. I decided that I should shadow a dentist and see if it could be a good career for me andFullSizeRender something that I can see myself committing to. Unfortunately, my dentist retired around the same time that I was looking to shadow. So with the help of the Yellow Pages, I found a doctor willing to allow me to shadow him. He was kind enough to provide me the opportunity to watch him work and observe his daily routine. I was able to see bridges, crowns, implants and annual checkups. Watching him work with his hands brought to my attention how much I would love to be able to incorporate that in a career. However, I was reminded of my passion for dentistry when I interacted with a patient who was in a great deal of pain and happened to only speak Arabic. My ability to speak Arabic allowed me to communicate between the patient and the doctor. With my help, the doctor was able to relieve her pain. Afterwards, she was so grateful that she gave me a hug and thanked me for being able to explain her situation. It struck me immediately that it was the interaction with patients that elevated dentistry above all other professions and was the main source of my enthusiasm years ago. The more I shadowed, the more I desired to be a dentist.

After years of hard work and dedication, I achieved my dream of making it into dental school. I had no idea what was in store for me and was shocked at the amount of work required to stay afoot. I would often find myself overwhelmed and wondering if it was all worth it. After two years of intense book work, I finally found myself in a clinic treating patients. As with all professional school, I found myself exhausted, and after years of having my head buried in a textbook it seemed as if I had forgotten what made me so passionate about this profession in the first place. I was given the opportunity to serve as a FullSizeRender (1)dentist on a mission trip to the Dominican Republic. The experience was everything that I hoped it would be, and more. Being able to treat these patients who would otherwise be unable to see a dentist was an amazing experience. We helped countless people in 4 days at the clinic, including many children. Serving the underprivileged gave me the sense of purpose that I had seemed to have lost somewhere in the previous years. I found myself on the same trip one year later, this time as a mentor to younger dental students. The experience I had on each of the trips gave me the push and motivation that I needed to graduate.

Reflecting back, I have been graduated from dental school for a year, and took my knowledge of dentistry into the real world. Writing this column has given me the chance to once again reflect on my career and my ambition to help those less fortunate and in need of adequate dental care. With every patient I treat, I remind myself what makes my job the greatest job in the world. It’s not the paycheck, the job security, or the flexible schedule; I have the greatest job there is because I have the opportunity to reach out and help people every day. There will always be bad days at work, and mornings where I want to stay in bed, however, I could not ask for a more fulfilling job. I plan to continue doing mission trips and hope to create one of my own in the future. Each day I am thankful for my childhood dentist, who created that interest and spark in my younger self. Without his kindness and compassion, I may not be where I am today.


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Every Dog Has His Day in Emergency

Karim Mahmoud Jawad, DVM, BA Biology
Small Animal Veterinarian, Northwest Animal Hospital, Detroit, MI

It was February 10, 2017. I remember that day clearly, for multiple reasons. It was one of the worst days I’ve ever had at work, and eventually turned into one of the best. It was the day that I elevated myself, not just in my career, but as a person.

The morning started like any other for me. I set my clock to 6:45 am because I tell myself if I wake up at that time, I’ll actually get things done. In reality I wake up an hour later 99% of the time. That allows me 15 minutes to get dressed, brush my teeth, and take care of my cat before I walk out the door. I don’t really eat breakfast that early because my appetite is nonexistent, so I end up eating closer to noon, but I also don’t prepare myself lunch to take15235924_10102710161361958_2625706162728446929_o because I’m too lazy. Unless my employees bring their leftovers from yesterday’s dinner to share with me (which they usually do) I don’t eat til I get home from work.

On a typical day I will arrive anywhere 15-30 minutes late depending on morning traffic. After I park my car inside the gate, I walk to the back door only to be met by a row of hungry and restless boarding dogs, constantly barking in my ear. After that I hope to God one of my employees made coffee and I pour a cup, sit down and drink it hoping the phone doesn’t constantly ring and exacerbate my crappy mood. I love my job don’t get me wrong, but we are usually very understaffed so things don’t always run as efficiently as they should. That lack of order and consistency takes it’s toll on me from time to time. It’s so bad that on most days I find myself answering the phones, which I absolutely hate doing. Our boss, the senior doctor and owner, manages three veterinary clinics including this one. He will often have people move around between clinics, even myself. Thankfully, one of our technicians from another clinic agreed to come work today with me because the schedule book was full and I had virtually no help. 

