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Worcester Medicine
Medicine and Media
Behind the Scenes Part I
One Doctor's Experience with Medicine and the Media
Physicians and the Press:
Perspectives through Experience
Advocacy and Media Images of Nursing
Humanities in Medicine Legal Consult Financial Advice for
Physicians Creative Writing
Gerald F. Berlin Creative Writing Award - The Patient
Unexpected In Memoriam Guest Editorial:
Medicine and Media The fascination that the media ~ small screen, big-screen, cypersphere, and print ~ has with medicine has reached new heights over the last decade. On TV, we just witnessed the end of the ER era on NBC, while Grey's Anatomy, Scrubs, House, Private Practice and newcomer Nurse Jackie are all strong ratings favorites. Dr. Oz Sanjay Gupta and Dr. Phil have become celebrity physician experts upon whom viewers rely to get their medical expertise. Medical Directors, Hospital Administrators and Chairmen must become expert in handling the media, frequently relying on in-house PR experts to perfect the art of spin. TV, radio and newspapers employ medical reporters to help distill medical news for consumers. And pharmaceutical companies direct market their wares on TV, frequently forcing the hand of physicians when dealing with their patients’ demands for state-of-the-art treatment for various ailments. This issue will explore these challenges to the image of the physician and to our practices and will perhaps give all parties a better understanding about the new interrelationship we all must embark on to make it all work.
TV and the MD: A View From Lala Land Networks, writers, advertisers and viewers have romanced the public with medical dramas (and comedies) since its inception. Shows like Dr. Kildare and St. Elsewhere which ran for 6 years, and M.A.S.H., which had an 11 year run, are still part of our collective memory as health care providers. The newer incarnations often run just as long and generate immense revenues. Documentaries involving medical conditions, both common and rare, air frequently. The news rarely airs without a story on a health care issue as evidenced by the presence of a health correspondent on every station. With all these genres of medically inspired programming, physician input is essential but varies immensely from one type of show to the next. ER, the series, ran for 15 years, making it one of television’s longest running series. House is presently the number one TV show, with Grey’s Anatomy running in the 4th spot and Scrubs not far behind. This translates into big dollars, where a minute of advertising time on Grey’s Anatomy alone runs in the range of $415,000. To maintain viewer interest, themes change and new plots are needed. So where does the material come from when the writers start running out of ideas or need insight into how a medical condition should be portrayed? As a surgeon in Los Angeles, I can tell you that much of it comes from practitioners in the area whose experiences and insights are “recruited” by assistant producers and writers scouring the town for stories. At some point, all of us have watched a show and been shocked at the disconnection between the portrayal and reality. Of course, medical shows are not alone in this. Attorneys and ~ even more so ~ law enforcement professionals have the same amazement at and often distaste for the far fetched re-enactment of their daily existence. So who provides the medical insight on and off the set and, once provided, what happens to that input? One of my influential mentors, skilled in offering appropriate one liners for any occasion, provided me with an insight which reflects the Hollywood motto, “Never let the truth get in the way of a good story.” Don’t get me wrong, creating a more interesting story line is not always a bad thing and is often a necessity. Unfortunately, it may come at the disillusionment of the medical “adviser.” As professionals, the importance of gathering “factual data” to establish a care plan is ingrained in us and we are keenly aware of the paramount role of honesty. However, this may run counter to the needs of the show, leaving the medical advisor at odds with the plot that is being created. Advisors are a necessity on and off the set of medical dramas and comedies. The resident advisor is most commonly a nurse and is responsible for maintaining the “integrity” of the set and sometimes the content (blood looking like blood, terminology bearing some resemblance to reality). When the show ventures into waters distant from the knowledge base of the resident advisor, outside expertise are sought. In my experience, these range from phone conversations (often gratis, with physician compensation being the achievement of a valid portrayal of one’s specialty), to script review and sometimes on-set consultation. With the advent of endoscopic procedures, requests for unidentified video are not uncommon, nor is filling in briefly on the set when the actor’s ability to provide a realistic shot continues to elude him or her. What becomes apparent is that there is only a limited amount of interest in the facts. A common response from a writer or director is, “OK ,so we could say this… Right?” The “TV” version may be a stretch of the truth and a negotiation with the “MD” follows to find a way to adapt the medical condition or clinical finding to something that would fit the script. Whatever frustration develops in this reworking of the facts needs to be replaced by an understanding of the framework within which the TV and film industry work. There must be a balance between the understanding of the needs of the audience, the episode, the network, and the desire to contribute to what the rest of the world will view as reality. Having said this, the “advisors’” level of satisfaction correlates with the ability to achieve truthfulness in the writing. Beyond the prime time drama, news magazines, documentaries and the news itself involve physician input. My personal experience with these has been quite positive. The fact that what is being reported is “news” implies a factual basis. Of course, the facts that they are looking for may have no relation to what the physician feels are the important elements. News commentary allows an interesting glimpse at the inner workings of a network. Arriving at a local CNN or ABC news studio off hours, there are only a couple people working, yet everything moves in a timely fashion. After you are seated, just a few minutes before the interview, through the earpiece comes a quick introduction by the producer in New York or Atlanta with a couple key tips and the questions Anderson Cooper or a similar interviewer will be posing. Moments later, the interview begins. And there it was, 1-2 minutes to educate the world on your specialty and maybe get a bit of institutional recognition (it would be naïve to think anyone will remember your name once the 2 minutes are over). News magazines, 20/20 and its related cousins on the various networks are quite different. In this forum there is a chance to really tell a story. In our case, we had the opportunity to describe the planning, ethical considerations, dilemmas, institutional role (or reluctance), the surgery and the outcome in the separation of 2 sets of conjoined twins. It should not come as a surprise that there is a direct correlation between the networks’ interest in the story and your own personal, emotional and intellectual input into the case. These are stories that have mass appeal because they describe life changing events that as a physician or surgeon has consumed often months or years of your life. You’ve had the chance to be a part of the story and it is part of you. The last genre is the documentary. Here’s a real situation like the news but with time to properly tell a story, although the ultimate product still ends up being at the discretion of the producer and executive producer making final decisions in the cutting room. I recently had the chance to travel to India and Nepal and work with a documentary team on a story of conjoined twins in those countries. Not knowing what to expect, I returned with insights into the making of a documentary and was rewarded with an opportunity to better understand the life of a patient in the healthcare system of a third world country. Making a documentary is a labor of love. The documentary makers tend to be passionate about their vision and the subject matter which they have pitched and ~ luckily ~ have been given the funding (a relative term generally not inclusive of any real creature comforts) to go out and make. The documentarians’ underlying desire is to ultimately bring reality to the screen, to tell a story that brings the real life of the subject to the viewer. Yet, reality in a third world country happens slowly. Cars, buses, medical testing, translation, and