Volume 37

September - 2022

Cover: engulfed

Career, social joys, and existential fulfillment — these are the metaphorical pillars that define us. In different phases of life, different pillars take precedence. But for many of us in medicine the career pillar has taken disproportional bandwidth. It has come first, depleting the existing pool of energy from the remaining entities.

From this first cumbersome pillar rises a thick, overpowering wave, like an impassable rip current dragging across the thin fabric, leaching into the adjacent canvases, submerging them. Made of plaster, the current was once moldable, forgiving, but now has become solidified and impenetrable, requiring the strength of metal blades to separate. Upon solidifying, the wave has drowned out the pillar from which it arose, and has taken grasp of the adjacent two in its all engulfing path. No longer malleable; something one must ride out away from the safety of shore until it releases its grasp ultimately in the deep, uncharted water. Once connected, the three pillars now stand fractured apart by the process. With each new layer of texture, the original canvas gets more covered, lost under a disarray of dust — unrecognizable.

Letter from the Editors:

Welcome to Art of Emergency Medicine, an online blog featuring amazing works of art created by your Emergency Medicine colleagues, along with their own stories of wellness and inspiration.

With National Physician Suicide Day occurring on September 17th and the recent news an internal medicine resident who died by suicide earlier this month, we felt it is pertinent to revisit Physician Suicide, how to identify it, and where to seek help. 

The physician (and by proxy all of healthcare and first responder) mental health crisis isn’t new,  but has been thrust into the forefront with the COVID crisis and fallout. With ever increasing waiting times, endless patients, and overuse of the 911 system, it seems that emergency medicine professionals are being pushed to the brim with less and less time to actually care for themselves. These providers can give off the appearance that everything is put together, but truly be suffering through moral injury, depression, anxiety, and other mental health problems. 

If the problem is so rampant, why don’t we see more providers seek help? One challenge that has prevented providers from seeking help has been a historical stigma against mental health for several years. There is concern that a physician's license may be removed if they are seen to seek help for mental health issues which not only jeopardizes their livelihood, but threatens a lifetime of work spent to achieve their degree. Indeed, this is what we saw with the passing of Dr. Lorna Breen, whose name has inspired numerous interventions and passage of a new bill in Congress. 

There also calls into question feelings of weakness or incapability if those in the clinical setting are unable to care for themselves. We’re taught throughout medical school and other training programs that the most important thing is our patients, and we sacrifice our health, time, and youth to dedicate it to these patients, often suppressing our own feelings and crises to enter into this social contract. If we admit we need help, there is a fear that it may signal we cannot maintain our half of the social contract. 

But what if we do admit we need help, would the problem then be addressed sufficiently? Unfortunately no, a number of barriers still exist to seeking timely and appropriate mental health care. The current state of our healthcare system means waiting months before you may get your first appointment with a therapist or psychiatrist. If you do get that appointment, then there is still the pressure of taking time off and pulling in one of your already exhausted colleagues for another shift. 

Medicine is a team sport, and we can take this moment to learn how to support each other and ourselves through our mental health journey. 

What are the signs of a provider going through a mental health crisis? Well, they’re subtle. You  may see a provider start to have changes in mood, with abrupt swings in emotions. They can switch from depression and feeling like nothing can be done to an activated state and unable to sleep. You may see them start to withdraw from their close friends in the hospital or express a detachment from their job. They may start to talk about death with increased frequency or express feelings of wanting to disappear. All of these should be taken as warning signs for you to help your colleague or seek mental health if you notice these within yourself. 

How can you seek help?

• Reach out to the new national number 988 if you find yourself in a mental health crisis or if you need support. You’ll be connected to a local mental health expert who may be able to help connect you with resources if needed. 

• Find what options your institution or hospital offers. Often they will have peer-support groups, institutional psychologists, or critical stress management teams. If your institution does not have them, request them. You will not be the only provider having these same struggles. 