Work was going by exactly as expected. My appointments kept coming in constantly, with people showing up either way too early or wait too late, creating congestion in the waiting room. This is normal for a veterinary practice. But given how small our building is and how little manpower we have I really try to avoid too many dogs being in such close proximity to one another. I was running around so much, and my technician made the transition between clients a lot smoother. But as the day wore on I noticed my technician and all my other employees ordered food from Wendy’s. I was a little annoyed by this because as far as I could recall nobody had bothered to ask me if I wanted to order anything. I probably would’ve said no anyway, but being that I was the one doing the most work. that didn’t settle with me. Eventually my secretary told me I forgot to do vaccines for a few dogs that were grooming. I don’t check the grooming schedule usually. If there is a dog or cat in the grooming room that needs my attention it’s someone’s responsibility to communicate that to me because my duties are not with the grooming dogs but with whoever is in the appointment books to see me. We really do try to structure things properly but no one is perfect and these particular dogs were ready to go home when they should have been vaccinated earlier in the morning. At that moment I got noticeably upset.

I told my assistant that I wasn’t made aware about these grooming dogs needing vaccines. I have a bunch of clients waiting to see me and I’m struggling to get these vaccines done with one of the dogs being very anxious towards needles. In so many words, I told my technician and assistant they weren’t doing their jobs properly. Truthfully they were in slacking but I knew I could have handled this situation much better. I eventually cooled down and took time to speak to them individually and apologized. My technician told me “if you need something to be done, just say it, and we will do it. Don’t keep it to yourself and expect us to read your mind. You need us just as much as we need you”. Historically I’ve always had a temper for as long as I could remember. In fact when I first started here, a particular outburst almost got me fired. My boss is a very kind and generous man, but he was extremely angry at me. 17834305_10103018760367078_8318781085444417353_oAfter dodging that bullet, I decided to start seeing someone, to help me manage my anxiety and stress. I still see this person to this day and I’ve made so much improvement, but my violent outbursts have more or less evolved into passive aggressiveness, which is what this particular incident could be described as. I felt horrible about the whole thing. I couldn’t wait for the day to end and the kind of cases I saw didn’t help. At 5:00 pm I got my jacket and keys and went to the front desk. I looked down at my appointment book to find no remaining patients. But then I immediately looked up, only to be met by a distressed young lady holding a yorkie with a puppy stuck in its vagina. I thought to myself “Shit, I’m not going home”.

This dog was an intact female who I haven’t seen in a long time (nor did I know she was pregnant). The clients have another male dog in the home who is also intact, which explains this situation. The dog in question was suffering from dystocia (difficultly giving birth) and she couldn’t push this puppy out. The dog even tried pulling her pup out with her mouth, but ended up gnawing off its the rear legs. I managed to pull the puppy out manually with lubrication, but of course he was already dead. The problem was only just beginning, for it was likely this dog had more puppies. If that was the case, she’s gonna need an emergency c-section. Even more problematic is I knew looking at the client that she wasn’t gonna be able to afford the surgery, and we are not a 24 hour emergency hospital. My boss was already gone and my staff already left for the evening. The client agreed to pay for an X-ray and we found three more puppies left. We discussed the price range for this surgery, which I called my boss to see if we could work something out with her. He gave me a price that was fairly reasonable, it was just a matter of the client agreeing to it. My boss asked me if I was going to do it and I told him “I’m not sure yet”. I just couldn’t take it anymore though, if this lady didn’t agree to the surgery nobody else is going to do it for cheaper, and her dog was probably going to die along with her puppies. After giving her the price she said she was going to get money from some relatives who agreed to help pitch. I took the money as a down payment, and while it wasn’t a lot of money, I told my technician “f*%& it, we’re doing this”. 

As we were getting everything prepared to do the surgery, I called my boss and I told him I’m gonna cut. I don’t think he believed me because he never came by. Now I’ve assisted with a couple C-sections on previous dogs and cats, but I never took the lead. My technician was more experienced with C-sections while assisting other doctors so she was guiding me through the whole thing. My assistant already went home for the night, but she told me she would be back if we decided to do the surgery, and as such she returned. Given the circumstances we needed as much people to help as we could get, so the client came back. After I opened the abdomen, I could visualize the uterus very easily. After a few incisions I managed to get all three puppies out. Unfortunately one of them, a male, was already pronounced dead. The other two, both females, managed to survive with the help of my assistant and the client holding and massaging them back to life. After lavaging the abdomen of uterine discharge and contents, we proceeded to remove the entire uterus and ovaries (not just because they were so friable and weak from me manipulating them, but also to avoid a future pregnancy). Doing a spay on a dog that is in heat or pregnant is not easy. There’s a lot of inflamed tissue, large blood vessels to be mindful of, and the dog is already in a dire state to begin with. But I had my technician with me and she gave me the confidence I needed to see this through. 