the people themselves move at an entirely different pace. When you add the need to get realistic footage from multiple angles with one camera, one producer/cinematographer, and one assistant, it becomes clear that life in the film industry moves at a very different pace than the one to which we are accustomed. What this “down time” afforded proved to be the greatest reward. It was in these hours that I gained an understanding of the symbiotic relationship among access to health care, quality of life, and a “debilitating” condition in a place where healthcare is not a “right.” To see first hand the life of 40 year old conjoined twins and contemplate the alternative existence had they been separated was enlightening. To separate a set of twins creates 2 disabled individuals in a country not equipped to support them rather than a carnival oddity that provides the resources to support an extended family of 25. It is through the format of the documentary that this raw and in depth exposure of the issues which surround and impact the lives of the individuals can truly be disclosed. In this situation, it was the medical history which created the vehicle for the story, disclosing many of the details of the twins’ past lives as well as the medical insight. TV provides us with entertainment, comedy, stories of triumph or failure, and it documents people and conditions from around the world. Many of these shows are based on medical conditions. The MD can try to bring as much realism as possible to the screen and the reward is the chance to show our caring, compassion and love of what we do. There are even the rare times when there is a chance to travel and see just how lucky we are to be able to provide our care to everyone who needs it. Behind The Scenes
Part 1 This summer I heard Joshua Bell playing a Max Bruch violin concerto at Tanglewood. The last time I had listened to Bruch was a couple of years ago during a cold Massachusetts spring when I was driving to work one morning listening to a local classical music station and thinking about a pediatric patient I’ll call “Bobby.” Bobby was a 10 year old boy in the PICU who had had a massive head bleed while playing during recess. His condition was irrecoverable and his parents asked that his organs be donated. He was soon to be taken off life support, but, because there needed to be a process of clearing his body of sedative medications, a number of days had passed since his admission. The clinical staff and others of us had become quite attached to the parents and to the patient’s younger brother. That morning during my commute, Bruch’s “Scottish Fantasie” was playing on the radio. A part of the piece leads one to envision youthful dancers in a bright glen, and that morning, as the piece was coming to a close, I remained in my car in the hospital parking garage thinking about this child, his parents and his younger brother. The day before, I had seen Bobby’s brother kicking the soda machine outside the PICU waiting room and yelling at his mother, “Not die, Mom! You said he would NOT die!” When the music finished, I went in to my office and later up to the PICU. The nurses told me that Bobby was in the OR, his organs being recovered. When I heard Joshua Bell playing the Bruch piece this past July I was taken back to that intense day in early spring when this child died, and, because of his parents’ courage and generosity, unknown others had received a chance for life. This kind of experience does not occur in most people’s work day. Remembering this helps us to understand why there is such a fascination with the lives of people who work in medical settings, a current preoccupation with their portrayal on television, and an intense interest in writing by physicians concerning the way they make patient treatment decisions. Because their decisions have such vital implications, people wonder what physicians are like. Are their human foibles like our own? How do they react to the life and death dramas with which they have to cope? In his editorial in the current issue of this magazine, Dr. Hirsh wonders whether the current media’s focus on all things medical by way of television and movie dramas, direct advertising of drugs instructing the patient to “Ask your doctor about…,” and the current use of the internet are shaping public perceptions in a negative way. In a previous Worcester Medicine article (May 2009), I referred to my neighbor who talked about his responsibility as a parent to use the sources at hand on the internet to help him navigate the medical system. Others may look at television series to give them a sense of the world of medicine about which they know very little. “ER,” “Scrubs,” “Grey’s Anatomy,” “Private Practice,” and the infamous “House” focus heavily on the personal relationships of their characters who call frequent codes and diagnose mostly exotic illnesses. From the point of view of medical practitioners, these programs give unbalanced, extreme portrayals of caregivers which negatively affect the public’s view of them. However, human beings are always trying to sort each other out. We use fictional accounts as just another perspective. We now have more sources to consult, more stories to consider. We are most curious, of course, about people in professions with the greatest potential impact on our own lives. Lawyers are closely watched as well for the high octane crises in which they are the prominent players, but although a person can go through life with few and sometimes no interactions with a lawyer, almost all of us will encounter physicians caring for us or a loved one at some time in our lives. Can we trust them? Are they focused on our welfare or are they distracted by other priorities? When we go to the hospital, how will we interact with these people whom we hope will have the clinical expertise to help us? We hope they are approachable enough for us to feel that, when we are not at our best, and sometimes at our worst, we can ask questions and receive compassionate and helpful replies. In my position as a mediator of medical care complaints, I know that often patients fear that they will not be able to communicate with their physicians. If there are no physicians in their circle of friends, and they have yet to see a physician for a serious matter, they wonder what it will be like when they do. How do they familiarize themselves with the physician’s world? They will search the internet, if they have such access, but I believe that many people think that television provides an accurate look “behind the scenes” in the operating theatre or in the Emergency Department. After waiting for three hours in our ED for treatment of a non urgent matter, one patient remarked to one of my colleagues, “People never have to wait this long on “ER.’” Patients are triaged, diagnosed, operated on and have recovered by the end of the show. These television programs emphasize drama at the expense of accuracy. On “Grey’s Anatomy,” the focus is heavily personal, featuring serial intimate relationships between attending physicians and their residents which would be frowned upon in most medical centers. On “House,” the diagnostician protagonist verbally abuses his team in a way that violates medical school policies, and his addiction to pain killers would have him in a contract with Physician Health Services and referred to a treatment center rather than still in practice. If these television dramas provide the public’s major source of information regarding medical professionals, they would not engender respect. On the other hand, as a neighbor who is a Buddhist priest said to me the other day, there is one aspect of these shows which may have a positive effect on the physician/patient relationship: they feature physicians with a broad range of racial and ethnic backgrounds. In years past, I have encountered patients who expressed blatant hostility toward physicians who were not white males. Regarding an Asian plastic surgeon assigned to his case, one patient asserted that he didn’t want a “…Chink taking care of me.” Another said he thought a foreign born physician on his care team “…should go back home where she belongs.” A father and daughter opined that South Asian physicians are likely connected with “terrorist cells.” Acting as a current counterpoint, the casts of television medical dramas are racially and culturally diverse. When the Chief Medical Officer in “Grey’s Anatomy” is an African American, an aspiring heart surgeon is Asian and another attending is a Latina, one can begin to hope that patients will accept such diversity of care providers in the real world and that patients and their physicians will be able to understand one another more readily as the barriers of prejudice come down. Susan N. Tarrant, M.A., is Director of Patient Care Services at UMass Memorial Medical Center.