• Start your journey early. Consider the importance of preventative health care to minimize the chance of entering into life-critical stages with acute suicidality. You may think of it similar to diabetes, with preventative care, you minimize the risk of an acute crisis such as DKA. Similarly, withearly and preventive mental health care can prevent entering into these acute crises. 

• Connect with close friends and confidants with whom you can openly and freely share your thoughts and feelings.

I Rise

After the 2016 presidential election left me feeling disheartened, I sought solace in Maya Angelou's poem, Still I Rise. Her words of resiliency and hope gave me solace and reminded me that the struggle to rise against oppression is universal struggle shared by people of all socioeconomic and ethnic backgrounds. It's a human endeavor that unites all of us. Forces of oppression can take on many forms--governments, domestic situations, or the demons inside our own heads that give rise to self-doubt and prevent us from reaching our full potential. Engraved onto the sculptures are Maya Angelou's words and the words "I Rise" in 35 languages, gathered from people in Dartmouth's community.

Made from clay at Dartmouth's ceramics studio, ranging from 4 to 18 inches in size.

Sandia SUnset

I've recently been finding great joy in painting. Though rewarding, life as an EM resident in a pandemic also takes a toll. I’ve found painting to provide a little burst of wellness to my day, and love that it’s an outlet free from the stresses of life and work. I just spent some time in the Sandia mountains in New Mexico, and the sunsets were stunning. This is my attempt to capture their fiery brightness and express gratitude for time to reflect and rejuvenate in such a gorgeous place.

Lights On eden

Walking through trails of nature leaves my mind wondering about all the people who have walked before me. How did they make it here? What were their hardships? How were they feeling? It keeps me grounded. I remember that I am only a small piece of a puzzle and am here to serve my purpose as truthful and fulfilling as I can make it. There's beauty all around, and opening my eyes to the greens of the world has largely benefitted my mindfulness. It's curved the burnout I faced as an M1/M2 and has helped me learn how to balance, prioritize, and truly appreciate the field I'm lucky enough to be in.

This piece was captured during a study break the week of Step 2. It was too beautiful not to stop and take it in. The light beaming changing the fluorescence of the environment was almost magical. I hope this photo inspires others to breathe in and relax.

The Lone cypress

As COVID isolation has given me a lot of time to edit photos and spend time reflecting, I found one of the hardest part is the constant worry about symptoms. After luckily avoiding COVID for 2.5 years, I’m now confronted with the true isolation of having the disease. I feel like this Cypress, isolated from the rest of the public, unable to move. The bright light that I have, is that unlike the tree, my separation is only temporary.

Do you want to see your art shared with the community? Don’t forget to submit today!

Finally, don’t forget to share Art of Emergency Medicine with your colleagues, friends, and family on Twitter or Instagram and like us on Facebook for all the latest news!

This Months Featured Artists:

Aunika Swenson, MD

Hi! I am an emergency medicine resident at Stanford. I've always loved art, but just recently started painting. I also love traveling and nature/landscape photography.

Monica Sheridan, MD

I’m an emergency medicine resident at Stanford, with an interest in medical education. I dabble in canvas and sculpture art, but my favorite outlet is dance. I also enjoy anything on a beach and experimenting with new cocktails.

Sima Sadeghinejad, MD

Resident physician. I first learned ceramics as an undergrad at UCLA. I also enjoy painting, mosaic art, furniture refinishing.

Sahar Rammaha

A career in medicine can often feel like life carries on without you. After completing pre-clerkship years of medical school, I made a conscious effort to stop this tunnel-vision road and watch the sunsets, go on walks, and open my eyes to world around me. Naturally, I wanted to capture these moments forever. I take photos as an outlet and sometimes post on instagram snapshots of my journal. Open your eyes to the world around you and you'll feel grounded and at peace. See more of her work or open a conversation on her Twitter or Instagram.

You can learn more about the artists featured in this and other volumes at our contributors page!