After we completed the surgery and closed the abdomen up, I was in complete shock. I don’t want any of you to think that I was in complete control of the situation, because I wasn’t. I was terrified and I knew that we could lose this dog even with a successful surgery. If I didn’t step up to the plate and take the bat, the alternate outcome wouldn’t have been much better. I used this as an opportunity to see what I was made of, to see if I knew what I was doing, and to put four years of Veterinary school to good use. My technician looked into my eyes and said “dude, you’re my hero”. I told her I couldn’t have done it without her. Not too long ago I was arguing with her about her work ethic and now I have tears of joy running down my face because of how grateful I was to her for getting me through this ordeal. Mom16508524_10102891473735508_95269319280587318_n woke up well and got to see her two remaining puppies in front of her face for a change. We couldn’t keep the dog in the clinic because we don’t have after hours services. But we could tell she was going to be fine and we sent her home with the proper medications and instructions. The client is still making payments for the surgery as we speak, the mom got her sutures removed two weeks later, and the puppies were nursing just fine. Everything worked out for all parties involved, thank God.  

I was very humbled on this day. I learned how to appreciate the work others do for me and to not take anyone for granted. These people aren’t just my employees, they are my family. I love everyone of them even if I don’t always show it, including my boss. As a matter of fact he called me the following day before I drove into work again. He asked if I was crazy and why I did the surgery without him? I told him I was going to, I made that very clear. He said he didn’t believe me! But after the laughs subsided he said he was so proud of me. The man isn’t just my boss, but my mentor and a second father. For him to say that made it all worth it, and I knew I was meant to do this for the rest of my life…..or until I decide to open up a restaurant. Alright I’m getting carried away, but one day!

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A Storm Like No Other

Wassim Jawad, MD, BSc Biology
Cardiac Electrophysiology Fellow, University of Massachusetts, Worcester, MA

cardiology-critical-care-fellowshipWhat am I put on this Earth to do?” We all ask ourselves this question every now and then; some of us more than others. I didn’t struggle much with it, at least not early on. I always knew I was going to be a doctor. It’s a long, grueling path, but one I did not waver from. I soldiered through four years of pre-med, four years of medical school (the first year of which was disrupted by a category IV hurricane), three years of internal medicine residency, and was halfway through my third and final year of cardiology fellowship. I felt like I had reached the top of the mountain. After countless punishing night calls, research, board exams and certifications, many are more than ready to move on and be done from training. I was no different in that sense, until I had that “moment” that everyone tells me about.

I could have just walked away. It had been another long day in the invasive cardiology lab, performing procedures and doing consultations. As always I make my way to the Cardiac Care Unit and sign out my patients to the on-call team, then I go home and enjoy whatever is left of my evening. Nobody would have thought twice about my leaving, I had already fulfilled my responsibilities of the day. I was at the nursing station, and I overheard a conversation about a patient that had just been admitted into the unit with a cardiac arrest. I thought to myself, “Okay, not unusual for the CCU, we deal with cardiac arrests all the time”. The on-call cardiology fellow was already on top of it, so I started to make my way out. The next thing I knew, the nurse told me the patient had already been shocked by the paramedics more than ten times, and another 15-20 times in the Emergency room.

Patients with very sick hearts are susceptible to potentially life-threatening “arrhythmias”, or abnormal heart rhythms. If not immediately treated with an electrical shock to restore normal rhythm, these conditions can be fatal. In rare cases, these arrhythmias keep recurring, requiring multiple shocks until the patient either dies, or the underlyinggraduate process is determined and definitive so that timely treatment is delivered. This is called ventricular tachycardia or sometimes a “Ventricular Fibrillation Storm”. What made things even more dire in this case was the patient was 26 years of age.

I walked into the young man’s room, and his emergent care was in full swing. His nurse, a big burly looking guy, was reduced to a ball of sweat trying to keep him alive with what was probably the best CPR I have ever seen performed. The code cart stood next to his bed, each drawer being emptied as drug after drug was being pushed by another nurse. Another nurse stood by his monitor, taking note of the time and which medications have been administered. At the helm was the on-call cardiology fellow, directing traffic and shouting out orders. With every shock delivered, normal rhythm would be restored, only to have the patient degenerate again into ventricular fibrillation minutes later, hence turning the process into a state of perpetual agony. This young man was dying right before our eyes and there is nothing we could do for him it seemed.

