“If you look the right way, you can see that the whole world is a gar-den.”

Frances Hodgson Burnett The Secret Garden

Ridiculous to Demoralizing San Francisco VAHCS Department of Medicine

Resilience to Despondence

Energy to Exhaustion

Resigned to Defiant

Hopeful to Disillusioned

My Child is Failing 2nd Grade

Perspective

If there’s been anything during these past five months, there’s been fluctuating scenarios, strong emotions, and uncertainty.

We started out in a frenzy—one of fear, energy and strong conviction that it would get better. This inevi-tably settled into acceptance of a long-road ahead, millions of COVID cases, cancelled summer plans,

the economy in freefall, an uptick in political rheto-ric, and civil unrest in response to heartbreaking, repeated injustices.

One of the reasons I like the 100k foot view above of the Bay area, is because you can’t see the masks or hear the discord. Everyone is equal and in this life together. It’s actually quite stunning, peaceful, and reassuring. At least until the continents collide again (as the 13 year old warns), the remarkable sight of our glorious part of the state, the peninsula, bay, ocean, and everything around will still be here once we work through this stuff. And we will.

Can’t we stay up here just a little while longer? No, it’s time to get back to work. Hang in there SFVA Medical Service.

INSIDE THIS ISSUE

Sublime

Morale Compass 2

HERO Awards 2

Hello...Goodbye 2

Featured Faculty 3

Chiefs’ Welcome 3

VA Proud 4

Mysteries 4

Show Me the Money 5

Wordsearch 5

Ridiculous

Deep Space Thoughts 6

Don’t Miss the Details 6

Familiar Funnies 6

Reopen Roulette 6

COVID Pendulum 7

Scratch that Plan 7

Mask Your Defiance 7

Abandon the Curve 7

Other

Carl’s Getaway 8

Homeschooling continued 9

Staycation Fun 11

I Read it Somewhere 11

KEN’S KORNER

RELEVANT DATES

POETRY

AND 8 OTHER TITLES WE CONSIDERED

Summer / August 2020

Volume 3, Issue 3

Look again at that dot. That's here. That's home. That's us. On it everyone you love, everyone you know, everyone you

ever heard of, every human being who ever was, lived out their lives. The aggregate of our joy and suffering, thousands

of confident religions, ideologies, and economic doctrines, every hunter and forager, every hero and coward, every crea-

tor and destroyer of civilization, every king and peasant, every young couple in love, every mother and father, hopeful

child, inventor and explorer, every teacher of morals, every corrupt politician, every "superstar," every "supreme lead-

er," every saint and sinner in the history of our species lived there-on a mote of dust suspended in a sunbeam.

Carl Sagan, Pale Blue Dot 1994

By Anna AbramsonALL I REALLY NEED TO KNOW...i learned at home.

Q: How does a homeschooler change a light bulb? A: First, mom checks out three books on electricity out of the library, then the children make models of light bulbs, read a biography of Thomas Edison and do a skit based on his life. Next, everyone studies the history of lighting methods, wrapping up with dipping their own candles. Then, everyone takes a trip to the store where they compare types of light bulbs and their prices, figuring out how much change they'll

get if they buy two bulbs for $1.99 and pay with a five dollar bill. On the way home, a discussion develops over the history of money and also Abraham Lincoln, since his picture is on the five dollar bill. Finally, after building a homemade ladder out of branches dragged from the woods, the light bulb is installed. And then there is light.

There are as many different types and reasons to home-

school as there are families. We had never planned to

homeschool, but the eldest of our three daughters is a non-

traditional kid who herself asked to be taught at home.

Many children do well at traditional school, get good

grades, do sports and have high

SAT scores that can get them ...continued on page 9

MORALE COMPASS

Some Antiracism

Resources

(thank you, Meshell

Johnson)

MULTIMEDIA

•Anti-Racism Resources for White

People by Sarah Flicker, Alyssa Klein (google doc, non-VA computers only)

•Sharable Anti-Racism Resource

Guide by Tasha K Ryals - LONG (google

doc, non-VA computers only)

•Anti-racism children’s/parenting

books dotphrase (UCSF Epic, from D.

Greenfield): .DGANTIRACISMREAD

•5 Ways to Show Up for Racial

Justice https://www.kqed.org/

arts/13881199/5-ways-to-show-up-for-racial-

justice-today

•75 things white people can do for

racial justice: https://medium.com/equality

-includes-you/what-white-people-can-do-for-

racial-justice-f2d18b0e0234

•21-Day Racial Equity Challenge https://mlpp.org/21-day-racial-equity-

challenge/

•HBR/fighting racism https://

hbr.org/2020/06/is-your-company-actually-

fighting-racism-or-just-talking-about-it

•The Moral Determinants of Health https://jamanetwork.com/journals/jama/

fullarticle/2767353 , Berwick

•11-Step Guide to Understanding

Race, Racism, and White Privilege http://

citizenshipandsocialjustice.com/2017/10/14/11-

step-guide-to-understanding-race-racism-and-

white-privilege/

•Allyship is an active practice that

requires action — The Who, What, and

How of being an ally for social justice

•Podcast: Brené Brown with Ibram X. Ken-

di on How to Be an Antiracist

BOOKS

•White Fragility by Robin DiAngelo

•How to be an Antiracist by Ibram X. Kendi

VIDEOS Dear Bruh. A Eulogy. A Baptism. A Call to Action. https://youtu.be/CqviucsNGP4

Neil Degrasse Tyson on being Black, and Women in Science https://www.youtube.com/watch?v=z7ihNLEDiuM FOR FULL LIST, click HERE (UCSF Box)

2

We frankly think you’re all heroes for maintaining a positive can-do spirit during this time and for figuring out our Zoom invitations. A few amazing people have stood out for their work on the operational front-line and we wanted to recognize them individually as... Medical Service HEROES JULY

Erica Youngblood, Veterans’ Integrated Perioperative

Clinic, ORH Transitions Nurse

For always stepping up to help out when there is need, for

doing it with no expectation of reward. For bringing a

warm ray of sunshine into everyone’s life she touches eve-

ry day. An embodiment of goodness and positive energy,

Erika is someone with whom we’re lucky to walk the hall-

ways. THANK YOU for everything you do for our Service,

our veterans, and employees. Rock on, Erica.

AUGUST

Kevin Kane & Elizabeth Gregg, GIM —Respiratory Screening Clinic Leadership

Okay, here’s the deal. We have a clinic—and we’d like you to run it. The well-being of our

Medical Center depends on the sound functioning of this clinic. You must keep up with

constantly-evolving guidelines in multiple areas (masking, testing, etc.) and update your

processes to meet evolving needs on a dime. All eyes from HICS will be scrutinizing the

operation of this clinic. The clinic may have 2 patients a day, but must be staffed for more

than 20 in a morning—and providers on whom you rely are largely volunteering their

time. Congratulations and Good luck! Oh, and thank you, heroes.

