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Diastole: Residents at rest

The Department of Internal Medicine’s Diastole blog encourages residents like Sarah Lee, M.D., to use writing as a chance to reflect and build resiliency.

The Department of Internal Medicine’s Diastole blog encourages residents like Sarah Lee, M.D., to use writing as a chance to reflect and build resiliency.

The patient lay in her hospital bed and stared into space, unable to make eye contact with the doctors who had come to help her.

Battling end-stage HIV/AIDS, the woman seemed unable to come to terms with her condition.

“I’m not sure if she could hear us, or if she was in denial and chose not to respond,” says Sarah Lee, M.D., a second-year resident in the Department of Internal Medicine. “It was frustrating and sad. That was my first year, and it was tough to deal with something like that so early on.”

Lucky for Lee, she had help. For the past two years, first-year residents have written reflective blog posts with the hopes of normalizing reflection and increasing resilience.

“That first year can be pretty jarring,” says Megan S. Lemay, M’11, assistant professor of medicine in the Division of Internal Medicine. “It is overwhelming for the best of us. As they face extremely difficult tasks, we are teaching the residents skills in resilience so that they can keep themselves well.”

Diastole, the relaxation phase of the heartbeat, is the perfect name for the blogs, Lemay says.

“If the heart does not take time to relax and then fill up, blood won’t be pumped out,” she says. “In the same way, if you don’t take time to relax and reflect, you have nothing to give.”

Interns have reflected on a variety of assigned topics, including the role model whose traits they want to emulate and the challenges they face in treating patients with mental illness. When Lee and her classmates were asked to reflect on their lowest and highest day in haiku form, she shared her experience with the non-verbal patient by writing,
She won’t look at me.
Only nods and sighs out loud.
Wonder what she feels.

Her haiku along with others from her fellow residents are featured in the latest issue of the Medical Literary Messenger, a web-based journal that strives to promote humanism and the healing arts through prose, poetry and photography.

“Sometimes it’s easier to try to forget a difficult experience,” Lee says. “But to share them, as well as your good ones, is healthy.”

Interns have also written about the embarrassment they feel when they make a mistake, the stresses of long hours and the sadness of losing a patient.

“They are identifying with each other and building empathy,” says Lemay, who is also an associate editor of the Messenger. “When they share their emotions the feedback they are getting is, ‘I didn’t realize anyone else felt that way.’”

The blogs are part of a larger resiliency program that includes monthly meetings and workshops that help interns cope with the demands of residency. Lemay oversees the blogs and meetings that are part of the overall resiliency curriculum created and run by Stephanie Call, M.D. M.S.P.H., program director, and Rebecca Miller, M.D., assistant professor.

“I don’t think people realize that taking the time to reflect on the challenges they face is normal,” Lemay says.

Lemay has been writing and publishing prose since she was a resident. When a patient she had been visiting throughout her first year passed away, she doubted her career choice.

“I wrote about it four months later as part of a workshop, and it lifted this burden from me,” she says. “It was extremely powerful.”

She hopes interns today experience similar benefits.

“I think 20 years ago the attitude was to suck it up,” Lee says. “But today, it’s OK to talk about what you are feeling. It’s great we can focus on our wellness too.”

By Janet Showalter


Surgeon and inventor: Class of 2012’s Max Sirkin brings military medicine closer to home

Max Sirkin, M’12, and Col. Jason Hiles have invented the SHRAIL, a new system that helps improve care for soldiers injured in the field.

Max Sirkin, M’12, and Col. Jason Hiles have invented the SHRAIL, a new system that helps improve care for soldiers injured in the field.

There are many qualities that make a good surgeon. According to surgeons themselves, one of those qualities is an innate desire to understand how something works and find ways to make it work better.

Surgeons, of course, apply that talent to the human body. But there are a few who seek additional outlets for that inner drive. That was the case for Max Sirkin, M’12, who has found a second calling as an inventor.

“Doing surgery is a dream job, but I had always wanted to do more,” Sirkin says. “I wanted to be an inventor, but all my ideas had been taken and research wasn’t for me.”

As he worked his way up to the rank of major in the U.S. Army, Sirkin began to speak with physicians and surgeons who had served overseas, sometimes in far-flung parts of the world. In those areas, taking care of soldiers can present challenges, they said. Sometimes, those challenges can be life-threatening.

