Book Club: Inspiring A Career In Medicine

Transcript

Dr. Angela Kade Goepferd: This is talking pediatrics, a clinical podcast by Children’s Minnesota, where the complex is our every day. Each week, we bring you intriguing stories and relevant pediatric healthcare information. As we partner with you in the care of your patients. Our guests, data, ideas, and practical tips will surprise, challenge and perhaps change how you care for the most amazing people on earth, kids.

Welcome to Talking Pediatrics. I’m your host, Dr. Angela Kade Goepferd. Today, we’re premiering our book club series with guest host, Dr. Gabi Hester, who you’ll recognize from our guidelines with Gabi series. Today, Dr. Hester sits down with a multidisciplinary group of clinicians to discuss books that influenced their careers in medicine. Specifically, books that inspired them to pursue medicine or a particular field of pediatrics, and why. Listen in with our experts and maybe you’ll discover something new to read this summer.

Welcome to book club with Gabi.

Dr. Gabi Hester: Today on guidelines with Gabby, we’re going to take a little bit of a different approach. We’re going to focus today on books. And just like any good book club, I’ve joined a number of my good friends today to help me share some of my favorite books and talk a little bit about why they inspire me and challenge me as a healthcare provider. So with no further ado, I’d love for all of my friends to introduce themselves and share a little bit about what brought them into health care.

Dr. Kerry Whittemore: Hi. I’m Dr. Kerry Whittemore. I’m a pediatrician in Salt Lake City with University of Utah Health. I spend most of my time in a clinic that serves mainly refugee and underserved children and children of immigrants. And I joined health care for that reason. For taking care of an underserved population.

Natalie Lu: Hi. My name is Natalie Lu. I’m a registered nurse and I work in patient safety, so I support our system by way of making care delivery safer. I found my way into healthcare on topic by way of the reach out and read program. I was a volunteer in our clinic at Children’s Minnesota, back in 1997. And my role was to show up and read to kids in the waiting room while they were waiting for their well child checkup and where they would receive a book just to help enforce to families, why reading is important and to help them make it a part of their routines. And as luck should have it, it led to a career in health care for me. So, happy to be here today.

Dr. Gabi Hester: That’s such an amazing story, Natalie. Thank you for sharing. And I love that that was back in 1997, it sounds like. And just to continue that circle, we have someone else who’s really connected with reach out and read with us today. Molly, can you introduce yourself?

Dr. Molly Martin: Hello. My name is Dr. Molly Martin. I am a pediatric hospitalist at Children’s Minnesota, and I also hold a role in our medical education department supporting the education for medical students and PA students. And I think I actually found my way to medicine through reading. I’ve always been a voracious reader with a deep respect for and curiosity about the stories of others. Medicine for me holds that same expansiveness. It’s a great field for someone who is intellectually curious, is happy to be in a space where you can never know everything and wants to hear and connect with other people with a window into the world of lived experiences different than their own.

Dr. Steve Selinsky: Hi. I’m Dr. Steve Selinsky. I’m a pediatrics chief resident here at Children’s Minnesota. I did my training in internal medicine and pediatrics, and really found my way into the healthcare world through public health and global health. And that’ll probably bear out in some of the works that I talk about today.

Dr. Gabi Hester: We’re going to start out with the key question. What book inspired you to enter health care?

Dr. Molly Martin: When I reflect on what books have held me in medicine, or feel like they describe the experience I’ve had as a healthcare provider, one that really stands out to me is My Own Country by Abraham Verghese. It’s a memoir about his time early in his career as an infectious disease physician practicing in rural Tennessee, in the 1980s, around the time of the emergence of the HIV and AIDS crisis. And he really details the social challenges faced by his patients. He documented how homophobia impacted the way his patients accessed and received care and approached a situation riddled with prejudice and fear, standing with his patients at times when no one else would. It also for me, really shone a light on the service of foreign medical graduates and both the incredible care that they deliver to patients in our country, but some of the challenges that they face in doing so. Many of you may know Dr. Verghese from other works of his, like Cutting For Stone was a popular novel.

Dr. Kerry Whittemore: I read it in medical school and it was definitely quite moving.

Dr. Gabi Hester: I like Molly, what you said about standing with their patients [00:05:00] when no one else would. I think a little bit about some situations in the last year, listening to Kerry talk about how she takes care of primarily refugee population and how often we are serving as advocates for those children and families and the importance that healthcare providers can play in those situations.

Dr. Molly Martin: Yes. I see the practice of medicine is critically intertwined with confronting issues of social justice. And it’s really powerful to be able to participate in a career that allows you to think about those issues and maybe hopefully make a difference for patients and their families.