KEEP THE NOMINATIONS COMING! Seen a hero lately? You’ll know it when you do.

Monthly Award, handsome pen. Email Heather Nye or Ken McQuaid

SINGING OUR HEROES

HELLO...GOODBYE

As summer brings the winds of change, and

the occasional viral particle floating upon that

wind, we bid a masked-farewell to those who

have served the SFVA well and warmly wel-

come newest members of our community.

HELLO

GIM

Dr. Archana Sridhar (former ZSFG chief,

coming from Highland)

Heme/Onc

Dr. Franklin Huang (UCSF faculty researcher, prostate cancer)

Dr. Li-Wen Huang (former UCSF fellow)

Hospital Medicine

Dr. Priya Joshi (from Philly VA)

Dr. Christian Mewaldt (from MGH)

Dr. Lowell Nicholson (from UCSF) OB/Gyn Mitzi Hawkins (former UCSF fellow) Rheum Dr. Ramani Krishna Chaganti (UCSF faculty researcher, OA hip)

GOODBYE

Moving on...

Dr. Kim DeQuattro, Rheumatology (heading to

Highland Hospital)

Dr. Elizabeth Marshall, GIM (going to Wyoming

to work for National Health Service )

Dr. Mike Hurley, Hospital Med (heading to

Blackstone

Retiring

Dr. David Lovett Dr. Paul Simpson

(Nephrology) (Cardiology)

T

RIG

GE

R W

AR

NIN

G: R

IDIC

UL

OU

S J

OK

ES

AN

D N

ON

SE

NS

E

FACULTY

FEATURE Meet Dr. Ashley McMullen

Dr. Ashley McMullen was born in Houston, TX. Though spend-ing her earliest years in Chicago with grandparents, she returned to Houston in grade school and reports lamenting Houston sports teams while growing up since the Rockets last/only NBA championships in 94' and 95' (editor’s note: we secretly won-der why Ashley didn’t start following the Bulls after 1995…and on behalf of the Warriors, sincerely apologize for the last 4 of 5 playoff runs )

After earning a B.S. in Neuroscience from Trinity University in San Antonio, Ashley spent a year doing HIV research in Boston, followed by medical school at UT Houston. She moved west for the first time to complete residency at UCSF, in the SFPC pro-gram, then served a year as chief resident - becoming the first dedicated ambulatory chief at ZSFG.

It has been nearly a year since Ashley joined the SFVA Division of General Internal Medicine in September 2019 as a primary care provider and preceptor for the Medical Practice and the Downtown Clinics.

She notes “It was definitely a little intimidating to leave the General for the VA. I'd spent most of my residency and all of my chief year there. However... I knew I needed a change of pace. Jeff Kohlwes was instrumental in helping me see the different opportunities to grow as an early attending at the VA while also fulfilling my commitment to serve a uniquely vulnerable com-munity at the Downtown Clinic.”

Additionally, she welcomed the opportunity to work with ad-mired faculty mentors Denise Davis and Meshell Johnson. Once starting, she was astonished by the organization of SFVA outpa-tient clinics (the PACT model) and has enjoyed working within an integrated system, with ease of communication between col-leagues and specialty services.

She further exclaims, “The clinic leadership is also fantastic - shout out to Maya Dulay, Sara Rumrill, and Emma Shak!”

Ashley is part of the 2019 class of Watson Scholars at UCSF and plans to use funding to do work in narrative medicine - specifi-cally exploring the integration of narrative competency in medi-cal education as a tool for improving connections across differ-ences. She is also a new faculty affiliate with the UCSF Dept of Humanities and Social Sciences and directs a new narrative med-icine curriculum for residents in the Health Equity track based at ZSFG. Lastly, she is the host/producer for a new story-telling podcast series in partnership with The Nocturnists, entitled The Nocturnists: Black Voices in Healthcare.

Apart from working on her radio voice for the podcast, Ashley is a proud bibliophile and introvert. She is currently reading an amazing collection of essays called Disability Visibility, edited by Alice Wong. She loves connecting with her family back home and her church in Oakland on Zoom, as well as a good socially-distant beer with friends. Ashely also reports spending a consid-erable amount of time either doing or thinking about her natural hair.

A belated welcome to the SFVA, Ashley... we are so excited for all the things you bring to our community!

3

Shirin Hemmat, VA Outpatient

Shirin was born in San Francisco and raised in northern California. She graduated from UC Berkeley with a degree in Biology before attending UCSF to earn her medi-cal degree and complete her resi-dency training in Internal Medi-cine. During medical school, Shirin obtained an MPH degree at UC Berkeley in Epidemiology and Biostatistics. Her master’s thesis examined the effect of publicly reporting procedure outcomes on statewide myocardial infarction mortality rates. Her research has continued to focus on quality improvement efforts, including examining the impact of perfor-mance measurement/target setting in large health systems and redesigning clinical workflows to improve distribution of medica-tions used for the treatment of opioid use disorder and prevention of HIV. Her other academic interests include medical education and the advancement of women in medicine. In her free time, Shirin enjoys watching Jeopardy, taking spin classes, reading out-side and spending time with her friends and family.

***

Colette Dejong, VA Inpatient

Colette grew up in Urbana, Illinois. She attended Brown University, earning a degree in Development Studies. After college, she interned at Partners in Health in Boston and spent a year working for Green City Force, an environmental justice non-profit in Brooklyn. She attended medical school at UCSF through its Program in Medical Education for the Urban Underserved (PRIME-US). During medical training, she completed a year-long research fel-

lowship at the UCSF Center for Healthcare Value, conducting a national study of pharmaceutical marketing that was covered on the front page of the Wall Street Journal (and on NPR’s Wait, Wait, Don’t Tell Me). She stayed on at UCSF for residency, train-ing in internal medicine and completing a 2-year editorial fellow-ship at JAMA Internal Medicine. She plans to pursue a career in academic cardiology with a focus on expanding healthcare access. Outside of medicine, she enjoys surfing and exploring the Califor-nia coast with her partner Laura and their dog Gary.

***

Yaanik Desai, VA Inpatient

Yaanik grew up in Atlanta, Georgia. He studied Biomedical Engineering as an undergraduate at the Universi-ty of Pennsylvania. In college, he joined Arjun Raj’s systems biology lab, and studied how cells behave at the individual level. He returned to Atlanta for medical school at Emory University, and conducted research in cardiac electrophysiology. As a resident at UCSF, he was part of the PRIME clinical research pathway and did research in cardiac bi-omarkers. His future research interests are in the applications of Machine Learning in medicine. He is passionate about all things food and wine.