One Doctor’s
Experience with Medicine and the Media As a physician interested in improving public understanding of health issues, I often return to the following statistics: the circulation of the New England Journal of Medicine, which has the largest paid subscriber base of any peer-reviewed medical publication in the United States, is just over 100,000 copies. Subspecialty journals have substantially lower volume; for example, Stroke has only about 15,000 paid subscribers and the Archives of Pediatrics and Adolescent Medicine claims to “reach” just over 30,000 worldwide readers. By contrast, the The Boston Globe has a daily circulation of roughly 300,000 to 500,000 copies, National Public Radio reaches almost 2 million listeners daily, and NBC’s “Today” morning show is watched by almost 6 million people. There’s no doubt that academic research can change the world for the better. But there’s also no doubt that the popular media is unparalleled in reaching large numbers of people. Yet physicians often shy away from media involvement ~ perhaps fearing that the television, radio, or print articles rarely contain nuance. As a result, only a tiny number of major newspapers or magazines have a physician who is a member of the editorial board or a regular columnist; no major radio outlets have physician-communicators on staff, and most television networks rarely feature stories primarily reported and produced by physicians. To my way of thinking, these vacancies represent a tremendous opportunity for physicians to advance public health and medical literacy. In 1997, the year of my pediatrics internship at Children’s Hospital Boston, a widely publicized murder trial in Boston first inspired me to write for the general public. An infant, Matthew Eappen, had been murdered by his nanny, Louise Woodward, and the medical evidence was plainly evident to any physician familiar with the medical details. However, the popular perception in the media (including The Boston Globe, New York Times, and numerous other publications) was that an innocent nanny was being railroaded by overzealous physicians. Fascinated by the disconnection between medical evidence and public discourse, I wrote a long, detailed essay about the case during an elective month during residency. After almost a two years and dozens of rejection letters from all kinds of magazines, the piece finally ended up in the hands of a New York based publisher, who remarkably asked me to write an entire book on children’s health. By then, I was a pediatrician in Navajo country in Gallup, New Mexico, which allowed plenty of time to write. My book, A Map of the Child: A Pediatrician’s Tour of the Body, was published in 2003, during the first year of my pediatric cardiology fellowship back in Boston. Soon I learned another lesson: even books that are considered successful rarely sell over 20,000 hardcover copies, even though many (like mine) make best-seller lists. Broad impact requires targeting much higher visibility media, like newspapers, radio, and television. In many ways, however, having written a book opened doors to those venues. It also helped that I’d developed a thick skin and knew that dozens of rejection letters were expected for every successful media foray. Over the next few years, I wrote a monthly column on children’s health for The Boston Globe and contributed a variety of essays to the New York Times and the online magazine Slate. I also joined the advisory board of Parents Magazine and wrote commentary for National Public Radio. One of the advantages of being a doctor was having a stable source of income from my “day job.” As news budgets have declined, many outlets increasingly depend on freelancers, which can mean more opportunities for doctors who don’t depend on writing for support. And in writing provocative pieces grounded in medical data, I’ve tried to influence important medicine health policy questions including obesity, health insurance and reform, cancer treatment, and numerous other issues. Writing for popular media, and especially commenting on controversial topics, can be tough. As an academic physician, I find that balancing narrative drama and scientific honesty requires a commitment not only to write clearly, but also to communicate clearly with editors and producers. Invariably, one can also get angry responses from readers (for example, an article regarding the scientific data behind breast-feeding generated almost 300 emails a few years ago) and accusations of attention-seeking. Establishing and maintaining credibility is an ongoing task for physicians interested in media work. For those who want to get involved, I recommend first developing a strong social and political conscience and reading the medical literature closely. This preparation helps develop useful ideas and passion. Then write something, such as a letter to the editor or a commentary for a local paper or another accessible venue. Over time, these experiences will help you develop your communication and writing skills. Of course, one must expect failures and rejections ~ to this day, I still regularly get my queries rejected by all kinds of publications ~ but persistence pays off. Darshak Sanghavi, MD is the chief of pediatric cardiology and assistant professor of pediatrics at the University of Massachusetts Medical School. Some of his writing and media work can be seen at www.darshaksanghavi.com.
