Over the Shoulder
By Brandon Williamson, MD

Editorial note: Dr. Williamson is a clinical assistant professor in the family medicine residency at Texas A&M.

If you deliver enough babies you know that it will happen at some point.

The bed is broken down, the reassuring sound of the baby's heart rate is thumping from the machine, and the mother is pushing in this last portion of the marathon that has been her labor. I watch the head slowly crown and then retract back toward the mother. My heart sinks. My first shoulder dystocia since I finished residency. I look over my shoulder to let my attending know, but no one is there.

I flash back, suddenly, to a different hospital and different delivery room (Room 6, which I will never forget) with a similar situation.  

"Shoulder!" I call and begin the maneuvers. I look around, frantically.

"I'm right here, we've got this," my attending quietly says from over my shoulder. I proceed through the maneuvers under his direction, eventually removing the posterior arm and, finally, the baby. I take the newborn to the warmer and he starts crying.

Pure relief.

Then I am back in the present, my intern looking around, worried. I don't see any of them, but I feel all my attendings just over my shoulder. We proceed through the maneuvers, and the baby comes out crying.

Pure relief.

The transition from resident to attending is a difficult one, but we take our teachers and mentors with us. They are there, just over our shoulder.

Staying Afloat
By Anonymous

When you're a student in medical school, it becomes your whole life. I know that we're told to keep up with our hobbies, keep up with our loved ones, balance, balance, balance. But let’s be honest, how many parties have you gone to where the main subject was “What did you get on this question”? How many times have you taken a day off from studying, only to receive a barrage of messages from your well-meaning group chat asking about the objectives of this lecture or that lab?

And is the advice to remain balanced viable if you're constantly on the brink of failure?

How does one enjoy their hobbies and carve out time to visit family when they are scraping by as it is? How can you not feel like a failure for having just passable grades when we've been trained all our lives to value intelligence with concrete percentages and rankings?

Maybe other people are watching their lives go by around them, stuck in the world's longest time lapse photo, but they can at least find comfort in knowing that their grades are  okay. Their work was worth it. Maybe it was worth it to miss their family members’ funerals, their best friend's graduation, and other moments that constitute the fabric of a meaningful existence.

It’s all happening around me. I feel as though I am floating in the middle of the ocean, ears underwater. Corpse pose. Controlling my breathing so that my body does not sink. I hear muffled ripples of the world around me, but the sounds lack any intelligible meaning or urgency.

What if, when I finally wash ashore, the world I knew is gone?

Interview with Dianne Kraft, PhD
By Alysia Hall and Ty Fields, M1s

Dr. Dianne Kraft is the assistant dean for diversity at the Texas A&M Health Science Center College of Medicine. Before working at the Health Science Center, she was the diversity education coordinator for Texas A&M University's Department of Multicultural Studies. Dr. Kraft received her undergraduate education at the University of Texas at Austin before gaining both her M.S and PhD at Texas A&M University.

Alysia: Could you describe your path from working on A&M’s main campus to working here?

Dr. Kraft: Before working on main campus, I was teaching at the University of Houston-Downtown as a psychology professor. That was my last teaching job. It was great—I don’t know if you know this, but UHD is one of the most diverse campuses in the country. It was 30% black, 30% white, 30% Hispanic, and 10% Asian. You just don’t see that kind of demographic in most places. When I had the chance to switch gears and use my social psychology background to create a more inclusive environment at A&M, I took it. Plus, I had been teaching for 20 years or so, and it was time to try something different.

My friend Dave Macintosh was the dean of diversity at the College of Medicine at that time. When we started to work together, he began drawing me over to the medical school almost immediately. I was teaching selectives and facilitating small groups in Med Camp. What I hadn’t realized was that Dave was setting me up to be his successor. He was very intentional in that, and I was like, “Oh boy, medical school is really cool, I like it over here.”

Ty: Could you talk about how it was different to work with the main campus students versus the medical students?

Dr. Kraft: I love you guys. You’re all so smart, and you’re all probably unhealthily driven. And I like it better here because of the focus and the drive that you all have. I’ve been in higher education my whole life, either as a student or a professor.  I also like to think that perhaps I might be able to influence students to value all of their patients, and provide unbiased, quality care—care that might better patient outcomes and improve quality of life. That’s a really awesome way to spend your time.

Alysia: What are some of the goals you are working towards at the moment?