How long have you guys been at it?” I asked the fellow. “More than 30 minutes. We’ve tried everything and he keeps going back into V-Fib” she said. While she remained calm, the look of concern was clearly evident on her face. She had been running this code for longer than many would consider a valiant attempt, just hoping he would pull through. She didn’t want to see a 26-year-old man die….Neither did I!

I poured through his chart, reviewing what we knew about him already, as well as his electrocardiograms. At the time, the prevailing thought was that he may have been suffering from myocarditis, an inflammation of the heart muscle, often precipitated by a viral infection. This is commonly seen in younger patients, and can present with V-fib storm. However, all the conventional management approaches did not provide relief.

When your treatment plan isn’t working, you must always re-evaluate your diagnosis. This is a fundamental concept when it comes to managing patients. I began to look and see what else could be going on. In quickly reviewing his electrocardiograms, I noticed that he may have something completely different. I asked the fellow if she had tried treating him for V-fib storm precipitated by Brugada Syndrome (a rare disorder affecting the electrical conduction Wassimsystem of the heart, rendering patients at risk for fatal arrhythmias). She said she had not, and at that point she would have tried anything. We initiated treatment, and almost immediately, the extremely tense and ominous atmosphere had subsided. The patient’s heart rhythm finally stabilized, and our relentless, sweaty nurse who performed the chest compressions stood above our patient, desperately trying to catch his breath. We all stood there in silence, waiting to see when he would go back into V-fib, but it never happened again. A collective sigh of relief overcame everyone in the room. Our young patient lay there, hooked up to the mechanical ventilator, half awake, with tears flowing down the side of his face. After more than 62 shocks, countless chest compressions, and a barrage of medication infusions, he was going to walk out of our hospital. This man’s journey through life did not end on this night.

It was after all this that I realized that my journey through arduous training was not going to end after cardiology fellowship. I went on to specialize further in the field of cardiac electrophysiology (the study of heart rhythm disorders). I look back on this ordeal as one of the most powerful experiences that shaped the direction I wanted to take my career in. I was motivated by my loving family, my wife and my children, who teach me the value of life everyday.

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The Best Moms Become Grandmas

Shady Shebak, MD, MEHP (Candidate)
Founder and Chairman of MOVE, Movement for Outreach-Volunteerism-Education
Child and Adolescent Fellow, Michigan State University Department of Psychiatry, East Lansing, MI

Second Semester…

It was December 10th, 2009. I was in medical school, and it was nearing the end of my second semester. We were actually studying for finals, and finals were critical for me this time around. I was not doing so well in my classes, as it was an off semester for me. I was struggling through biochemistry, pretty much failing the class, and having difficulties with immunology and physiology. It was a rough time for me, mostly because I was just not getting it that semester. Sometimes, we go through unexplainable periods in life where our energy, our hearts and souls are just not into ‘it’, and this was the story of my second semester in medical school.

Shady MDAnyways, I was in a tough spot. I needed to pass all of my finals, and actually needed to do fairly well on my biochemistry final in order to pass the semester and not have to retake any course. If I failed all three, heaven forbid, I’d actually be dismissed from medical school! I was anxious, terrified at the prospect, and could not tailor my focus to one final at the expense of the others since I was in pretty bad shape in all three classes. What a mess!

Nothing could have prepared me for what happened next. I was taking a break from studying. Actually, we were taking a break from studying, as I studied with a consistent study buddy, and we decided to just relax for a bit. I went onto Facebook, and I saw that my brothers’ had changed their profile pictures to my grandmother’s picture. I immediately knew what this meant and broke out in tears. I could not hold back my emotions. I loved my grandmother to pieces, and she really was a mother and a caretaker for me. More than my siblings and maternal cousins, I spent the most time with her as the oldest of the “kids”. I was practically raised by her for much of my childhood. I always wanted to sleep at her house, and we’d stay up at night watching old Arabic movies and shows. The Arabic channel at the time was called “TV Orient”, and I remember I would just enjoy those moments dearly.

One time, I remember becoming fairly ill, vomiting and I had a terrible headache. I’m sure there were many more instances of illness, but this time sticks out to me as my grandmother put my head on her lap and read various Qur’anic verses. I was about seven years old, so I thought this was some magical ritual going on! Surprisingly, I felt better.