Physicians and the Press: Perspectives through Experience A shrinking press corps aside, media coverage of health care has exploded, especially in Massachusetts. Health reform, primary care, tiering and pay for performance, retail clinics, pandemic planning, medical malpractice, and legal, legislative, and regulatory decisions affecting physicians and the practice of medicine – and what it all means for patients as well as physicians – are critical subjects capturing local and national attention. Such news coverage gives physicians the opportunity for a stronger voice in the ever-widening conversations on health care. For physicians unaccustomed to public platforms, however, media relations can be alien territory. Worcester Medicine asked two recent Massachusetts Medical Society presidents for their perspectives. Dale Magee, M.D., a private practice gynecologist and a past president of the Worcester District Medical Society, served MMS from 2007-2008. Bruce Auerbach, M.D., vice president of emergency and ambulatory services at Sturdy Memorial Hospital in Attleboro, served from 2008-2009. Both had years on various committees and three years as Society officers. And both served when the important issues came to the forefront. As president (and sometimes even before), they were the chief spokesperson for MMS. What were your expectations of media as an MMS officer? Dr. Magee: Policy and media questions do not always have a one-to-one relation. One must have a sense of what MMS is trying to accomplish as well as a set of facts that can bridge the gaps. Dr. Auerbach: Knowing the MMS staff, I knew I was in good hands. I fully expected I would be well-briefed and prepared for interviews. What surprised you about media relations? Dr. Magee: I knew there was a mixed bag, but I was impressed with how smart most reporters were and how well they would get many different perspectives and synthesize them into a brief, focused report. Dr. Auerbach: I was always surprised at the media’s inability to plan, even for issues that are not “breaking news.” Also, some reporters had little knowledge of the subject they were covering. What do you consider to be the most important key to successful media relations? Dr. Magee: Know your facts and view the interview as a conversation in which you need to adjust what you say to the needs and background of the reporter. If you’re giving them a prepared statement they’ll know. Dr. Auerbach: Responsiveness, and the quicker the better. Where do you rate the job of chief spokesperson and why? Dr. Magee: Top of the list. Credibility with the public and making MMS look good not only has meaning for the public but it also reaches members and potential members. Seeing the MMS president on the news makes me feel a lot better about belonging to the MMS than getting a mass mailing from the home office. Dr. Auerbach: Close to, but not at the top. We have a plethora of content experts within the organization, and sometimes the president may not be the best spokesperson on a particular issue. What did you find the most difficult aspect of media relations? Dr. Magee: Preparation is everything. Also, controlling tone and expression are important in taped interviews. Dr. Auerbach: Deadlines, and the need to be immediately available at a moment’s notice to respond. That, plus the fact that you need to have time to become informed about the issue at hand to provide a cogent response. How would you judge the media’s ability to report on health care and physicians? Dr. Magee: Very good. However, there’s a herd mentality, and while we can expand on the perspective of the day, it’s not easy to be a lone voice. Dr. Auerbach: Favorably. While some lack knowledge, a significant cadre of reporters understands the issues and reports well. Does the voice of physicians make a difference? Dr. Magee: It does, but we must walk a balance between telling the truth and appearing negative or self interested. The conversation begins with others suspecting self interest, and we have to convince them otherwise. Dr. Auerbach: Absolutely. We’re “on the ground” with our patients, always putting them first. There’s no better group or more important voice to be the lead in speaking for patients or the healthcare industry. What advice do you have for other physicians? Dr. Magee: Be friendly, understand their point of view, know your facts, speak in plain English, don’t be afraid to be idealistic. Dr. Auerbach: Understand that the media can, and should, be our friend. Get comfortable speaking with them through training and practice. Present yourself as a caring, honest patient advocate. Use interviews to educate reporters. Be available. Candor and brevity are keys. Rick Gulla can be reached at 781-434-7101 and rgulla@mms.org.
Advocacy and Media Images of
Nursing The public perception of nursing in the media is an important issue, especially in light of the nursing shortage and increasing demand for nurses as the US population ages. Pervasive negative images of nursing in entertainment media, advertising, news coverage, and on the Internet may discourage nursing as a career choice and damage the public’s trust in nursing care. Concerned people advocate for accurate depictions of nursing in the media, as outlined below. Nursing Advocacy Websites To counter negative fictional characterizations of nurses in entertainment media and advertising, a group of nursing graduate students started the non-profit, web-based Center for Nursing Advocacy (http://www.nursingadvocacy.org/) in 2006. The Center’s advocacy strategy was to monitor media portrayals of nursing, which were communicated as alerts to a network of nurses. This strategy was effective against some images. For example, Disney stopped selling “sultry” Jessica Rabbit nurse pins for Nurses’ Week 2004 after receiving hundreds of protest letters within 48 hours of the Center’s advocacy alert. Similarly, Physician’s Formula, a cosmetics company, rescinded a print ad depicting a sexualized image of a nurse after receiving 75 protest letters from nurses. The Center also regularly alerted its network of nurses to advocate directly to television producers as they aired episodes of “Grey’s Anatomy,” “House,” and “ER.” This advocacy effort did not meet the goal of reversing the shows’ negative images of nursing. The only prominent nurse character among them, “ER’s” Abby, left nursing for medicine. “Grey’s Anatomy” and “House” open again this fall. Meanwhile, the Center for Nursing Advocacy is closing. However, the need for advocacy is so important that a group of nurses recently extended the mission of the Center by creating a new site, The Truth about Nursing (http://www.truthaboutnursing.org). The new site’s home page includes reviews of “Nurse Jackie” and “HawthoRNe,” which debuted on cable TV in summer 2009. Jackie is an experienced emergency nurse and an active addict who works while using, steals from patients and colleagues, and has sex with the hospital pharmacist, her supplier. Christy Hawthorne is portrayed as a seasoned expert and Chief Nursing Officer, but shows poor clinical and leadership skills. Advocating Against Negative Entertainment Images of Nurses Negative images of nurses in entertainment media are important. When impressions of “ER” were examined in a focus group study of 1,800 children (grades 2-10) in 10 cities, results showed students of all ages viewed nursing as “a girl’s job” without possibilities for advancement (Sherman, 2000). Such a view would directly influence choice of nursing as a career, with an indirect effect on the nursing shortage. Thus, nursing advocates should target youth by volunteering to speak to school groups and others about nursing, participating in school-based career fairs and taking part in community programs, thus enabling high school youth to engage with practicing nurses. Myths about nursing can be challenged in public forums for children and adults by timely blogging, editorials, and reviews for general news sources. Nursing advocates can also use dialogue and exemplary practice to educate patients about “real” nursing care. Images in the News and Advocacy In Australia, news coverage of a strike by mental health nurses juxtaposed “largely deprecatory images” of both mental health nursing and mental health patients (Farrow & O’Brien, 2005, p. 187). Pushing back against negative portrayals of nursing in news stories requires a different kind of advocacy because they are based on real life situations, not fiction. Since public perceptions are