Dr. Steve Selinsky: I think that idea of medicine as a powerful social force is a really powerful one for me and a lot of my peers, as we decided on medicine and made that decision early on. I know when I was an undergraduate, I had a lot of thoughts about the world and what I wanted to be in it. Medicine was not necessarily the thing that I saw as the place where I would fit in. I had read actually Tracy Kidder’s Mountains Beyond Mountains kind of later in college and realized that medicine as a structure was something that disproportionately serve different groups, very differentially. And seeing the way that those structures kind of held sway over people’s lives, I think was a really powerful force in helping me make the decision to start looking at public health as an issue that’s worth pursuing and start looking at medicine and thinking about medicine as like you said, as a powerful social intervention that we could take part in.

As opposed to some of the stories that we read about physicians that are very individually focused, I think Mountains Beyond Mountains is fairly individually focused around Paul Farmer, but on a second reading a few years ago, you realize the number of people that he had around him, sort of supporting him and working through that journey. And I think that that’s been something that stuck with me as well.

Dr. Gabi Hester: I like that you bring that up, Steve, and it makes me feel like I need to read that book a second time. Because when I read Mountains Beyond Mountains, [00:07:00] I was terrified to be honest. It felt like the work that he was doing was so important and so inspiring and at the same time, it felt to me that I had to give up other things in my life and sacrifice other things in order to achieve that outcome. And I think we’re learning that that’s not necessarily true. Maybe no one’s going to write a book about me, so maybe I haven’t moved mountains or gone beyond mountains.

But individuals can make little differences in people’s lives that are really impactful without necessarily having to be the one, as Paul Farmer does in one of the vignettes in the book, hiking through a remote village to deliver the medicine to a family in a rural situation. There are other ways that you can impact. And I think he mentioned the power of systems and how we can build our systems to support that need as well. Natalie, what about you? What book inspired you to come into health care?

Natalie Lu: So, a book that inspired me to come into healthcare before I even had healthcare on my radar or in my crystal ball was It’s Always Something by comedian extraordinaire, Gilda Radner, who was part of the original Saturday Night Live cast and crew. And she writes serial comic approach to her journey with ovarian cancer and gives a very poignant narrative on the humanity we share when we consider this walk we are on in care delivery. And I read this book when I was a communication major, the first go round in my first career in the field of communications. I was just really interested in leaning into the stories we have to tell each other and what we have to learn from listening. And I read this book with that open part, and I remember just feeling in awe of the role of those who care for others on the journeys that our patients and families are on.

And I want to read just a very short excerpt from the closing of her book. “Some poems don’t rhyme and some stories don’t have a clear beginning, middle and end. Like my life, this book has ambiguity. Like my life, this book is about not knowing, having to change, taking the moment and making the best of it without knowing what’s going to happen next. Delicious ambiguity.”

And as I dug into my bookshelf and dusted off the covers of a couple of others that have been mentioned here in our chat today already, this one really stood out to me as a book that inspired me to think about the gray area that all of us are navigating. And the fact that, like my dad has always said nothing good lasts forever and nothing bad lasts forever. And you never know where you’re encountering someone in their day or in their journey as you hold that dear. And this book for me, I can pick it up and I can open it up to any page and just be reminded of a personal narrative that helps us hone in on how to listen.

Dr. Gabi Hester: I find that the personal narrative, reading about other people’s experience navigating the healthcare system and navigating illness is so powerful. And I know there are some other great books out there that really speak to that as well.

Dr. Molly Martin: One of the books that I found to be particularly powerful in that genre was a book called When Breath Becomes Air by Dr. Paul Kalanithi. It’s another memoir and it was beautifully written by a neurosurgeon who was diagnosed with stage four lung cancer toward the end of his career. He was in his mid-thirties around the time. One of the big themes in the book, it’s his transition from doctor to patient. It’s a profoundly beautiful book, but also devastating to read so I would recommend having some Kleenex on hand, if you’re going to read it.

Dr. Gabi Hester: I know. I’m tearing up just thinking about it.

Dr. Molly Martin: It’s wonderful. He reflects on his journey as a physician in training. One of the things that struck me the most is the idea that empathy leaves you really open and vulnerable. We all know in our career in healthcare, that you can be the best, smartest, most attentive care provider and patients will still die or have difficult outcomes. I think about that a lot and how you live in that space. A space where sometimes the control isn’t yours any longer. And he really is able to speak eloquently to that as he loses control on his journey as a patient. It’s really a book worth reading.