When I saw the Facebook picture, all of these memories flooded. I remembered all the nights I spent teaching my grandmother English, while she would teach me Arabic. I remembered all of the times I spent with her shopping for candy, or going on walks, or Shady Shebak grandmalaughing hysterically. I remembered her grace, her love, and her life lessons. I remembered her stories that she told us about her childhood in Lebanon, learning English from Mrs. Brown, whoever that is! And I also remembered her 10 year struggle with Alzheimer’s, as she gradually began to forget and lose insight and behavioral control. Fortunately, I knew her so well before and after the Alzheimer’s, that my memories were of a fuller picture of who my grandmother was. She was a lady, a wife, a mother, a grandmother, a friend, a pious Muslim who never missed a prayer.

With those memories, I remember taking the rest of the day off from studying, and I reflected on her life. I spent the weekend lightly studying, and went in the following week to take my finals. I did the best I could, and after my last exam, I headed right to the airport to spend my two week break with my family and friends back in Michigan. I had a few hour stop in Charlotte Airport, and I decided to open my laptop and check my grades. Only immunology was posted, and I had passed! It wasn’t for another two days until all of my grades posted, and with God’s grace, I had passed all of my exams. I went on to finish medical school, and never had a semester quite like my second semester ever again!

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Treat Others Like Family

By Ali Chami, DPM (Candidate)
Kent State University College of Podiatric Medicine, Indepedence, OH

Like many people in the Dearborn, MI Arab-American community, I am a first generation American. My parents worked hard to put food on the table while their children went to school, in hopes of them living better, more comfortable lives than they did. However, my siblings and I were never really nurtured to excel in academics. My parents didn’t have the time to simply sit down and tutor me, let alone speak much English. I grew up hating school, and I was never thrilled about being forced to do things I didn’t want to do. I saw the years between elementary and high school as a burden more than as a privilege. I was literally in summer school every year from 7th grade til graduation. Due to this, I was the guy who had an asterisk next to his name on graduation day. I felt embarrassed for my parents and myself. I was determined to make it up to them, and more importantly, to myself.

chamis-parentsWith my diploma in hand, I was ready to start college. I didn’t know what field I wanted to study, and worse, I had no guidance. Most parents (especially Lebanese) want their children to do something prestigious, preferably in the health sciences. Initially I chose pharmacy, but one semester into college, a high school friend convinced me to change paths and become a nurse anesthetist. During this period, I enjoyed learning as much medical knowledge as my determined brain could absorb; from symptoms to diagnoses, complications to medications. The clinical setting was amazing. I got to help treat patients and went the extra mile for them as best as I could. But despite this I felt the nursing field was limited. I did eventually complete the courses required to finish the nursing program, but I took more classes to ready myself for medical school. I decided to pursue podiatric medicine as my specialty due to the surgery aspect and the potential of owning my own practice one day.

During my clinical time in nursing, I learned so much from interacting with patients. The biggest takeaway was to be happy with the life you have because it can be much worse. I always wished my family had the luxurious lifestyle growing up, but nowadays its completely different. The reason for that is for the health of my loved ones. There are so many people who have unfortunate illnesses and would trade anything to rid of it, even if it means being homeless. This ideology stems from the six weeks I had in obstetrics, with the fortune of being able to witness a Cesarean section being performed. The procedure went well, however the newborn wasn’t born exactly “normal”. The child had 6 toes in one foot and 4 fingers on one hand. The mother was so saddened, but every clinician in the operating room was happy. Not because the child was born with a unique abnormality, but because it was a non-life-threatening defect. I’m sure they’ve seen many worse cases, and I believe that’s why they kept telling the mother “it could be much worse”. As my fiancé and I progress through our relationship, the topic of children has been brought up multiple times. It always ends in us praying for healthy children, no matter what our situation is.

chami and helena.jpgAlong with nursing, the clinical aspect of podiatry has taught me to go the extra mile for my loved ones as well. When you’re caring for patients, you feel like it’s your duty to give it your all. I didn’t really feel this way for my loved ones (growing up). There would be times where I would give minimal effort because I felt it wasn’t my job to. Nowadays, I find any chance I can to help, whether big or small. The reason for this was from an elderly woman I treated. She came in for routine foot care, no problem. When I was finished, she told me that she’s been to multiple Podiatrists in the area but not one person treated her the way I did. Then she asked a little bit of my background and we soon found out that she was a neighbor of my grandparents. As she started to tear, she basically told me that my ancestors and she were family. I was also told that I treated her like family the whole time, and she asked for God to keep me on this earth. This struck a cord with me. I thought to myself “this is how family should be treated, no matter what.”