CHIEFS’ WELCOME By Susie Wlodarczyk

MAKING THE VA PROUD

Christine Hsieh, PhD, was promoted from Assistant to Associate Adjunct Professor

Mary Whooley received the 2020 Howard S. Luft Mentoring Award in Health Services and

Health Policy Research, from the Philip R. Lee Institute for Health Policy Studies

Ashley McMullen of GIM started a new podcast: The Nocturnists: Black Voices in

Healthcare series which has received great press and feedback from listeners. Here's a link to the podcast: https://

podcasts.apple.com/us/podcast/the-nocturnists/id1322741272 She was also invited to do a podcast on race for the Lancet:

https://podcasts.apple.com/at/podcast/the-lancet-voice/id1499803146?ign-mpt=uo%3D2

Cynthia Delgado of Nephrology was named to serve as chair of the American Society of Nephrology Diversity and Inclusion Com-

mittee and co-chair the National Kidney Foundation (NKF)-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kid-

ney Diseases.

David Rapko of GIM was awarded the UCSF Family and Community Medicine Excellence in Student Teaching Award by graduat-

ing medical students.

Denise Davis of GIM was named DGIM Poet Laureate in the UCSF DOM poetry competition! (see page 14)

Geoff Stetson of Hospital Medicine along with fellow med-ed scholar at Emory teamed up to create A Twitter Teaching Partner-

ship - #MedEdTwagTeam. They deliver weekly faculty development on Twitter. The last 8 posts have focused on teaching in the

online environment and have been viewed tens of thousands of times.

James Frank of Pulm/CC received the UCSF GME Innovation and Excellence Award for his work as program director of the pul-

monary and critical care fellowship

Lianne Gensler of Rheumatology, Lowell Lo of Neprhology and Judith Wisneski of Cardiology were named 2020 UCSF De-

partment of Medicine Master Clinicians . Three of five awardees were from the SFVA!

Daniel Calabrese of Pulm/CC and Scott Bauer of GIM were selected as inaugural Grunfeld Scholars (Carl’s Junior Award). This

new initiative invests in early-career clinician-scientists to grow the pipeline of future leaders in research.

Daniel Calabrese also welcomed a beautiful baby boy, Russell Lucca Calabrese born July 18 weighing 6 lbs 14 ounces. Congratu-

lations!

Robin Goldman of Hospital Medicine was selected for the UCSF Teaching Scholars Program 2020-2021

Jacob Berchuck of PRIME IM residency (who worked with Hem/Onc at SFVA and is now a fellow at Da-

na Farber) was interviewed for NCI blog on his project (publication with Dr. Sunny Wang included under ‘I

Read It Somewhere’) https://www.cancer.gov/news-events/cancer-currents-blog/2020/lung-cancer-

treating-mental-health-longer-survival

Maren Scheuner of Genetics was recently named Co-chair of the national Clinical Genetics subcommittee

that was assembled to advise the VA Genomic Medicine Program Advisory Committee on issues pertaining to

germline genetic testing for precision oncology patients in the VHA.

Phyllis Tien of ID received a letter of commendation from Dr. Anthony Fauci for serving on the National

Institute of Health COVID-19 Treatment Guidelines Panel. https://www.covid19treatmentguidelines.nih.gov/

Dr. Theresa Cheng of GIM just completed a 6 year stint of service to the American Board of Internal Medicine—Internal Medicine

Board Exam Committee. She wrote several questions you may see on the boards exam, including one vignette featuring a veteran!

4

CONGRATULATIONS TO ALL! Please continue to send us your super-human, amazing, and noteworthy accomplishments

Russell Lucca

Calabrese

EVER WONDER … ? SFVA & OTHER MYSTERIES

Who was Miley?

Why did building 41 get built before building 40? And how did they arrive at

a naming convention for the seemingly random-numbered campus buildings?

Is there any water in the water tower? What is it used for? Should we fill it

with hand sanitizer?

What compels any human being to throw a

mask on the ground? (same question for gloves)

For all the COVID delays on construction, there sure is a lot of construction going on…?

In 1919, what was criteria for an effective mask? Was fashion ever a consideration?

How so many highly accomplished & kind faculty miraculously gathered on the campus

atop a cliff above Lands End that calls itself Fort Miley?

John Greenland of Pulm/CC received his VA Merit Award for his project, Accelerated Aging as a

Cause of Chronic Lung Allograft Dysfunction.

Ashwin Kotwal of Geriatrics received Hellman Family Award for Early Career Faculty (research on

loneliness & social isolation in older adults with dementia)

Michelle Estrella of Nephrology & Mike Shlipak of GIM were awarded funding for HSR&D for their

research program CKD CASCADE OF CARE (C3) INITIATIVE PHASE 1

Anthony Baker received fundable score for NHBLI grant Multiscale computational modeling of RV

failure

Anne Schafer of Endo/Metab will receive NIDDK funding for RO1 Skeletal Health in DM1 and role of diabetic kidney disease

Ashwin Kotwal of Geriatrics was awarded the 2020 AGS Health in Aging Foundation New Investigator Award

Dr Mehrdad Arjomandi of Pulm/CC and OEM received notification of probable funding for CSRD grant entitled Modulation of

COVID-19 by Smoking: The Basis for a Clinical Trial.

Li-Wen Huang of Heme/Onc was awarded the UCSF Pepper Center Research Education Core (REC) Scholar award for her re-

search in aging and hematologic malignancies

Maren Scheuner of Genetics (Heme/Onc) received the following awards/grants:

1) VAHSRD SDR grant for WISDOM for VA: A study to optimize passive recruitment efforts into the WISDOM study, a national breast ca screening study.

2) VA QUERI supplement grant for a study on the assessment of clinician preparedness to integrate germline genetic testing into preci-sion oncology practice (Maren Scheuner supplement PI, Mary Whooley VA QUERI PI).

3) Extension/modification for her VA HSRD IIR: Precision Medicine Care Coordination in the VHA.

Phyllis Tien of ID had her K24 renewed for another 5 years by the National Institute of Allergy and Infectious Disease. Her project

is entitled HIV, HCV and Gender Effects on Liver, Bone, and Vascular Health.

Katie Sarmiento of Pulm was awarded a four-year ~$700k VA grant for her project Improving Access to Sleep Apnea Care: a

pragmatic study of new consultation models.

SHOW ME THE MONEY

5

https://www.puzzles.ca/word-search

THIS PHOTO DEPICTS…

A. Smooth sailing

ahead

B. Attempt at de-

creasing property

taxes with house-

boat status

C. Complete aban-

don with respect to

balance of proper-

ty damage vs. en-

tertainment

D. Futility

E. Belief

6

DEEP SPACE THOUGHTS

TRIGGER WARNING: RIDICULOUS JOKES AND NONSENSE

“...we are practicing judicious use of jokes...to preserve critical humor supplies” Sublime to ridiculous

REOPEN ROULETTE: WHAT SHALL WE OPEN FIRST THIS TIME ?

When one part of an organization is suffering,

what better means of mitigating damage than

to poach from another well-functioning part?

Staff may choose to capitalize on exciting de-

tail opportunities, spurring on the next vacan-

cy in their current position. A practice that

resembles robbing Peter to pay Paul and domi-

noes simultaneously, the ‘detail’ process has

created great excitement this year. Take your

pick—quick before they’re gone!