Dr. Kraft: One of the goals I’m currently working on is my intimate partner violence program. I need to finish my IRB and do a research study. One of our faculty members was killed last year by her husband. She was an amazing transplant surgeon who was working on bringing holistic review to residency. She was doing amazing things—she was smart, she was kind, she was funny—and just one year ago her husband killed her.

After the incident, I began researching how many medical professionals are affected by intimate partner violence. About an hour and a half into my search, I had already found 20 cases. That’s just from looking at newspaper articles—not even a full search of all databases. It happens to physicians, too. The stereotypes of “battered women” are that they are poor, uneducated and lack resources. But we need to start thinking that it happens to professional women all the time.  

I want to take all of my background in gender violence and bring it to people in medical school. You’re taught how to address these things with your patients, but you’re not taught to talk about it with one another. Everyone thinks, “You’re going to be fine” but the truth is, that’s not how intimate partner violence works. It cuts across all social classes and economic lines. So this is the project I’m most passionate about: working to bring awareness of this issue into the curriculum.

I want to make students and medical professionals aware of what the warning signs are, because [abusive partners] don’t start out by punching you or by slapping you. They start out by saying, “Are you going to wear that? Are you going to call me when you’re there?” It’s loss of power, balance, control, and/or self-esteem—that’s how bad relationships tend to start. In fact, it’s probably already happened to some of you, because the incidence of violence against women in this world is terrifying. This is not to say men don’t suffer from abuse—it’s just that more often the abuse they suffer is psychological. They do not often die from it. Women die from it. No one should be abused, period. But, no one should have to die from it.  

Ty: Since you mention that, could you speak to how your project relates to public health?

Dr. Kraft: Intimate partner violence is a huge public health issue, and it’s a huge mental health issue.

I talked to two of [the transplant surgeon's] friends who are colleagues of mine and asked if they knew that she was being abused. They both replied, “She wasn’t being abu-,” and then they caught themselves. I don’t think it goes from no abuse to murder—maybe one in a million times. But [this surgeon], who was much beloved, managed to compartmentalize her family life from her professional life. What kind of toll did that take on her? What kind of toll would that take on anybody? That’s a huge public health issue and a mental health issue. I wonder how much that plays into the issue of physician burnout—because no one’s asked the question. We don’t know. As far as statistics go for general research in the matter, anywhere from 25 to 75% of women and 5 to 20% of men experience intimate partner violence within their lifetime. That’s a public health crisis right there—why aren’t we talking about it more?

Alysia: Staying in the vein of public health, you recently attended the “OUT for Health” conference at Dell Medical School. Could you tell us a little about your experience?

Dr. Kraft: Oh, it was wonderful! I was extremely proud of our school. We had the highest attendance of any medical school in Texas. We had over 26 people come—that’s incredible. It was extremely well done—the main speaker was Madeline Deutsch, the clinical lead for the Center of Excellence for Transgender Health at the University of California San Francisco.

I went to the “Sexual Health and Pelvic Floor” session which was interesting – I didn’t know that there were pelvic floor physical therapists out there.

Ty: Is that for after giving birth? Or just in general?

Dr. Kraft: It’s for a lot of things. It’s not just for after giving birth, it’s also great for sexual health. If you don’t have strength in your pelvic region, lots of things can go wrong—like incontinence or anorgasmia. The speaker does a lot of sexual counseling as well, and I’d love to bring her here to give a talk.

Ty: That is interesting. We’ve got some more light-hearted questions for you now—are there any must-try places for food in B/CS that you recommend?

Dr. Kraft: I love Indian food, so Taz is a favorite. Tempura 40 is great too!

Alysia: Do you have any hobbies you like to pursue in your time off?

Dr. Kraft: Reading. I try to read 100 books a year. I don’t usually quite make it—I almost made it last year. I also love my dogs, and I like binge-watching shows—binge-watching is such a genius invention. You can watch for hours without commercials—it’s brilliant. But overall, reading is probably my favorite.

Ty: Do you have any book recommendations?

Dr. Kraft:  My favorite from last year is Sing, Unburied, Sing by Jesmyn Ward. It’s a novel set in Mississippi about a 13-year-old black kid who communicates with ghosts and animals—there’s a magical element to the novel. It’s so compelling.

Alysia: Is there anything else that you’d like to share with us or with the Synapse readers?

Dr. Kraft: I guess if I had one message, I’d say—when I come at people and they say, “Oh, here she is, talking about diversity again,” I hope people who start to clench and turn away, I hope that they can open themselves a little bit, because it’s so easy to think that the way you’ve lived is the only way that people live. I want people to open up and realize that there’s value in seeing things from another perspective and everyone has a different outlook. I think that’s the essence of what I’m trying to teach—that not everyone has the same outlook or experiences.