shaped by headlines, captions, and photos, and stories are chosen by editors, writing letters to editors becomes an obvious and timely nursing advocacy strategy. Research can also be a powerful advocacy tool when it uncovers patterns in the media. For example, Internet depictions of nurses as “science-oriented,” “promiscuous,” and “powerful” increased between 2001 and 2004, while images of nurses as “committed” and “authoritative” decreased (Kalisch, Begeny, & Neumann, 2007). Advocacy responses to damaging news coverage are often coordinated by state or national nursing associations and professional organizations. Responses include letter-writing campaigns to call out biased reporting, releasing press briefs, and countering negative coverage with responses by nurse leaders. Creating a Nursing News Media Presence One concern about the public perception of nursing is the absence of a nursing perspective in the news media. To fill this gap, nursing advocates suggest creating a place for nursing among news service resources. For example, nursing schools and departments can host regular open houses for the media, reaching out to cultivate good relationships between expert nurses and journalists. Nursing advocates can work with their organizations’ gatekeepers to include expert nurses among those prepared to respond to journalists’ requests for comment (Meier, 1999). Establishing nurses as hosts (e.g., “Healthstyles,” weekly on WBAI Pacifica Radio), columnists, or commentators on news networks and syndicates would increase nursing’s presence in the media. Locally, advocates can create nurse-speaker bureaus and regularly write on issues critical to the public, submitting press releases to news outlets and posting them on their organizations’ websites. Nursing advocates can also write to their legislators, thus raising policy makers’ consciousness about seeking nursing consultation and expert testimony on policy initiatives. These strategies may encourage news editors and the public to see nursing experts as legitimate health care authorities. Other Strategies What else can advocates do to promote accurate public perception of nursing in the media? Consult and engage expert nurses in designing websites and brochures for organizations providing nursing care. Write your legislators and favorite news sources with requests for expert nursing commentary on issues affecting health and the nursing workforce. Collaborate with nurses as co-principal investigators in research studies. Seat doctorally prepared nurses on policy development teams and expert panels. Tell the producers and sponsors of media promoting stigmatizing images of nursing that you’re tuning them out. Put away T-shirts and mugs with slogans trivializing nursing, and skip the greeting card depicting a “naughty nurse.” Take every opportunity to affirm good nursing practice to help the public perceive “the truth about nursing.” The future of the nursing workforce and patients’ lives depend on nursing advocates. Anne Kane, RN, PhD, is Assistant Professor at the Graduate School of Nursing, University of Massachusetts ~ Worcester. References: AACN (2009). Nursing fact sheet. Retrieved June 18, 2009 from http://www.aacn.nche.edu/Media/FactSheets/nursfact.htm CNN (2000). Your health: Medical errors linked to nurses, retrieved June 18, 2009 from http://archives.cnn.com/2000/HEALTH/09/15/your.health/ Farrow, T. L., & O’Brien, A. J. (2005). Discourse analysis of newspaper coverage of the 2001/2002 Canterbury, New Zealand mental health nurses’ strike. International Journal of Mental Health Nursing, 14, 187-195. Kalisch, B. J., Begeny, S., & Neumann, S. (2007). The image of the nurse on the Internet. Nursing Outlook, 55, 182-188. Meier, E. (1999). The image of a nurse - Myth vs. Reality. Nursing Economics, 17, 273-275. Sherman, G. (2000). Memo to nurses for a healthier tomorrow coalition. Retrieved June 18, 2009 from http://www.nursingadvocacy.org/research/lit/jwt_memo1.html )
Humanities in Medicine:
Narrative Medicine: Honoring the Stories of Illness On April 20, 2009, Rita Charon, MD, PhD, spoke at the University of Massachusetts Medical School in a program sponsored by the Lamar Soutter Library’s Humanities in Medicine committee and the Department of Medicine. Professor of Clinical Medicine and Director of the Program in Narrative Medicine at Columbia University, Dr. Charon teaches literature and writing in the university’s medical center and the Department of English. Often honored for her contribution to medical education, Dr. Charon spoke of the value of narrative writing in health care and signed copies of her book, Narrative Medicine: Honoring the Stories of Illness (2006). She first extended a special welcome to members of the audience who were not health care providers, telling them that “…doctors have forgotten what you remember.” Her point was that physicians often forget their memories of being patients themselves, considering cases exclusively from their limited perspective as clinicians. Dr. Charon described how patients become dehumanized when physicians, residents, and medical students become preoccupied with the mechanics of treatment, neglecting their human needs. Concerned primarily with symptoms, medications, and technical procedures, they forget the importance of ministering to a whole person, rather than to a body alone. As Dr. Charon noted, “The body is separated from the self…” when caregivers view their patients only as organs, symptoms, or a disease. This limited perspective robs both clinicians and patients of their humanity. On call, often sleep deprived, harried students struggle to treat what seem to them hordes of sometimes uncooperative patients. Aware they are on trial as apprentice physicians, wary of making mistakes, medical students may understandably begin losing compassion for their patients, thinking of them only as bodies to fix. To overcome such limitations, Dr. Charon has developed a narrative writing-based method of empowering caregivers ~ doctors, nurses, residents, and students ~ to view their patients more humanely. Combining her devotion to medicine with her passion for literature, she originated the idea of having students use the power of their imagination to write the story of the patient’s hospital experiences from the patient’s point of view. Students compose in the first person, imaginatively transforming themselves on paper. In order to tell stories as patients would tell them, students must learn to listen ~ a skill essential to every physician. Narrating their patients’ stories, they can enhance their capacity for empathetic awareness. Attempting to understand their patients from the inside out, students, especially, might come to identify with them. Nevertheless, as Dr. Charon emphasized, they must learn to balance the subjective feelings of an artist with the objective thinking of a clinician. To achieve this balance, she devised a narrative competence course, a course unique in medical education. Students continue to routinely making entries in the bedside chart in standard medical terminology. They dutifully enter data and describe their patients’ progress in clinical terms. Such records provide absolutely indispensable information vital to the patients’ treatment. However, Dr. Charon’s students also maintain a “parallel chart” shared with their peers in class. Making entries in this “chart” in everyday language, students comment frankly about their interaction with patients in the course of treatment. They learn they are not alone in harboring ambivalent feelings about their patients. They learn to acknowledge and accept their feelings, and, above all, they learn how their patients contend with illness, and why they sometimes contend with their doctor, just as their doctors contend with them. The “parallel chart” reveals insights no conventional hospital chart can reveal. Dr. Charon convincingly argues that this kind of writing should become part of every doctor’s education. In her final remarks, Dr. Charon stressed the value of integrating the humanities into medical education. She stated that forty percent of today’s medical students major in the humanities as undergraduates, but somehow, by the time they graduate from medical school, they lose their powers of imagination. She explained how studying literature, philosophy, history, and languages will train students in the same skills they learn in medicine: analysis and synthesis, deduction and induction. But the humanities, she asserted, better reveal the deepest truths of the human heart ~ truths we learn by writing ourselves, and by reading the writing of others. The speaker made clear her long time commitment to humanizing medical treatment. Her original ideas have helped to bring patients and caregivers closer together, emphasizing their common humanity by adding art to the science of healing. Asked to inscribe the Lamar Soutter Library copy of her book on narrative writing, Dr. Charon distilled to its essence her message to the UMass Medical School audience. She wrote, “For those who read and write in their work with the sick. The rewards are beyond our ken.” Legal Consult:
Information Security Coming to an Office Near You Health In 2007, the Legislature passed a measure, chapter 93H,
that required those who own or license personal information about
Massachusetts residents to notify those residents and state officials in the
event of a security breach. This was in response to a long series of
identity theft incidents – notably that involving TJX and approximately 40
million credit Draft regulations were issued last summer and intended
to be eff The rules require providers to take steps to safeguard
personal information in paper and el The CISP is to include designation of one or more
employees responsible for maintaining the CISP, identifi For personal information stored on computers or other
wi The new proposed regulations do contain some potential There are sure to be more public discussions of these
new information security mandates as we head toward the compliance date
early next year. Providers will need to monitor those discussions and
review their existing policies and procedures. As with the security breach
notifi Financial Advice for Physicians: The Emerging Role of Fixed Annuities PIAM is developing more resources for physicians and family members interested in fixed annuities. Fixed annuities offer a variety of possible advantages over other types of similar investments. Despite their apparent simplicity, however, there is a great deal to understand about the variety and use of fixed income annuities. Soon we will be operating a special Annuity Desk for physician members and their families to answer their questions and offer quotes. Today, a growing number of investors are looking for more stability in their returns. For older Americans, income reliability is essential. Worries about investments exposed to sudden market shifts that can wipe out a life savings are a huge concern. Consequently, there is increasing interest in fixed income investments that can pay a competitive rate of return while protecting principal. Savings accounts and CDs which are offered through banks offer safety (they are FDIC insured). However, bank interest rates are near an all time low and savings account and CD interest is fully taxable the year it is earned. Fixed annuities have certain advantages over savings accounts and CDs. For example, annuities typically pay higher levels of interest and the interest is tax deferred until it is withdrawn. In addition, annuities have major advantages over savings accounts and CDs when the owner passes away (see below). These distinctions and others can make a big difference for you and your estate. An annuity is a contract between you and an insurance carrier. It is a long-term investment. You agree to give the carrier a certain amount of money (principal) for a certain amount of time. The carrier agrees to give you a certain interest over time. You can take the interest as a monthly income or you can let the interest grow without making a withdrawal. As long as the insurance company remains financially sound your principal will earn interest and it will not decline in value. Unlike banks, annuities are not FDIC insured but they do have protection through state Guaranty Funds which back other insurance products. The following example shows why someone would use a Fixed Annuity that offers tax-deferred growth for long-term savings. Assume $100,000 earning 4% interest each year for 5 years and without money taken out of the account. At the end of the 5 years a CD that is taxable every year would be worth $115,254 assuming a 28% tax bracket. At the end of the same 5-year period, a Fixed Annuity would have grown to $121,665. The tax deferred Fixed Annuity has accumulated $6,412 more than the CD. The longer the money is left in a tax deferred Fixed Annuity, the more dramatic the difference in accumulation is. At the end of 10 years, the taxable CD will have accumulated $132,834 while the tax deferred Fixed Annuity will have accumulated $148,024, a difference of $15,190. The benefit of tax deferral increases the longer the time frame and the higher the interest rate. Fixed annuities also offer additional advantages such as riders that allow access to the money without any penalties in case of financial hardship, terminal illness and nursing home needs. Other riders ensure that if the owner of the Fixed Annuity passes away this money will not incur penalties if accessed after his or her passing but prior to the annuity’s initial length of term. Another advantage of using a Fixed Annuity for long-term savings when compared to a CD is how the money is handled at the owner’s passing. The money in a CD will pass to the beneficiary after going through the probate process and this often creates delays and added expenses. Fixed Annuities pass to the beneficiary without going through probate as long as the beneficiary is an individual not an estate. Without question, annuities have their detractors. Financial experts sometimes criticize annuities for early withdrawal penalties and fees. Naturally, investors who go into annuities ignoring the “rules” by which they operate can get penalized. Although most annuities allow some degree of early withdrawal (i.e. 10% per year), investors need to know that withdrawing more than the contract allows will result in a penalty. However, by learning the rules and using annuities to your strategic advantage, you can make them an important part of your overall financial plan. The Growth of Equity Indexed Annuities Equity indexed annuities (aka Indexed Annuities) have become an increasingly popular type of fixed annuity. Not to be confused with variable annuities which invest in stock mutual funds, indexed annuities use interest rates based on a formula tied to a stock index such as the S&P 500. Indexed annuities actually invest in fixed income instruments similar to other fixed annuities. Indexed annuities give investors the chance to put money into a stock-like investment, getting some of the upside potential of the stock market but without the risk. If the market goes up, an indexed annuity will pay a return tied to the market. If the market goes down, the indexed annuity will typically pay “0” or no increase and the investor loses no principal. Today, there are some excellent indexed and traditional annuity opportunities for investors. However, annuities can differ greatly by contract and carrier. It is imperative that investors use an independent broker who has access to multiple insurance carriers and can help suggest a contract that will work best for you. As the population ages and more people seek future income security, annuities will likely play an ever increasing role. As you learn more about fixed income annuities, it will give you both peace of mind and make you a better investor. Introduction for Gerald F. Berlin Creative Writing Prize Award The University of Massachusetts Medical School (UMMS) recently honored seven medical students, one student from the Graduate School of Nursing, and one medical resident during the Fifth Annual Gerald F. Berlin Creative Writing Prize Award Ceremony and Reading on April 15. Established by Richard M. Berlin, MD, poet and UMMS associate professor of psychiatry, the Gerald F. Berlin Creative Writing Award encourages creative writing among UMMS students and residents and honors Dr. Berlin’s father, who struggled with a severe chronic illness. Berlin is the author of the poetry collection How JFK Killed My Father, which describes his career in medicine as well as his father's illness. “Creative writing gives students and residents a special opportunity to reflect on their experiences, to maintain their humanity, and to heighten their empathy for the suffering of their patients,” said Dr. Berlin. “These are qualities that bring doctors closer to their patients and I know these are the qualities my father always looked for and admired in his own physicians.” The prizes were awarded as follows:
Honorable Mentions:
Gerald F. Berlin Creative Writing Prize Award Winner The Patient Unexpected By Joel Bradley Submission for the Gerald F. Berlin
Prize for Creative Writing He felt himself relax – he had thought he might not be admitted. He heard his breath for a moment beneath the erratic symphony of beeping monitors, which piled up and faded away as he was wheeled past inpatient rooms, hospital beds and treatment areas. The long corridor walls gave him the feeling of falling slowly down a funnel, the walls, floor and ceiling angling into one another in a long symmetrical sweep. It reminded him of the awkward arrogance of early studies in perspective, only the clothes were different, the people etched to scale. He recognized that for others those thinning dimensions constituted a vague, foreign dread - but for him they were a return home, and again he was surprised to feel that way about a place he had never been. He exchanged pleasantries with the nurse wheeling him past the wards, but was careful not to seem more pleasant than he should, given his condition. The aimless chatter was a welcome cloak for his gaze, which was busy flickering aside to whispered conversations over charts and monitors, human shapes under white sheets and faded pajamas, waiting room magazines, families. He wondered if Jeffrey Murphy, R.N. (plastic badge swinging rhythmically from a blue clip at his waist) could detect how grateful his patient was for another chance to take part in this vast human library: wanting to be there, but with the delicious luxury of not needing to be. Of course, he could not. They stopped at a long, high desk, with four oblique rectangles of computer monitors peeking over the top. Jeffrey laid a thin file on the counter and waited. The concert of electronic sounds settled in now, washing over the place. Phones, beepers, radios and the arrhythmic cacophony of beeping, blinking vaudeville monitors played steadily, hardly ever changing enough to be noticed, except by those connected to – or by – them. There was a whole, but no one seemed aware of it – all were simply individual players and sections, warming up in rooms backstage with no conductor. “Okay, who’d you bring us this time?” the nurse behind the counter said brightly, addressing both of them at once, perm, forehead, brows and eyes breaking the plane of the desk, then re-submerging. Her tone carried the customary theatrical annoyance, a familiar artifact of hospital staff everywhere, like a dusty and ungainly vase that manages to be charming not because it is elegant, but ordinary – expected. “Robert C. Matthews – for undiagnosed heart palpitations, acute abdominal pain. First visit here. ER. Insurance is Blue Cross – photocopy in the back.” “Always one step ahead darling,” she approved, genuinely grateful to avoid the paperwork. “Room 8 it is, Mr. Matthews. I do sure hope you enjoy your stay with us,” she drawled, smiling sympathetically, standing now, affecting an over-polite hotel receptionist. He noticed how tired she looked. Matthews smiled the way he knew he should – appreciatively, but with a taut, languorous note of someone made anxious by the continuous surprise of severe pain. As the wheels beneath him groaned away on the tiled synthetic floor, he smiled inwardly. The curtain of the tidy, dull cubicle was flung wide on its runners and his stretcher was spun into place, beside the bed. No: he assured Jeff that he was fine moving there himself, but compromised by accepting a proffered hand as he negotiated the uneven gap. A moment later Matthews was at last partially alone while Jeffrey strode over to discuss his chart with one of the circulating nurses at a row of computers along the opposite wall. He could hear their murmuring and a few words, but not enough to tell what was being said. He had long ago gotten over being anxious under such circumstances, perhaps because he took refuge in knowing that the actual reasons for his being there didn’t really matter: only the need, which justified it. Briefly Matthews wondered – as he often did – if it should frighten him how much he wanted to be here – how need had materialized from the want – how sick he had become. But he recognized no fear in the way he felt, and the intoxicating wash of relief that had followed him in the revolving door of the ER had for hours been seducing his doubts, beckoning with the familiar resignation he was still not ready to call addiction. A committed hiatus; only it kept getting longer, and with time, less explicable to friends and family. They thought he was on some kind of extended sabbatical, and, in a sense, he was. Matthews put the thought aside and felt himself relax. He noticed the way the curtain hung in long, even folds. He drank in the aseptic smell of his stiff pillow, the papery character of the pressed, loosely-tucked sheets. He started picking up the smaller humming of machine-motors beneath the beeping, heard the footfalls coming at different paces and angles, the hushed voices blending in beneath those of actors on a nearby television turned a little too loud. II Dr. Jen Magovern was striding through the same wards the same morning with the peculiar levity of someone who had just come to the much-doubted end of years of perceived inadequacy. She was nearing the end of her final year as a resident in Portland, and was already in the process of interviewing with practices in different parts of the Northeast, where she had grown up and to which she wished to return. The third anniversary of a nearly faultless marriage was nearing, and she was almost ready to finally let herself feel happy without restraint or worry about her capacity to weather the arduous sacrifices of a life in medicine. Only during these past few months in the hospital had she stopped bracing for the blow of rebukes and corrections from superiors that had been the wind and wrack of her education – she felt comfortable, confident, at last settled into the rhythms of a personality she could sustain without contrivance. She knew the protocols, the procedures, whom to ask for what, and when to ask it. She had worked hard to avoid the petty failings that come of long hours and little sleep, and earned the respect (or tolerance) of the staff. She had been waiting a long time, and it still felt dreamlike, almost too weightless to be believed. Though just back from a day off, she knew most of the patients already: Jane, Steven, Gail, Alessandra, Solomon – patients who were now people to her beyond their charts, which grew thicker with each day, taking on new tree-rings, new scars. It often surprised Magovern how quickly she could feel close to these lives, whose histories she had come to know so recently and at such feverish pace, under the pressure of illness, the fear of pain, the awful opacity of the unknown and unanswerable. It often felt like those minutes were years. Parting the manila biographies now, she scanned the new lab values and lists of vital signs, which were the latest chapter of physiologies she had grown used to wrapping in their human blanket. “The stories of physiology are also the stories of people,” she recited to herself - something an old mentor had told her many years before. Meanwhile Magovern wrote quickly in the hieroglyphics of acronyms and abbreviations, adding to the intimate tales she already had the privilege to know: work and home life, a childhood illness, the family history, important allergies, broken bones. She had become acrobatic at multitasking – thinking and doing all at once. Afterward she signed her name with the same sharp, resolute authority: a flourish that at last carried the feeling of solidity. It was in those small assertions that Magovern had found her proof: evidence that announces itself not by grand motions, but in the smallest of details. A history spoke out from within those scratched and scrambled lines, and she was proud of it. Two new admissions today: a person suffering a third-degree electrical burn and another with undiagnosed heart palpitations, presenting with acute abdominal pain. She practiced their names, her rule to cover over the fact that she had never been gifted at remembering them. Magovern tripped over the second on her first pass through, misreading it. “Name: Robert Matthews. Age: 48,” she corrected. She chuckled, recognizing in the address and occupation – “Oregon,” “Journalist” - the idle voyage of sentimentality she had taken. Of course, it wasn’t exactly an exotic name, and she had just