From that moment on I planned to go the extra mile for those I love. Not just for the family that I currently have, but also for the family I hope to create in the near future. It is important for me to do that if I hope to have the same impact on other people’s lives as I did with that patient. I plan to carry myself this way as I start my own family, to ensure that they live the best lives possible, in the same way that my parents wanted for us.

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Sentimental Journey

By Hael Ghaleb, DC
Palmer College of Chiropractic, San Jose, CA

My name is Hael Ghaleb. On July 15, 1987 I was born in Sana’a, Yemen. Since my father was a United States (U.S.) citizen at the time, I was also born a U.S. citizen, abroad. Most people who see my birth certificate think my father was serving the military, but he was actually a musician. He partied until he was about age 40 and decided to settle down and create a family. My mom was 20 when they got married and she wanted to study Russian Literature, but of course my father had other plans. After I was born, my father decided to move back south, to Aden, where both of their families live. I can recall driving through the mountains, living by the sea, and can also recall parts of preschool and kindergarten.

adenIn the fall of 1994, a civil war broke out between the North and the South. We were far away from the conflict, so some family members who were near the fighting moved into our apartment. We were living in my maternal grandfather’s place, next door to a diplomat. The mansion he lived in had big gates and villas. I remember bullets bombarding his house until he surrendered, and the soldiers in Jeeps rolling in, as well as the day the war ended, with the North winning. My father knew then that we had to leave the country.

No one in the family was happy about the decision, but they all understood why it needed to be done. To my dad, it was a sign from God, to take your kids back to the U.S. where it was safe so that they can get a proper education. We flew into Chicago in late October 1995, and then we drove east to Dearborn, Michigan. Seeing snow for the first time, I was thinking how weird it was that houses in America had roofs that dispersed rain water rather than collect it, or how weird it was not to being able to see mountains anywhere I look. I missed living by the sea and mountains, but I was so happy and excited because everything was new. The cars, the roads, the police, the businesses, and the people were all different from what I was used to.

It was a bit difficult at first. All the kids called me “boater”, I had never seen a computer in my life, and for once I didn’t have to wear a school uniform. My brother and I conformed quite easily, especially given the fact that we were still surrounded by an Arab American community, making the transition a lot easier for us. Unfortunately, around that time was when the World Trade Centers fell, and shortly after that, my parents divorced. My mother moved out of the house and we moved in with her, but of course kept half of our stuff with our dad and we were welcome there any day of the week. It was hard of course, but if I could go back in time I wouldn’t change a thing. They both remarried a few years later and produced more children with their new spouses. I went from being the oldest of two to the oldest of seven in no time. My parents seemed a lot happier, I was almost done with high school, and I was also excited by the prospect of raising a baby brother and sister.hael

Time seemed to fly the older I got, and before I knew it I was attending Wayne State University with a focus on Pre-Medicine and Biology. I was dating my high school sweetheart at the time. She lived in Canada and we would have to cross the bridge or tunnel once or twice per week to see each other. She started attending Wayne State as well and I moved out of my house into an apartment next to school for the last two years of my undergraduate studies. I wasn’t sure about becoming a medical doctor and dealing with insurance companies or big pharma. I felt home sick even though home was just a ten minute drive. My ex-girlfriend came from a Chaldean Catholic family and were strict about who their daughters’ date. They never did accept me of course, being a Muslim and asking for their daughter’s hand in marriage. The longer we kept seeing each other the harder it was to break up, but unfortunately our relationship ended after 5 years. Since then I was lost about what direction I wanted to take with my educational career, until I discovered Chiropractic medicine and finally chose a school in San Jose California. Everything seemed to be working out, for if I didn’t move to California my ex and I would continue to struggle with the break up and hurt each other. I broke her heart either way when I moved west, but I had to go out on my own and restart my life. I felt like a brand-new man with a different perception. The easy-going lifestyle, wonderful weather, culture, sports, and of course Silicon Valley were right up my alley.