Deputy Chief of Something Else

CDC Director (Center for Disillusionment

and Chaos)

Instructor, Disruptive Behavior 7: End

Game (tasers, takedowns & tie-ups)

PODUS (PPE Officer to Deem Us Safe)

Associate Chief of Blame

Associate Deputy Director Vice Chief Person

THE TOP 5 DETAILS ...YOU

DON’T WANT TO MISS

How much space may a space survey

survey if a space survey may survey

space?

If an office is unoccupied and no one is

around to see it, is it really empty?

8th Grade Common Core Math: If you

have 3 faculty who are teleworking 3 days

a week each and they formerly shared

one office at the hospital...how many

offices will it take to socially distance on

days they are on site? PART B. If you

hire an additional 0.5 FTE who teleworks

one day a week two months from now—

based on current projections of COVID-

19 prevalence balanced by PPE supply

pipelines...how big will each office need

to be?

A Med Center wide musical chairs

event will supplant all space committee

requests. Code Blue announcements will

be suspended while faculty roam hall-

ways waiting to pounce on available offic-

es, clinics, and research space when the

music stops. With few mechanisms to

otherwise provide adequate social dis-

tance in the current footprint, a survival

of the fittest model has been adopted.

Set list includes:

‘Never Gonna Give You Up’ Rick Astley

‘You Belong to Me’ Carly Simon

‘Harder to Breathe’ Maroon 5

‘Jump’ Van Halen

Hair Salons

Dog Parks

Schools

Liquor stores

Indoor dining

Bars

Hospitals

Museums

Malls

Basketball stadiums

Sock Boutique

Medical clinics

Gyms

Life saving surgeries

National Parks

Wineries

Six Flags

Churches

Disney World

Sutro Baths

Car dealerships

Cemeteries

Mini golf

Bars

FAMILIAR FUNNIES? FORGIVE US

Seen some of these cartoons before? Remarkably recognizable punchlines? Feeling like a

character in the movie Groundhog Day? Though supplies are vast, your observations are

accurate. We are practicing judicious use of jokes in these unprecedented times. Reuse and

recycling of witticisms during COVID have been employed to preserve critical humor supplies.

Rest assured, your happiness is of utmost importance and your laughter our number one pri-

ority during this crisis. Each joke has been carefully decontaminated through both UV light

and hydrogen peroxide treatments (with a spritz of 70% isopropyl alcohol for good measure—

which may make some jokes sting)

We cannot guarantee the integrity or hilarity of each joke following multiple decon—reuse

cycles, but assure you the alternative is quite grim.

SPACE RECOVERY PLAN

VOTE BY MAIL or tweet @SF_DPH

This time we’ll listen

Local city authorities have decided to give up on previous approach of flattening the COVID curve...and recently adopted a strategy

more realistic in current COVID climate. Bending to pressure from virus protesters decrying “Gaussian is gauche! Flattening of

curves is like an old dance move!” public health officials have acquiesced and announced new campaign...Happiness is Hyperbolic!

Exponential Excitement! Updates on signage with current slogans are ongoing. y=ex

TRIGGER WARNING: RIDICULOUS JOKES AND NONSENSE

During the flu pandemic of 1918, our fair city had one of the strictest mask policies in

the country and worldwide. Even then, masks represented a cultural divide through-

out the country….and elicited venomous defiance! And free admission!

https://untappedcities.com/2020/07/15/the-anti-mask-league-of-1919-the-cultural-battle-of-an-

enduring-pandemic/

7

ABANDON THE CURVE

HISTORY REPEATS ...PREDICTABLE HUMAN RESISTANCE?

January 25th, 1919, The San Francisco Chronicle. San Francisco, 1918

The SURGE-REPOPENING Pendulum ...where are we now?

SCRATCH THAT PLAN EIGHT WEEKS IN THE MAKING

We set out for India at the end of February before COVID took hold and returned March 13, just as the Bay Area moved to shelter-in-place. We watched that from a distance, but were still focused on the beauty and contrasts of India. (For those who don’t know, in the last two decades I have traveled to many distant lands.)

When Columbus set out for India, it was likely the richest country in the world. No, it was not because of the spices, although that was an-other reason. The jewels and precious metals were staggering, although some of the great ones (e.g., The Peacock Throne) were later plun-

dered. Yet, today more than 360 Million people live in poverty in India.

In the parts of India that we went to, there were multiple castles and forts from that earli-er era which retain their beauty. We saw: Jaipur, the Pink City, with its Amber Fort Pal-ace of the Winds and City Palace. Udaipur with its marble palaces on the Lake and its City Palace. Jodhpur, the Blue City, with its massive Mehranargh Fort. These are the result of the great Mughal Empire, which was Muslim. Yet, we were there at a time of rising Hindu nationalism, even among the guides. We would have had a different reaction four years ago, but what was said by them rang chillingly given what our own leadership has said.

The most magnificent building is of course the Taj Mahal, a tomb in memory of the wife of a Mughal Em-peror. My wife and I found it to be the most beautiful building we had seen in the world. As magnificent as the pho-tographs are, they cannot capture what you feel when you see it. Yet, the many beautiful tombs are in a country whose majority believes in religious cremation. The tombs and mosques feature non-representational art, while the Hindu temples are so adorned with images of their gods you could spend a day at each and not see all the beauty.

Despite the intensely packed cites, there is the outdoors. The Thar dessert, which ends at the Jaisalmer Fort of the Golden City, was a key part of the Silk Route. India has mag-nificent birds and of course tigers. The nature preserves, were the 19th and early 20th century Raj’s hunting reserves, but are now open to the public.

In modern India the colors remain rich. It is most obvious in the clothes. Moving through the bazaars is a visual treat, albeit saturating at times. But we also were there during the Holi Festival, when friends, families and communities celebrate by throwing colored powders on each other (yes, the United safety instruction film is true).

The food is of a much more complex flavor than we usually get here. We brought home spices from a family store deep in the market of Jodhpur.

