Just make it easy...
On setbacks, annoyances, and reviewing the academic year
In April, I announced that you could earn CME for reading this little newsletter. Setting up all the links and reflection questions took a while, but it felt like something worthwhile for readers. And I was soooo excited.
Unfortunately, just a few weeks after I made the announcement, CMEfy changed its whole dang business model to address pushback from accrediting groups. I get it - they needed to do it, but also so annoying for me. So, without much chance to see if you all were interested, I’ve had to delete all the continuing ed info I’d built for all the ethics educational posts (I’m still in the process of finding them all). The same company is launching an alternative, but I haven’t decided yet if it makes sense to use it. Maybe the universe is telling me that CME is too unnecessarily serious. We’ll see…
Setbacks like these make me feel like I wasted many very precious hours that I should have spent doing something else — like writing about ethics topics. It’s so easy to see this work I’ve now thrown in the garbage and think why couldn’t I have seen this coming? Why don’t I have a crystal ball? I don’t have time for this.
But that’s not how real life works. The cost of experimentation is failure. And honestly, I hate it.
These wasted time and effort situations often throw me into a bit of a funk, and I retreat rather than react. So, I’ve neglected you - in part because I’m embarrassed to tell you that I made you a promise about offering CME, and now I have to tell you I can’t keep it. Maybe this is silly, but I am who I am.
Sorry. And for those of you who didn’t care about the CME, I’m relieved you’re still reading since this hubbub didn’t impact you one bit.
Mid-year Reflection
This week, I had my annual review at my academic job. It’s kind of nice that it falls in June—an alternative season to January for an annual reflection. I’m a busy bee of a human, industrious but flitting from interest to interest. That means I often have little insight into the question, “What have I been up to the last year?” Left to only what’s top of mind, I could easily rattle off the things I didn’t finish this year, the ideas that bore no fruit, the projects that plagued me, the ones where collaborators abandoned ship, and the companies I depended on that fell through.
My mind often gravitates to the negative.
In prepping for my annual review, though, I realized I’ve had a pretty good year. Much better than I gave myself credit for. So, if you’ll indulge me, here’s some of the stuff I did this last academic year that’s pretty cool - at least if you’re a little nerdy like me.
Papers
I published several papers - which are the primary currency in academia. I like to joke that I don’t technically have to write papers (I’m not in a “publish or perish” job) but I am vain and like to see my name in print.
Violence in the pain clinic: the hidden pandemic. Published in Regional Anesthesia and Pain Medicine.
I loved working with these co-authors! I’m particularly proud of the first author, Yousof Fawzy, an incredibly talented and interesting medical student. Before medical school, he had a whole career working on hospital workplace violence prevention. The world will be a better place for having him as a physician.
ACCEPT-AI: Recommendations for the use of pediatric data in artificial intelligence and machine learning. Published in Nature Digital Medicine.
When a post-doc named Vijaytha Muralidharan cold-emailed me to talk about ethics and AI, I almost didn’t respond. I didn’t want to talk about AI. I didn’t want AI to consume my time. But I did talk to her and I’m so glad I did.
Resuscitate but not Intubate? Partial Codes in Pediatrics. Published in Pediatrics.
Partial code status—a variation on whether healthcare teams will provide chest compressions, intubation/ventilation, and/or medications—is challenging in adult and pediatric care. This perspective piece adds a little something to the conversation - thinking about informed consent, staff moral distress, and even the choice architecture of how we write our online order sets.
Physician Unionization: Opportunities and Challenges for Anesthesiologists in the United States. Published in Anesthesia and Analgesia.
Unionization is seen as a pretty dirty word in many physician spaces, but that perspective is changing and evolving. Of all the papers I’ve written, this one had MOST collaborative writing team ever. We went through the manuscript together line by line, arguing about what we mean and how to best express it. I’m really proud of how this paper turned and and hope it continues to spark discussion among anesthesiologists about the role unions might play in our work.
Chemical Restraints for Obstetric Violence: Anesthesiology Professionals, Moral Courage, and the Prevention of Forced and Coerced Surgeries. American Journal of Bioethics.
Any chance to write with my pal, Caitlin Sutton is a huge win. (We’ve written and lectured together, and it’s always a good time). I’m particularly proud of this piece highlighting the profound power anesthesiologists have to render people unconscious and how this relates to the risk of forced surgeries.
Lectures
I gave a bunch of lectures this last year. Two big lectures on the importance of abortion in anesthesiology at the American Society of Anesthesiologists. I got to speak about abortion care at Oregon Health Sciences University - both with the anesthesiologists and the obstetricians. I spoke about the importance of trauma-informed care in treating patients with substance use disorders at an ASRA conference. Based on my AI work, I gave several grand rounds talks on the importance of mitigating pediatric algorithmic bias.
If you want to watch me talk about kids and AI, you can watch Generation AI: Protecting Kids from Pediatric Algorithmic Bias.
Learning & Growing
I took a Trauma Mitigation Master Class through a group called Lodestar. I had already signed up for it when I found out my friend from intern year (first year of doctoring) would be one of the instructors. We’ve both come a long way since managing neonatal lab results and putting in umbilical lines. Later this year, I plan to complete the certification process.
I also completed training in the 3 Vital Questions framework through The Empowerment Dynamic. I spent three days with David Emerald and a solid, fabulous group of co-workers, learning how to identify the drama triangle and help people adjust their perspectives.
One in Five
One of the things I’m most proud of is teaching my first undergraduate class as a primary instructor. I’ve spent the last 12 weeks teaching a course called One in Five: The Law, Politics, and Policy of Campus Sexual Assault. Last year, I had the honor of assistant teaching with the class founder, Professor Michele Dauber. It’s been busy and frustrating and wonderful and I loved it. I’m wildly fortunate that my friend and fellow physician, Dr. Arghavan Salles, co-taught with me. She’s smart and challenged me in new ways. And we got to hang out two times per week for the whole quarter, which otherwise would not have happened. (Note: If you can EVER do something like this with a dear friend, I highly recommend it.)
I love the students and their energy. I love their bravery in taking a class that discusses a topic that is otherwise largely off-limits in “polite” conversation. After taking this class, the students know more than almost every other student, faculty member, and administrator about Title IX, case law related to sexual assault, and how policy shapes their experiences in college and beyond. They learn to identify and debunk rape myths. I watched them grow in their confidence in talking about these issues.
I’m finishing reading and grading their papers this week, and my heart is full.
A lot of anesthesia and ethics consults
Of course, the constant in my life still includes time in the OR and doing ethics consults (and increasingly the administrative parts of running the ethics service).
I continue to work on our elite liver and kidney transplant team, taking care of little kids with organ failure. I’ve had some tough cases this year and am so proud of how much I’ve grown in my practice in the last ten years.
I also love being on our GRACE (Gender Recognition and Affirmative Care through Education) team, providing high-quality, compassionate care for our trans, non-binary, and queer patients.
Recently, I got a promotion in our ethics center - I’m now the Associate Director of Pediatrics. There are more administrative responsibilities, so I’m trying to get way better at delegating after umpteen years of relying primarily on doing way too many things myself. I’m excited for what’s ahead.
What about you?
Do you have any mid-year reflections? What are you proud of this year? What has helped you make meaning?