remembered some of his memorable words: Dr. Matthews had been an advisor to her during the arduous initial years of medical school. He was a person of rare poise and reflection in the hectic sphere of medicine, involved in uncountable things, but always capable of prioritizing a conversation in front of the elevators or on the way down one of the long hallways, even when his direction was opposite your own. Matthews was one of the few physicians who paid more attention to people than to his pager, which seemed to spend more time vibrating than in silence. Magovern smiled openly at the thought: the last months had been so infernally busy that she had scarcely thought of him directly. That is, she hardly made it through a day without recalling his words, which had carried her through the darker episodes of her early disenchantments with medicine - even long after she had left Massachusetts. He had been among her interviewers at the grey, indifferent gates of medical school, entering her life at a time when she was being won over by the doubt and pessimism endemic to the application process. She had felt remarkably at ease talking with Matthews - there was something redemptive in his manner, something that made her forget about apologizing for what she couldn’t say, didn’t know, or hadn’t yet done. During that first talk, it had seemed as though he were pulling from her insights she hadn’t been aware she possessed, abandoning the fabricated offerings she had polished again and again, as though they were treasures. That had been a turning point: to her surprise, she was admitted, and shortly afterward Matthews wrote to congratulate her, encouraging her to shadow him sometime at the clinic he ran out on the edge of the city. That was where Magovern went after her first day of class all those years ago, and from where she now stood, it felt at once like an endless journey and a casual jaunt - but for certain, that was where it had begun. Her last note sent by e-mail several months back had gone unanswered, which was certainly unusual, but not unheard of – his schedule had always been borderline heroic, and more likely than not, sleepless. Speaking of which, her pager was buzzing. Reminiscences for later, then. Lifting herself from the daydream, she strode off to check in on the patient with the burn. III Twenty minutes later, she entered, and stopped. They looked in silence, not knowing for how long. He didn’t attempt to deny the unmistakable: something about seeing her made him let immediately go. “I’m not really sick,” Matthews said. His words shook as he said them: pale, fragile. “That doesn’t matter,” Magovern said, after a pause she wanted to be full of many things she couldn’t yet say. “I’m glad you’ve come. Wait.” He heard her say his well-worn words, and nodded as if to release her from the gravity of the room. She returned moments later and pulled a blue plastic chair in from the wall to sit facing him, close, listening. After he began, she said nothing; his words rolled on, pained but careful, articulate. Matthews spoke of the endless marching burden of the ill, and how the fatigue had seeped into him, the insidious pain of not being able to do enough: to do everything. A small car crash around that time had sent him to hospital with a mild concussion, and everything had collapsed – a sudden leave of absence, a marriage that faltered then failed, and shortly afterward, the first feigned hospitalization. There followed a second, a third: a simple task with his knowledge of medications and idiopathic ailments. Changing only his first name to maintain some stubborn formality of his former self, he had since moved from place to place, uncovering rainbows of anguish to hide behind. It reminded him vividly of what he had left, reanimating the pain and dependence, the fear, the argument for why he had needed to care for the vulnerable, helping him forget how vulnerable he had become. It was the wonder without the weight, and he grew to need it, that feeling of at last being cared for. The unruly beauty of healing was the only thing that remained to him, only it was never quite his, and it left him unmoored, an unquenched specter floating in - but unable to return to – life. Watching had become his only treatment. Without it, only the past remained, and by now he knew well that memory alone was not enough. There was no ladder and no strength left to help him emerge from where the fall had left him stranded. After everything had been said, Magovern got up to leave, sensing the fatigue caused by the exquisite labor of confession. Slowly, she removed her white coat and folded it, placing her stethoscope on top and setting it on the table beside his bed. “For when you’re ready” she said, and walked out, leaving the chair in its place by the bedside. It was late already – she had been drawn deeply into his strange tale of tragedy and lost herself. She shuddered, feeling helpless and blank, wondering if she should have said more, done something differently. It went on like this for days. Each morning she greeted him, gathered her coat and stethoscope and went off on rounds. At the end of each day, she placed her stethoscope carefully on top of the folded white coat that bore her name in blue cursive letters, setting it near his bed. For when you are ready. Otherwise they said very little, addressing only the particularities of his treatment, a charming charade neither ever admitted taking pleasure in. They both waited. On the ninth morning, Magovern was paged on her way in: Matthews had gone. The bed in room 8 had been made by the time she arrived, and the nurse confirmed that he had checked himself out that night, denying further treatment, saying only that he was feeling “…well enough to get better on his own.” Returning to his room, Magovern stood looking again at where the stethoscope had disappeared from the surface of the folded coat, leaving an impression behind in the bright cloth. Joel Bradley can be contacted at Joel.Bradley@umassmed.edu, (413) 329-7279
A. Jane Fitzpatrick Kilroy, MD Dr. A. Jane Fitzpatrick Kilroy passed away on May 3, 2009 at the age of 92. Fondly called “Dr. Jane” by the many people whose lives she touched, she spent her last years in the Knollwood Nursing Center. She was originally from Southbridge, Massachusetts, and received her BS degree from Jackson College and her MD degree from Tufts Medical School in 1942. Her internship was at Worcester’s Hahnemann Hospital and residency at Metropolitan Hospital in New York City. Dr. Jane practiced in Worcester from 1945 to 1985 and served on the medical staffs of Worcester City, Hahnemann, and St. Vincent hospitals. She was an assistant professor of pediatrics at UMass Memorial. The above is her “professional” information. I remember Jane as a friend and colleague, sharing call for many years and enjoying her stories about practicing in Worcester. She was a true community physician – an ardent supporter of the VNA, Girls Inc. and the Massachusetts Society for the Prevention of Cruelty to Children. How many of us bought those cup plates she sold for MSPCC? The Worcester Department of Public Health’s Immunization Clinic is named in her honor. She volunteered 45 years with this department, running that clinic and administering vaccines on a twice weekly basis. True to her kind and unassuming nature, few people knew that she twice received the key to the city, was awarded the Bardwell Flower Award in 1989 from Worcester Youth Guidance, and received an honorary doctorate of humane letters from Worcester State College in 2004. For those of us lucky enough to be invited to her home in Worcester, we saw the beautiful pieces of furniture that she refinished during her evenings at the Worcester Craft Center. Often we heard about how she did bowling that week, too. One story I remember was her explaining a small trophy that sat on her mantle – she received that trophy for skeet shooting while on a cruise! She was a devoted wife to her husband, Dr. Ed Kilroy, who predeceased her, mother to five children (Nancy predeceased her), and grandmother to seven cherished grandchildren. Dr. Jane was such a wonderful role model to those of us starting in practice and lived a long and productive life both professionally and personally. Her legacy lives on in the Worcester District Medical Society with the A. Jane Fitzpatrick Community Service Award, given in her honor each year to a physician who exemplifies the spirit of serving our community as Jane did. Lynda Young, MD |