Finally, a word about COVID. While we were there, the first three cases were reported far to the south of where we were and linked to Italian tourists. In the middle of dinner that night, the waiters disappeared. They returned wearing masks and gloves. From then on many, but not all, tourist areas had precau-tions. Signs appeared saying if you had symptoms, you were not allowed in. Your temperature was taken by infrared thermometer before entering attractions and hotels. In one town, we were even required to wear masks. How they rolled that out so fast was mind-boggling and

in stark contrast to the lack of masks when we returned here. Yet, as we know, COVID had already spread there too and they do not have the re-sources to provide for 1.3 billion people. As I write this, they are 3rd in the world with more than 2 million known cases and 5th with more than 42,000

deaths. May we continue to learn from each other ∞

Taj Mahal. Carl and Gay Grunfeld living on the

edge...arriving in India March 2, returning to US on

March 13, 2020

GETTING AWAY ...WITH CARL GRUNFELD

Unexpected complimentary medical evaluation for Carl on vacation,

who is perplexed why they are not also checking TFTs

ANNA’S FAVORITE EDUCATIONAL TED TALKS

https://www.ted.com/talks

sir_ken_robinson_do_schools_kill_creativity?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare Do schools kill creativity?

https://youtu.be/h11u3vtcpaY Hackschooling makes me happy

https://youtu.be/oyWA3p4aVHM 5 dangerous things schools should do

https://youtu.be/zuoPZkFcLVs Rethinking challenging kids

https://youtu.be/BnC6IABJXOI Toxic culture of education

https://youtu.be/2Yt6raj-S1M School makes kids less intelligent

https://youtu.be/3E7hkPZ-HTk Quit social media

8

Celebrating Holi!

into good colleges, though many do so to meet the requirements set for them by someone else. The goal for homeschooling is to allow kids to learn who they are; find out their interests, strengths, goals, dreams, unicorn abilities; make many mistakes and learn from them free from shame and fear of failure in the eyes of others. In short, the goal of school is to train for a future job; the goal of education is to learn how to learn. I’m including links to my favorite thinkers on education and role of technology in education at the end.

I mention this before mentioning curriculums, apps, subject resources, and basic survival through each day, because we basically make

everything else up as we go to meet the goals of education. Our kids are now 9, 7, and 3, and are all very different types of learners. While

our eldest and youngest stayed home last year, our middle child chose to stay at school, so we had both a point of comparison for our rela-

tionships, behaviors, independence, academic progress, and the onset of “Zoom-life” in the past year.

The “HOW” of homeschooling:

In California, there are 3 options for legally homeschooling: joining a private or public school’s independent study program (a great op-

tion if offered during this time); filling out an affidavit certifying your home as a private school; or enrolling in a homeschool charter

school. Information for all three can be found here: https://www.cde.ca.gov/sp/ps/homeschool.asp. We chose the charter school option

as a new homeschool family to have some curriculum advice from a teacher and access to a small pool of funds which are otherwise not

accessible in the private school scenario. We borrow textbooks, order engineering kits, science experiments, and have access to many

online resources if we so choose. The extra “overhead” is check-ins every 6 – 12 weeks and 3 standardized tests per year.

There are limitless options for curricula both online, via apps and podcasts – or go com-

pletely screen-and-device-free. There are many local, regional, national and even physi-

cian homeschooling groups who discuss the options in detail.

Neither my husband nor I had ever been homeschooled or considered homeschooling as

part of our life plan. We do not have education backgrounds or degrees above what

many of you have, we both work full time but were equally committed to making things

work. For purposes of explaining the how, we split our schedules evenly and work op-

posite schedules on a 7-day model, mostly keeping 1 meal of the day as family time.

Regardless of the day of the week or time, at least one of us is usually working.

We parents have different interests and strengths, but share basic structure. The two

readers have daily writing, math, and some sort of targeted educational reading daily.

Then we involve the kids into all house projects, meal planning, gardening, cleaning,

and cooking which need to happen every day. We continuously ask them questions, put

things into context, relate their learning to daily tasks, and look things up together. We

make many things from scratch and typically do all of our household chores ourselves,

which means the kids are pitting plums, baking bread, weeding, folding laundry, making

their own toys, sewing masks, refinishing furniture alongside us as we all learn Pimsleur

Spanish, or a sibling struggles through long division and a spelling test. The premise is

with strong reading, writing, and math knowledge, kids can learn anything on their own.

The “WHY” of homeschooling?

We recognize that most would not choose to even consider homeschooling outside of the

pandemic-induced school disruption, but after our own nail-biting start, we quietly hope

the kids never want to go back.

Relationships: In traditional work/school model, kids and parents spend most of their

time and best energy away from each other, come back to rush through the business of

life, chores and eating and repeat daily. Homeschooling brings the family together as time is no longer limited. If one parent has to work,

the kids are still able to bond together or with the other parent. The kids see us struggle through work, life-balancing, and occasionally

losing our cool. None of us are perfect, but the extra time together allows for more reparations and relationship building.

Academic rigor: US students are generally scoring progressively lower on math, reading and science over the past two decades, and score

in the middle of the pack as compared to other nations. California schools, which rank 37th in the US 1, are limited by “common core” cur-

riculum and generally teach to the average student. At least 30% of kids perform above grade level 2, conversely another 15% scores sig-

nificantly below grade level and are unlikely to catch up. Unlike school, homeschooled kids are given materials and encouragement to

advance per their ability, spending as much time as necessary to master the basics or fully investigate a topic. Most homeschool students

outscore public school and religious school students on college entrance exams, regardless of their parent’s education level, race, or eco-

nomic status 3,4.

Learning time, homework and busywork: Children who are doing well in the K-6 environment do not appear to benefit from homework5,

instead they view their assignments as obstacles to overcome. Children who are struggling with a topic need different approaches, real life

applications, reasons why the topic is of interest or of use to them, and a way to go at a slower pace without feeling shame. Our home-

school rule of thumb is “30 minutes of school per grade per day,” and no homework. So for example: 5th grader should do about 2 ½

hours of school per day; a 12th grader should do 6 hours; a 1st grader needs 30 minutes and then a lot of time to play.

Control over content, quality, and screen-time: Ironically enough, while I’m encouraging VVC use at work, I’m also minimizing screens

for my family at home. We do virtually no screen-based learning, apps or videos. Instead the kids are expected to learn from textbooks,

workbooks, a physical encyclopedia, pleasure reading, and by life experiences. The vast majority of the day is committed to art, music,

dancing, sewing, cooking, gardening, breaking and fixing things, puppet making, foraging in the neighborhood, making jams, hiking, bik-

ing, using various tools, playing cards, bird watching, and pretending. Our kids are now both testing at least 1 grade level ahead in most

subjects despite their seemingly whimsical lifestyle.

HOMESCHOOLING...continued from front page By Anna Abramson

Anna with her husband Mark and very dirty post-hike

girls (from left to right) Marion, Eve, and Frances.

9 ...continued on next page

10

D E

F

HOMESCHOOLING...continued

“Instructional Technology” benefits the corporations that sell them: We were shocked when we started reading the “Terms of Service” and

“Privacy Policy” documents for some of the school-mandated apps and learning platforms. These 4,000+ word legal documents 6,7 are de-

signed to allow the monetization of the data that is harvested from a child. Each child is uniquely identified and followed through their

schooling experiences. Their progress in the apps is sold and exchanged, and may be available to companies awaiting their application for

college loans. During Covid-19, there appear to be few options outside of screens and apps in a public-school setting for those who prefer

to limit technology use and value their children’s privacy.

Special needs learners and self-esteem: For us, committing to homeschooling appeared easier than going through the process of obtaining

an IEP (Individualized Education Plan). No child is created from a mold, but our school district expects kids to fit into its “District Learner

Profile”8. Not fitting the profile can make parents and children feel like failures. Some families seek out private schools, but kids with spe-

cial needs are sometimes neither welcomed nor adequately served even in private school setting. Frustration with school work, social situ-

ations and expectations can result in more difficulty in the household. While the special needs may always remain, often the home-based

education setting removes some of the stressors and allows for the child to rebuild self-esteem, then curiosity, and then mastery of academ-

ic material.