Sirkin, who is also now an attending general surgeon at Fort Bragg in North Carolina, learned that the mobile medical equipment doctors rely on in more austere areas of operation can be very difficult to assemble and move. Sometimes, certain pieces of equipment are not compatible with other equipment or materials. When minutes and seconds count, equipment that is easy to use can make all the difference.

Therein lay Sirkin’s big idea.

Max Sirkin, M’12 (left) and Col. Jason Hiles demonstrate the SHRAIL.

Max Sirkin, M’12 (left) and Col. Jason Hiles demonstrate the SHRAIL.

“I had never deployed, but doctors who had saw a real problem,” Sirkin says. “There was a problem when surgeons were setting up in remote geographies, and it was a problem I thought I could fix.”

Sirkin and his inventing partner, Col. Jason Hiles, developed the SHRAIL (short for the Sirkin-Hiles Rail System), a system that affixes to a standard stretcher – or litter in Army parlance. A variety of devices, monitors and products can be easily attached to and removed from the rails, so that they are accessible even while the patient is on the move.

“We thought why don’t we start with the rails on the side of every OR table, which are all created with set dimensions?” Sirkin recalls. “We found a way to make a rail that attached to the litter and can snap into place. We designed it so an 18-year-old in a stressful situation could put it together.”

The design, which Sirkin and Hiles first conceived in 2014, allows for far more freedom and mobility than previous options.

“Other options are big and expensive and you have to use specific devices that match a specific system,” Sirkin says. “It can take people who really know what they are doing to set it up, and even then the patient often still needs to get from the point of injury to the mobile medical station.”

One of Sirkin’s mentors, who saw the SHRAIL when it was still its “back of the napkin” stage, says Sirkin has long had a drive to invent.

A soldier tests the SHRAIL in near Fort Bliss, Texas.

A soldier tests the SHRAIL in near Fort Bliss, Texas.

“He has always struck me as someone dedicated to surgery,” says Col. David Cox, M.D., a cardiothoracic surgeon and deputy corps chief for the Army Medical Corps. “This was the result of his curiosity. One thing surgeons like to do is fix problems. With the SHRAIL, Max saw a problem that needed solving, and he solved it.”

The SHRAIL was featured in May at the Smithsonian Institution’s Military Invention Day. More importantly, it has been deployed to an undisclosed location, where it was successfully used.

Sirkin said the SHRAIL could serve other purposes that are not necessarily military in nature, such as search-and-rescue or disaster relief operations.

“Everyone who has been in an austere environment and had to do a medical intervention understands,” Sirkin says. “You can set up an operating room with what you can carry in your backpack. That puts the doctor and the soldier one step closer to being back at home, where doctors have everything they need to help a patient, and that means more lives saved. The goal is to get people closer to home.”

By Scott Harris


The incredible Class of 2022

The Class of 2022’s John Nestler paddled solo for 27 days through the Grand Canyon.

The Class of 2022’s John Nestler paddled solo for 27 days through the Grand Canyon. Scroll below for more pictures from the incoming class.

A tropical disease researcher who can diagnose Chagas disease and remove parasites from cows. And her classmate who has first-hand experience with typhoid fever and malaria – but as a patient.

EMTs and emergency department scribes. A ballerina who bakes wedding cakes, and an R&D engineer who has patents pending on the next generation of razors.

Volunteers who have staffed an HIV food bank in Barbados, free clinics in Ghana, a traveling Peruvian medical mission and the Domestic Policy Council in the White House.

A student who’s the first in his family to graduate college, and a classmate who’s the third generation to come to our medical school.

Thrill seekers and wilderness explorers who’ve skydived from a plane and scuba dived to a shipwreck. A kayaker who paddled solo for 27 days through the Grand Canyon, and a marathoner who ran his race without training first.

A first-generation American who was born in Sweden. A wanderer who spent their childhood living in 25 different towns all over the U.S., and another who calls Virginia’s smallest town home.

A traveler who crossed the Saharan Dessert on camelback. Another who walked 465 miles with pilgrims from around the world to visit a shrine in Spain.

One rescues cats, another names his house plants.

Wakeboarding, horseback riding and the sport of fencing – they’ve competed in all three. A pair of avid sock collectors might turn it into a competition.

One student can say the alphabet backwards – really fast.

Another applied, not only to medical school, but also to the Food Network’s Chopped TV show. Instead of waiting for her casting call – she is here on the MCV Campus now!

Story by Erin Lucero

Click the images below for expanded views.

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Updated: 04/29/2016