Dr. Steve Selinsky: I agree. It’s definitely one that pulls a lot of emotion. I made the mistake of reading that book on a transatlantic flight. And so I don’t recommend that as being the ideal place to read that book. However, one of the things about reading it as a trainee and in a similar place in my training that he was and reading it in the setting of having recently lost a loved one to cancer was really struggling. You’re having someone to struggle with in that tension between when are you a physician and when are you a family member and how can you be both and when can you be neither? It’s this really fine line of who am I in this world? And as you’re coming into your career and trying to figure that out, I think that tension is something that I was struggling with and identified with quite a bit in that book.

Dr. Molly Martin: His physician in the book too, I think has this beautiful way of moving him along in his treatment. She sits with him initially and sets a treatment course with him that allows him to maintain the things that are valuable for him. For example, she picks a specific type of chemotherapy for him that is less likely to cause problems with peripheral neuropathy, which for him would cause issues with his hands as a surgeon operating. And that idea of being a partner with your patient in their care also really spoke to me.

Dr. Gabi Hester: Kerry, how about you? What book inspired you to go into healthcare?

Dr. Kerry Whittemore: It’s actually not a medical book or one certain book. So in college I was a sociology major and I concentrated in peace and justice. And the work of Jonathan Kozol was what inspired me the most. I don’t know if any of you know him. So, he’s a writer who writes about the education system in the United States, mainly in how the children in poverty and children of color are really not getting an equal footing in this world compared to their counterparts. And it just really inspired me in terms of wanting to take care of the children that were underserved. I met him at a book reading in Philadelphia and he signed my book and I literally started crying cause he was like this activist hero for me, which is kind of embarrassing. But his books are really amazing. Amazing Grace is one of them. There’s just a lot of them. He’s inspiring for me to take the career trajectory that I have.

Dr. Gabi Hester: Steve, what about you?

Dr. Steve Selinsky: So I kind of mentioned Mountains Beyond Mountains earlier. After reading that I had gone on to pick up Pathologies Of Power, which is one of Paul Farmer’s Seminole works, but it really walks through what is justice in healthcare and more so what is illness and how is illness caused. And looking at the social structures that not just cause illness in vast swaths of people, but in individuals, in one person at a time. And so he walks through case by case of how illness is a manifestation of the social and political education failures, individuals of governments, of societies. And I think that really structured the way that I think about illness and in a way that has struck with me.

I went on to do public health and global health work for a few years before coming back to medicine. And I worry sometimes that being away from some of that work that I’m not doing the work that I had set out to do earlier. And as I reflect back on sort of how I think about how my patients end up in the hospital and why they’re there and what it really means to get home and get home safely and get home to a productive life. It’s still really based in those structures of [00:15:00] how do we guarantee basic human rights and how do we guarantee that they’re getting the things they need. And I think a lot of that comes out of a rights based approach that I got from.

Dr. Gabi Hester: It sounds like there’s a lot of connection between what Jonathan Kozol writes about and some of the other books that we’ve discussed today, as far as the intersections of power and poverty and social justice and health, and that important overlap, you can’t disentangle them. We’re all in the thick of it as providers in our various roles. Are there books [00:15:30] that you’re wanting to read again or a book that you have read again now that you’ve settled into your career a little bit and does it speak to you differently?

Dr. Steve Selinsky: I think going back and looking at some of the books that I read during medical school and specifically one that we all read during our first year was the Spirit Catches You and You Fall Down. And so that is one that I remember having a lot of discussions about. And the first year of medical school, everyone is coming from such different places. And so, to try to have a cohesive conversation about what someone else’s experience was, was a [00:16:00] really challenging one. But I’ve spent the last four years working in a refugee and immigrant based clinic that has a high Hmong patient population. And I would be really interested to see now that I’ve had this experience, how I reflect on some of the material. And maybe some people have read it more recently and have some thoughts.

Dr. Gabi Hester: I’d read it, I think as well in med school and had a very different take on it now that I’ve worked in healthcare and taken care of many children and families who are Hmong. And it still strikes me that even with this additional layers of experience and years of supposedly gained wisdom that I have, how I still miss the cultural lens and the cultural overlap and the importance of that. I think there are things that I know or think I know and then in the moment, sometimes I forget. As an example, one of the things they talk about in the book is it’s important not to call a child beautiful because their soul or their spirit may escape them. And that for me is just a natural thing that I do when I walk in a room and see a new patient.