We’ve all had times when we weren’t included. We’ve all had times when we felt rejected by those around us. I think if we put ourselves back in some of those places, at least emotionally, then we can find the path to empathy. We all have aspects of diversity—we do. It’s just that some of us have aspects of it that are a lot more visible than others.

What I want people to understand more than anything is that the world doesn’t treat everyone the same and we need to reach outside ourselves to truly understand that.

Do you have any more questions for me?

Ty and Alysia: No, that’s the last of our questions. Thank you for your time!

Perspective
By Anonymous

Amongst the constant studying, exams, research, and hard work, it’s often easy to lose perspective. As medical students, we are given the daily opportunity to hear patients’ stories and be involved in their treatment plans, even in their most vulnerable times. Learning about all the different diseases and their pathologies, some of which have had a direct impact on us personally, is challenging. Seeing a loved one suffer and/or pass away from the very disease we are studying is even more challenging. Helping a new patient through that same disease is indescribable. Though emotional, it’s extremely humbling to talk to a patient with a mutual understanding and struggle. To come full circle, from experiencing pain and loss from the very illness you are now helping treat in others, is unbelievable. What many of these patients may not realize is that, although I am one of their providers, they are supporting me tremendously in my loss as well. The world of medicine is incredible, in both good and bad ways. Perspective.

Never Stop Running
By Erika Clark, M1

Five years ago, this was any other day. I was a sophomore in college, and like the rest of us, I was “pre-med.” I had just stepped into the gym when I got the call. “Are you sitting down?” my mother asked. I sat down on the floor and proceeded to stretch. “Your dad isn’t okay.” As she went on, I learned that he had suffered a sudden cardiac arrest. His running partners found him on the floor. His heart had stopped. I felt my heart skip. His brain was damaged. My brain was fuzzy. He had been revived but was currently in a medically induced coma in an ICU in Dallas. They had placed three stents in his heart in hopes of success.

And so, I ran. I ran back to my dorm and I cried. And after some thinking and feeling, I knew it was time to do something. After all, we couldn’t have two family members incapacitated. So I flew home. Forget my classes, forget my exams, I was coming home.

It started out like any other spring day as I walked into the hospital. It was a balmy, sunny March afternoon. And that’s when I saw him. Face swollen as though he had been stung by a swarm of bees. Eyes purple and blue like a plum from where he hit his head as he fell. The room had the wintry feel of an icebox. Machines were chirping and croaking. He was surrounded by a tangle of wires. I was furious and wanted to help, but I knew that I knew nothing. After all, I was only “pre-med.”

And so I studied. I chose not to forget the classes and exams, after all. I sat in the waiting rooms, in the halls, at his bedside—and I studied. I would never let school beat me. He was not letting his heart beat him. So I kept on.

It started out as a cardiac arrest, but as the weeks passed he got worse. As he was brought out of his coma, he had a heart attack. Four more stents were implanted. He was doing well, and I went back to school so I could use my newfound pre-med fire to get through the year.

And then he coded. CPR was performed. Balloon pump was inserted. Triple bypass was done. So I came back. With my books and my homework I again sat at his bedside as I learned more about medicine, thus learning more about my own goals and dreams. He had a newfound fire and will to live, and he fought. So I left to take my exams with a deep pit in my stomach that I hope none of my patients will ever experience.

It started out as a recovery. And then he coded again. CPR. Coma. Finally, he received an ICD. Now this did the trick. His heart ticked on with this little device. It wouldn’t let him go. His heart was working, but it was a long road. He learned to walk again, talk again, drive again. But he didn’t have to learn how to fight again.

And then, I studied harder than I ever had before. The doctors, the nurses, the entire staff had made an impact on me that I knew I had to give back to my own patients one day. And here I am.

It started out as pain and ended as relief. It started as a tragedy and ended as a triumph. We have trained like pros, hurdled our enemies, and sprinted to the finish line at full speed. And we will never stop running.

Radhika Shah, Chairman of the Board
Mimi Phan, Managing Editor
Alysia Hall, Acquisition Editor
Jamie Weihe, Design Editor

THANK YOU

A special thanks to... 
Dr. Karen Wakefield for being our faculty editor,
Dr. Barbara Gastel for serving as editorial mentor,
and Dr. Gül Russell for providing support and encouragement.

The Synapse is sponsored by the Department of Humanities in Medicine at the Texas A&M College of Medicine.