But it was just as difficult as it was wonderful. The home sickness was severe, and I missed my little siblings dearly; they were growing so fast. I pushed on, with each challenge or problem that I had to face, without my family, molding me into the man I am today. Through the good times and the bad times, I made a great deal of friends inside and outside of school and became so close to so many of my peers. We still speak almost every day and I’ve been back to California on two occasions to watch them get married. As I sit here at this moment typing, I realize that it has been 3 years since I graduated Chiropractic school. That period of my life flew by so fast, and at the end of the day all you can do is laugh. You dread the time it will take you to reach your goal, but once you reach it (ironically) you’re stuck reminiscing about the journey.

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Will She Remember: Janette, Dementia, and I

By Hussayn Alrayes, DO Candidate 2016

Michigan State University College of Osteopathic Medicine, East Lansing, MI

Names and details have been changed to protect the identity of the parties involved.

I was only a week into my first internal medicine rotation, and made sure to wake before the crack of dawn so that I could arrive at the hospital by 5 am. My senior residents expected a lot out of me, and punctuality was no exception. After shrugging off the mist from walking across the parking lot to the hospital’s student lounge, I sat with my residents and medical student peers to sort out our patient assignments. Each of us would be assigned patients based on their reasons for admittance to the hospital—also known as their “chief complaint.”

The first case I received was that of Mr. James, who suffered from shortness of breath. This would be a relatively routine consultation for me, as I had developed a robust understanding of the cardiovascular and respiratory systems. Next was Ms. Stevenson, whose ailment was described as “lower limb swelling.” This could have been any number of things, but I immediately began to build a list of possible causes based on the information in her chart. Finally, the patient I was hoping to avoid was assigned to me: syncope.

Syncope—a term used to describe a transient loss of consciousness—was the bane of my existence, mostly due to the ambiguity of such a complaint. In medicine, the list of possible causes for fainting or syncope is almost endless, but one of the more common reasons is lowered blood flow reaching the brain. This may seem simple enough, but then comes the task of identifying the various possible causes of decreased perfusion to the brain, along with all the non-hypoperfusive causes of fainting. On top of all of these considerations, an epileptic episode, which can mimic syncope, can turn what seems to be a simple diagnosis into a murky one.

My patient’s name was Janette. I made my way down to the emergency room to gather all of what I needed to know about Ms. Janette, and upon a thorough review of her chart, I decided to pay her a visit.

Janette was a frail-looking woman in her mid-70s, laying in her bed with a deep bruise over her left brow, and some bruises over her arms—likely the result of having difficult veins for the nurses to start an IV. She gazed at me, and a warm smile stretched across her face. I introduced myself, voice still a bit shaky from my inexperience with patient interaction, and we began to talk about what happened to her. According to her, she tripped over a rug in her kitchen and couldn’t react in time to properly brace herself, hitting her left brow on the floor. She lost consciousness, and her daughter found her on the floor minutes after the episode. The fact that she had Alzheimer’s disease made sense as to why the story she was telling me was different from the story she told the paramedics.

She wasn’t trying to lie, but instead was subconsciously trying to fill in details of an event that she could no longer fully remember. After she finished recounting what happened, I posed her with the three questions we ask patients to assess their mental status: “Where are you right now? What year is it? What is your name?” She could only correctly answer the last.


Dementia Risk

Over the next few days, Janette was worked up from head to toe. CTs and MRIs were done to rule out any neurological cause of her fall, along with an EEG to rule out any seizures. The cardiology team worked her heart up and down, but came back with no explanation. Throughout her stay, every morning at 5 am, I would pay Janette a visit. Every time I entered her room, she smiled the same gentle smile she had given me in the emergency room, and would always greet me as if it were her first encounter with me; because to her, it truly was. I patiently reintroduced myself every morning, and calmly explained to this frightened woman why she was in the hospital.

One of the issues that people in the advanced stages of Alzheimer’s disease struggle with is slowed speech, along with the inability to remember basic words and names. In a hospital setting, a patient with this issue can be frustrating, particularly because there is pressure to see all patients in a limited span of time. Given that doctor-patient interaction is never monitored, being rude to this woman would have been all too easy. The thought of being abrasive toward her can creep upon the mind in these circumstances, especially given the knowledge that she would never be able to remember or recount the details of our encounters.

Anonymity can be a nasty thing sometimes. Closed doors have a way of enticing our darker thoughts to come forward, and in the midst of circumstances with no oversight or accountability, our moral compass can often be tested. In these situations, the tendency to favor one’s self-interest at the expense of others is quite tempting. As human beings, we are hard-wired to pursue our own selfish satisfaction, often favoring our own desires over doing what’s right for others. This results in a precarious sense of reduced accountability for our own actions, giving us free reign to indulge in more primitive behavioral tendencies.