I talk about, oh, what a cute kid they are, or try to point out something about them and the light that they have in their persona. And I realize that that is viewed differently by different cultures. And so, this was a good reminder of just trying to have cultural humility and recognize that there are different traditions and cultures and lenses and practices [00:17:30] and I have to try to educate myself on those different beliefs and traditions.

Dr. Kerry Whittemore: The full title, the Spirit Catches You and You Fall Down, A Hmong child, Her American doctors, and the Collision of Two Cultures. It’s a story basically about a Hmong family in California who are refugees, whose daughter has a diagnosis of epilepsy. Their interpretation of that diagnosis and the medical systems attempts to take care of her in the best way they can. And kind of the miscommunication between cultures that end up really hurting her in many ways. So I also first read this in medical school and the first thing I thought was, “Oh my God, these doctors are awful. They are not recognizing the factors in this family’s life that impact her medical care. The doctors suck, et cetera, et cetera, et cetera.” But when I re-read it, I find it to be more complicated and I have actually more empathy for the doctors. I think just given my role, like I said, in a refugee clinic, I find it overwhelming to try and know all the facets of the different families, cultures that I take care of and to not, like you said to call a baby beautiful. I just don’t know that.

And the second thing is the amount of time you have to take care of patients is never enough. So I could see the doctors being like, “She has epilepsy. You need to give her these medications.” And the frustration that they have when the family doesn’t give the medications properly. Not that the doctors are obviously perfect in that book by any means and there’s definitely lessons to be learned. But it is more layered and complex for me than it was the first time I read it.

Natalie Lu: Kerry, I would agree with what you just shared. In that, I think the book presents the perspectives of both the doctor and the family so well. And what I would piggyback on what you just shared is that re-reading that also after reading it 20-some years ago, I found myself really considering the empathy for physician colleagues and for the time and space that we have to show up and be authentic and to personalize the experience for each of the patients and families who we care for. And I think this book just does such a beautiful job of inviting us to think about how to have that empathy for each other. And if we can figure that out, I think we’ll do a better job of extending it to the patients and families who are in our care

Dr. Gabi Hester: This book was written originally in 1997. And as I was reading it, I noted there were some terms that maybe are outdated and no longer used. And I would love to see this same type of book written again now, and to see how much feels the same, like how much feels like we haven’t made progress, but then to see areas where we have progressed. And I would also love to see this same book written from a Hmong author, to see if that’s different, to see if it aligns with what this fabulous author, Ann Fadiman, who is a white woman, learning more about a culture that’s very different from her own. She tells a little bit about her own history in this. It’s a great book, and I would love to see the sequel written from a different lens and in a different era. Are there any books that surprised you about healthcare?

Dr. Steve Selinsky: So, one book that surprised and didn’t surprise me was Medical Apartheid by Harriet Washington. I think there’s some that I learned in medical about the history of medicine taking advantage of groups of people. Usually, groups of people who did not have a lot of power or did not have a lot of money or did not have a lot of freedom. And I think that collectively the medical community acknowledges that some of these things happen, but what I think the book did really well was it walked through event by event, sort of violation by violation and helped me understand the ways in which those violations accumulated in the collective understanding of medicine. And helped me understand the ways in which mistrust built on mistrust and ways that I’m continuing to struggle with in clinic and with patients on a regular basis.

One of the biggest points that I took away was, there is both the collection of these events in the past and the ongoing injustice that we live in. And both of those things contribute in very real ways to how I as a physician, I’m able to interact with patients where there is a difference in our privilege or color or race or creed. So, that one I think was helpful in creating a more complete picture of the relationship some people may have with the medical system.

Dr. Gabi Hester: I just want to thank all of you for joining today for our very first Talking Pediatrics book club. I hope there are many more in the future and it was so fun connecting with all of you and thanks so much for all of the great book ideas. I have a huge list going now of things I get to read this summer.

Speaker 1: Take home books.

Dr. Steve Selinsky: Number one, Pathologies of Power by Paul Farmer.

Dr. Molly Martin: Number two, When Breath Becomes Air by Dr. Paul Kalanithi.

Dr. Kerry Whittemore: Number three, the Spirit Catches You and You Fall Down, A Hmong Child, Her American doctors, and the Collision of Two Cultures by Anne Fadiman.

Natalie Lu: Number four, It’s Always Something by Gilda Radner.

Dr. Gabi Hester: Number five, Mountains Beyond Mountains by Tracy Kidder.

Dr. Angela Kade Goepferd: Thank you for joining us for Talking Pediatrics. Come back each week for a new episode with our caregivers and experts in pediatric health. For more information and additional episodes, visit childrensmn.org/talkingpediatrics.