Independence from school: Balancing “pre-Covid-19 life”

with 3 different kid schedules with school, activities and

family time on a daily, weekly, monthly basis was really

hard. Add to that early school let-outs, vacations, school

parties and the endless stream of e-mails from school was

overwhelming during normal times. Once the pandemic

hit, the amount of time and energy to keep up with distance

learning for just one kid became alarming. We had to en-

sure equipment was available, functioned, was not needed

by anyone else, at the right volume, and on the right screen.

This quickly exceeded the amount of work required to teach

any of the topics entirely in a home school setting. Teach-

ers expected students to constantly “Zoom-in”. Additional-

ly, freedom from school means freedom from the school

calendar. The kids can take field trips around the neighbor-

hood whenever you’re available; and eventually travel

whenever the parent schedules allow unencumbered by

weekends, “ski week” or typical holiday vacation times.

Child development and social skills: Last but not least,

children are naturally very curious and social. School is

designed around the expectation that children will stay still, be quiet, and move through the day as they are instructed to do. This is neces-

sary for orderly schoolwork, but is unlikely to foster creativity, individuality, and independence which are increasingly valued in many work

places. A child who does not have an inclination to sit down or stay quiet is frequently admonished for these behaviors. A child who asks

many questions or takes too long working on one topic drags down the pace of the class and is not able to fully engage with their topics of

interest. Despite the question of “socialization” being at the core of many arguments against homeschooling and perhaps a great fear posed

by the pandemic, homeschooled children are well adjusted 9,10 and are more likely than traditionally schooled peers to go to college 11, ob-

tain a professional degree 12, and report happiness in chosen fields and relationships 13. At home, kids are encouraged to spend as much

time as they need to on each topic for mastery, work independently, develop their hobbies, teach and care for younger siblings, share in

household duties, and gain a sense of pride that comes with autonomy. Homeschool families are also more likely than peers to do commu-

nity service 14 and participate in activities with people of different ages, further contributing to socially competent teenagers and adults.

While I recognize despite many possible advantages of homeschooling, most families would not pursue this option outside of a pandemic.

If you are interested in hearing more about homeschooling, partial homeschooling, working around special needs, or want my honest ad-

vice on pods, please e-mail, skype, or call me. For a tool man’s perspective on homeschooling a gaggle of girls, my husband and proof-

reader is equally happy to give his version ∞

Anna’s Fun List of To-Do’s for every family

Encourage everyone in the family to rotate car seat positions.

Encourage everyone in the family to sit in different living room spots.

On hikes and walks point out different kinds of trees, businesses, cars, houses, gardens.

Allow your child to make tents, sleep outside, take over a part of the yard.

Keep a vast supply of art materials, minimally monitor how these are used.

Allow your ceilings and walls to be constantly redecorated, but ensure only blue painter’s

tape is available for kid use.

Amass large number of Legos, building tools, popsicle sticks, egg cartons, cardboard

boxes; don’t monitor consumption (although do not eat Lego).

Take kids into your business where they can see how things are made, produced, created.

What books do they gravitate towards? Why? Read them and talk about them.

Make up stories, have the kids finish them.

Use phrases like: I wonder what’s up there? I wonder where that road leads? I wonder if

it’s going to rain? I wonder how this story will end? Then encourage guessing.

Make eggs five different ways and find out who likes which? Teach kids to make them.

Have your child develop a set of questions to ask people in the community.

1 https://www.usnews.com/news/best-states/rankings/education 2 Johns Hopkins School of Education, Institute for Education Policy, Large Percentages of American Students Perform Above Grade Level, August 16, 2016 (https://edpolicy.education.jhu.edu/how-can-so-many-students-be-invisible-large-percentages-of-american-students-perform-above-grade-level) 3 https://responsiblehomeschooling.org/research/summaries/homeschool-demographics/ 4 https://a2zhomeschooling.com/teens/act_test_results_homeschoolers/ 5 Review of Educational Research, Does Homework Improve Academic Achievement? A Synthesis of Research 1987–2003, Cooper, Robinson, Patall, March 1, 2006 (https://journals.sagepub.com/doi/abs/10.3102/00346543076001001) 6 https://lazcommunity.force.com/knowledgebase/s/article/Privacy 7 https://lazcommunity.force.com/knowledgebase/s/article/Terms-of-Service 8 https://www.mvschools.org/Page/6062 9 A Sense of Self: Listening to Homeschooled Adolescent Girls. Susannah Sheffer, 1995. 10 Homeschooling and the question of socialization revisited, Richard G. Medlin, 2013, Peabody Journal of Education, 88(3), 284-297 11 Homeschoolers on to College: What Research Shows Us, by Brian D. Ray, Journal of College Admission, 2004, No. 185, 5-11 12 Home Educated and Now Adults: Their Community and Civic Involvement, Views About Homeschooling, and Other Traits, Brian D. Ray, 2004. 13 Homeschooling associated with beneficial learner and societal outcomes but educators do not promote it, Brian D. Ray, 2013, Peabody Journal of Education, 88(3), 324-341 14 Home Educated and Now Adults: Their Community and Civic Involvement, Views About Homeschooling, and Other Traits, Brian D. Ray, 2004.

WHAT I DID ON MY STILL SHELTERING-IN-PLACE WORKCATION

11

Dr. Scott Bauer of GIM. 1) Bauer SR, Breyer BN, Oni-Orisan A, Steinman MA, Sim I, McCulloch CE, Kenfield SA. “PERSONAL: feasibility study protocol for placebo-controlled, randomized n-of-1 trials of tamsulosin for lower urinary tract symptoms.” Front Digit Health. 2020, in press.

2) Bauer SR, Scherzer R, Suskind AM, Cawthon P, Ensrud KE, Ricke WA, Covinsky KE, Marshall LM, for the Osteoporotic Fractures in Men (MrOS) Research Group. “Co-Occurrence of Lower Urinary Tract Symptoms and Frailty among Community-Dwelling Older Men.” J Am Geriatr Soc. 2020, in press.

3) Bauer SR, Scherzer R, Zhao S, Breyer BN, Kenfield SA, Shlipak M, Marshall LM, for the Osteoporotic Fractures in Men (MrOS) Research Group. “Association of Lower Urinary Tract Symptom Severity with Kidney Function among Community-Dwelling Older Men.” J Urol. 2020, in press.

Dr. Steve Bent of GIM. Bent S, Wahlberg J, Chen Y, Widjaja F, McDonald MG, Hendren RL. Quality of Life Among School-Age Children With Autism: The Oak Hill School Outcomes Study. Semin Pediatr Neurol. 2020 Jul;34:100808.