Looking back, I am glad I chose otherwise. In my interactions with Janette, the subtle affinity to empathize with others proved more powerful, and it kept me from being abrasive and cold. Perhaps it was her sincerity, her smile, or how pleasant she was to speak with at times. Maybe I just don’t have that in me, and my selfish thoughts stayed as thoughts, and would never mobilize themselves into action. Whatever the reason, what I do know is that it was important to keep treating her with kindness and respect, even if she never remembered it.

Janette was eventually diagnosed with vasovagal syncope, a wastebasket diagnosis given to those in whom all other known causes of syncope are ruled out. When I heard that Janette was getting ready to be discharged, I visited her one last time to wish her well. To my surprise, her son was in the room, helping her gather her belongings before taking her away. Before I could say anything, Janette began waving to me. Her son noticed the wave, turned to me and said, “Oh, you’re the amazing student who has been watching over my mom every day. She speaks very highly of you, and I really appreciate how much time and effort you’ve put into caring for her.”

I didn’t know how, but Janette had been telling her son the entire time about how I had been treating her. To this day, I don’t know if she spoke to him about me every day before her memory of our interactions faded, or if she actually did retain bits and pieces of our interactions that she recounted to her son later. What I do know, however, is had I acted on my thoughts of mistreating this woman because of my own impatience and stress, I would have impacted her in an entirely different way. And even worse, she may have even remembered it.

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Are You Going Home? EMPATHY

By Shady S. Shebak, MD

Psychiatry Resident, Virginia Tech Carilion School of Medicine, Roanoke VA

It was a tiring Friday night. I had been at the hospital all night admitting psychiatrically unstable patients to the psychiatric ward, and was exhausted. The night had barely started… Let me back up a little and start by explaining what “on-call” means. As a resident, and in my case, a psychiatry resident, we have on-call shifts where we stay overnight in the hospital. Basically, in the daytime (from 8:00AM-5:00PM) I work my normal shift, which this month happens to be in the child psychiatry ward. Then at 5:00PM, I start my on-call shift, and stay until 8:00AM the next morning. It’s very tiring, as we are expected to cover any complications that may arise overnight, and admit all new patients, and there are always plenty of new patients that need to be admitted for a variety of reasons. That day I had explained this process to one of my 9 year old child patients. The topic came up because she asked me when I was going home, and I told her I would be going home the next day at 8:00AM and she immediately became concerned. She wanted to know how I would sleep, or eat, or be able to stay up all night. I was actually quite surprised as usually no one thinks twice about it. Usually people just sigh out of relief that it’s not them who are up all night.

Anyhow, I forgot about our conversation and started my call shift, which was looking like it was going to be a very busy night. What happened between starting and finishing my call shift was not as important and is a blur that was eclipsed by what happened at around 8:15AM the next morning as I was ready to head out. I had to walk through the child psychiatry ward, and there was that 9 year old patient getting ready to eat her breakfast. She looked at me and said, “Are you going home to get some rest? Please tell me you will be resting today”. I must say, I was taken aback. I looked at her face which showed deep concern for my well-being. I felt a very warm sensation envelope my heart, and my face lit up with a smile. Here was a patient who had been going through hell, who had several medical conditions, and a psychiatric condition who was showing more concern over my well-being than many people have shown her as she struggled through her various illnesses. She was showing empathy in its most innocent and pure form, and it was beyond touching. I told her “Yes I am going to go home, rest, eat, and enjoy the rest of my Saturday and Sunday, and will see you on Monday”. She said “That’s good, you need to rest and be healthy, and take care of yourself”.

Empathy Definition

Empathy Definition

This short conversation really impacted me for the rest of the weekend. It made me feel appreciated, and gave me a lot to think about with regards to empathy, human kindness, innocence, and how we need to foster and cherish these concepts instead of trample on them as we get old and jaded. The professional world, and the adult world seems to be less concerned with these tender emotions than it is with machine-like efficiency, protocols, and reduced rationalism. We take children, and overtime turn them into adults, in the form of our tired selves, and something about that should not sit well with any of us. We too were once children who were vibrant, who cared, and I think sometimes it takes a child to bring us back to that reality. We must encourage and show appreciation for this type of empathy and innocence so as to nurture its continued development and break the cycle of machine-like expectations that we have for one another.


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