Dr. Paul Blanc of OEM 42: Garshick E, Blanc PD. Military Deployment and Respiratory Symptoms: Some Answers, Many Ques-tions. Chest. 2020 Jun;157(6):1407-1408.

Dr. Calvin Chou of GIM. Chou CL How COVID-19 Disrupts—and Enhances—My Clinical Work. Journal of Patient Experience. April 8 2020. https://doi.org/10.1177/2374373520918739

Dr. Beth Cohen of GIM 1) Ahmadian AJ, Lin JE, Neylan TC, Woolley JD, O'Donovan A, Cohen BE. Social integration and inflam-mation in individuals with and without posttraumatic stress disorder. Brain Behav Immun. 2020 Jun 11:S0889-1591(19)31325-X.

2) Azcarate PM, Zhang AJ, Keyhani S, Steigerwald S, Ishida JH, Cohen BE. Medical Reasons for Marijuana Use, Forms of Use, and Patient Perception of Physician Attitudes Among the US Population. J Gen Intern Med. 2020 Jul;35(7):1979-1986.

3)Scherrer JF, Salas J, Schneider FD, Friedman MJ, van den Berk-Clark C, Chard KM, Norman SB, Lustman PJ, Tuerk P, Schnurr PP, Cohen BE. PTSD improvement and incident cardiovascular disease in more than 1000 veterans. J Psychosom Res. 2020 Jul;134:110128

Dr. Ken Covinsky of Geriatrics. Portacolone E, Halpern J, Luxenberg J, Harrison KL, Covinsky KE. Ethical Issues Raised by the Introduction of Artificial Companions to Older Adults with Cognitive Impairment: A Call for Interdisciplinary Collaborations. J Alz-heimers Dis. 2020 Mar 30.

Dr. Denise Davis of GIM 1) Davis DL. Dare to Look. Acad Med. 2020 Jul 14.

2) COVID-19 Quick Tips to Connect: http://www.achonline.org/COVID-19/Quick-Tips

3) Rubinelli S, Myers K, Rosenbaum M, Davis D. Implications of the current COVID-19 pandemic for communication in healthcare. Patient Educ Couns. 2020. 103(6):1067-1069.

4) Cordero DM and Davis D. Communication for Equity in the Service of Patient Experience: Health Justice and the COVID-19 Pandemic. J Patient Exp. June 2020 https://doi.org/10.1177/2374373520933110

Dr. Gurpreet Dhaliwal of GIM. 1) Dhaliwal G. The Greatest Generation. JAMA. 2020 May 5;323(17):1696-1697.

2) Rendon P, Roesch J, Dhaliwal G. The Writing on the Wall: An Exercise in Clinical Reasoning. J Gen Intern Med. 2020 May 29.

Dr. Sanket Dhruva of Cardiology Dhruva SS, Ross JS, Akar JG, Caldwell B, Childers K, Chow W, Ciaccio L, Coplan P, Dong J, Dykhoff HJ, Johnston S, Kellogg T, Long C, Noseworthy PA, Roberts K, Saha A, Yoo A, Shah ND. Aggregating multiple real-world data sources using a patient-centered health-data-sharing platform. NPJ Digit Med. 2020 Apr 20;3:60.

Dr. Michelle Estrella of Nephrology Tummalapalli SL, Vittinghoff E, Crews DC, Cushman M, Gutiérrez OM, Judd SE, Kramer HJ, Peralta CA, Tuot DS, Shlipak MG, Estrella MM. Chronic Kidney Disease Awareness and Longitudinal Health Outcomes: Results from the REasons for Geographic And Racial Differences in Stroke Study. Am J Nephrol. 2020;51(6):463-472.

I READ IT SOMEWHERE…. NEW PUBLICATIONS

...continued on next page

Can’t keep a good man down! Dr. Chris Sha sweeps his

masked bride Sarah off her feet for a marginally-distanced

post-nuptials smooch. CONGRATULATIONS! June 2020

Dr. Scott Bauer does his best impression of Ansel Adams with fancy photo of him,

his wife and their dog. Nice career opportunity when you’re done researching!

12

Dr. Kenneth Feingold of Endo/Metab 1) Feingold KR. Oral and Injectable (Non-Insulin) Pharmacological Agents for

Type 2 Diabetes. 2020 Jul 12. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, Hershman JM, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Perreault L, Purnell J, Rebar R, Singer F, TrenceDL, Vinik A, Wilson DP, edi-tors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905364.

2) Feingold KR. Approach to the Patient with Dyslipidemia. 2020 May 11. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, Hershman JM, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Perreault L, Purnell J, Rebar R, Singer F, Trence DL, Vinik A, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID:

3) Feingold KR, Brinton EA, Grunfeld C. The Effect of Endocrine Disorders on Lipids and Lipoproteins. 2020 Mar 9. In: Feingold KR, Ana-walt B, Boyce A,Chrousos G, Dungan K, Grossman A, Hershman JM, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Perreault L, Purnell J, Rebar R, Singer F, Trence DL, Vinik A, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–.

4_ Feingold KR. Cholesterol Lowering Drugs. 2020 Mar 29. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, Hershman JM, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Perreault L, Purnell J, Rebar R, Singer F, Trence DL, Vinik A, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–.

5) Feingold KR. Triglyceride Lowering Drugs. 2020 Apr 17. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, Hershman JM, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Perreault L, Purnell J, Rebar R, Singer F, Trence DL, Vinik A, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 28402615.

Dr Lynn Flint & Dr. Ashwin Kotwal of Geriatrics Flint L, Kotwal A. The New Normal: Key Considerations for Effective Serious Illness Communication Over Video or Telephone During the Coronavirus Disease 2019 (COVID-19) Pandemic. Ann Intern Med. 2020 May 14:M20-1982. doi: 10.7326/M20-1982. Epub ahead of print.

Dr. Lianne Gensler of Rheumatology. 1) Liew JW, Reveille JD, Castillo M, Sawhney H, Naovarat BS, Heckbert SR, Gensler LS. Cardio-vascular risk scores in axial spondyloarthritis versus the general population: A cross-sectional study. J Rheumatol. 2020 Jul 1:jrheum.200188.

2) Liew JW, Huang IJ, Louden DN, Singh N, Gensler LS. Association of body mass index on disease activity in axial spondyloarthritis: sys-tematic review and meta-analysis. RMD Open. 2020 May;6(1):e001225.

3) Landewé RB, van der Heijde D, Dougados M, Baraliakos X, Van den Bosch FE, Gaffney K, Bauer L, Hoepken B, Davies OR, de Peyrecave N, Thomas K, Gensler LS. Maintenance of clinical remission in early axial spondyloarthritis following certolizumab pegol dose reduction. Ann Rheum Dis. 2020 Jul;79(7):920-928.

4) Landewé R, van der Heijde D, Dougados M, Baraliakos X, Van den Bosch F, Gaffney K, Bauer L, Hoepken B, de Peyrecave N, Thomas K, Gensler LS. Induction of Sustained Clinical Remission in Early Axial Spondyloarthritis Following Certolizumab Pegol Treatment: 48-Week Outcomes from C-OPTIMISE. Rheumatol Ther. 2020 Jun 11. doi: 10.1007/s40744-020-00214-7. Epub ahead of print.

Dr. Sam Goldman of OEM Akbilgic O, Kamaleswaran R, Mohammed A, Ross GW, Masaki K, Petrovitch H, Tanner CM, Davis RL, Gold-man SM. Electrocardiographic changes predate Parkinson's disease onset. Sci Rep. 2020 Jul 9;10(1):11319.

Dr. John Greenland of Pulm/CC Greenland JR, Michelow MD, Wang L, London MJ. COVID-19 Infection: Perioperative Implications: Reply. Anesthesiology. 2020 Jun 24.

Dr. Tonya Kaltenbach of GI Holmes I, Ha NB, Peng Y, Kaltenbach T. A Dermoid Cyst Presenting as a Hypoechoic Pancreatic Mass. Am J Gastroenterol. 2020 May 22.

Dr. Karla Kerlikowski of GIM Sprague BL, Miglioretti DL, Lee CI, Perry H, Tosteson AAN, Kerlikowske K. New mammography screen-ing performance metrics based on the entire screening episode. Cancer. 2020 Jul 15;126(14):3289-3296

Dr. Salomeh Keyhani of GIM. Keyhani S, Cheng EM, Hoggatt KJ, Austin PC, Madden E, Hebert PL, Halm EA, Naseri A, Johanning JM, Mowery D, Chapman WW, Bravata DM. Comparative Effectiveness of Carotid Endarterectomy vs Initial Medical Therapy in Patients With Asymptomatic Carotid Stenosis. JAMA Neurol. 2020 Jun 1:e201427.

Tummalapalli SL, Keyhani S. Trends in Preventative Health Services for Veterans with Military Coverage Compared to Non-Military Cov-erage. J Gen Intern Med. 2020 Apr;35(4):1330-1333.

Dr. Chris Lau of Cardiology. Kido T, Tabatabai ZL, Chen X, Lau YC. Potential dual functional roles of the Y-linked RBMY in hepatocar-cinogenesis. Cancer Sci. 2020 May 30.

Dr. Tracy Minichiello of Heme/Onc Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, Dager WE, Deitelzweig SB, Ellsworth S, Garcia D, Kaatz S, Minichiello T. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clini-cal guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020 Jul;50(1):72-81.

Dr. Jennifer Mulliken of ID Ward LM, Peluso MJ, Budak JZ, Elicker BM, Chin-Hong PV, Lampiris H, Mulliken JS. Opportunistic coin-fection with Pneumocystis jirovecii and Coccidioides immitis associated with idelalisib treatment in a patient with chronic lymphocytic leukaemia. BMJ Case Rep. 2020 Apr 29;13(4):e234113.

Dr. Meg Pearson of GIM Pearson M, Barker AM, Battistone MJ, Bent S, Odden K, O'Brien B. Implementing an established musculo-skeletal educational curriculum in a new context: a study of effectiveness and feasibility. Med Educ Online. 2020 Dec;25(1):1760466.

Dr. Carmen Peralta of Neprhology Peralta CA, Livaudais-Toman J, Stebbins M, Lo L, Robinson A, Pathak S, Scherzer R, Karliner LS. Electronic Decision Support for Management of CKD in Primary Care: A Pragmatic Randomized Trial. Am J Kidney Dis. 2020 Jun23:S0272-6386(20)30754-X.

Dr. Gabriela Schmajuk of Rheumatology Liu LH, Garrett SB, Li J, Ragouzeos D, Berrean B, Dohan D, Katz PP, Barton JL, Yazdany J, Schmajuk G. Patient and clinician perspectives on a patient- facing dashboard that visualizes patient reported outcomes in rheumatoid arthritis. Health Expect. 2020 Apr 9.

Dr. Nelson Schiller of Cardiology Thadani SR, Shaw RE, Fang Q, Whooley MA, Schiller NB. Left Atrial End-Diastolic Volume Index as a Predictor of Cardiovascular Outcomes: The Heart and Soul Study. Circ Cardiovasc Imaging. 2020 Apr;13(4):e009746.

Dr. Amandeep Shergill and Dr. Roy Soetikno of GI Soetikno R, Teoh AYB, Kaltenbach T, Lau JYW, Asokkumar R, Cabral Prodigali-

dad P, Shergill A. Considerations in performing endoscopy during the COVID-19 pandemic. Gastrointest Endosc. 2020 Jul;92(1):176-183.

Dr. Dolores Shoback of Endo/Metab 1) Clarke BL, Shoback DM. A bridge too far? Attempting to bridge the treatment gap in osteopo-rosis. Endocrine. 2020 May 21.

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I READ IT SOMEWHERE….CONTINUED

2) Shoback D, Rosen CJ, Black DM, Cheung AM, Murad MH, Eastell R. Pharmacological Management of Osteoporosis in Postmeno-pausal Women: An Endocrine Society Guideline Update. J Clin Endocrinol Metab. 2020 Mar 1;105(3):dgaa048.

Dr. Kendrick Shunk of Cardiology Yeo KK, Azarbal F, Zakroysky P, Dai D, Roe M, Wojdyla D, Low R, Shunk K. Differential Longitu-dinal Outcomes Following Percutaneous Coronary Intervention to the Left Internal Mammary Artery and Other Bypass Grafts of the LAD: Findings From the NCDR. J Invasive Cardiol. 2020 Jun;32(6):E143-E150.

Dr. Alex Smith and Dr. Ashwin Kotwal of Geriatrics 1) Kotwal AA, Lee SJ, Dale W, Boscardin WJ, Waite LJ, Smith AK. Integra-tion of an Objective Cognitive Assessment Into a Prognostic Index for 5-Year Mortality Prediction. J Am Geriatr Soc. 2020 May 1.

2) Block BL, Jeon SY, Sudore RL, Matthay MA, Boscardin WJ, Smith AK. Patterns and Trends in Advance Care Planning Among Older Adults Who Received Intensive Care at the End of Life. JAMA Intern Med. 2020 Mar 2;180(5):786–9.

Dr. Roy Soetikno of GI 1) Nguyen-Vu T, Malvar C, Chin YK, Kaltenbach T, Liu A, Myint T, Asokkumar R, Shergill A, Soetikno R. Simulation-based mastery learning (SBML) for rapid acquisition of upper endoscopy knowledge and skills-initial observation. Vide-oGIE. 2020 Mar 31;5(6):222-225.

2) Malvar C, Nguyen-Vu T, Shergill A, Chin YK, Baniya A, McAnanama M, Kaltenbach T, Soetikno R. The structure and delivery of a

novel training course on endoscope reprocessing and standard precautions in the endoscopy unit. VideoGIE. 2020 Apr 13;5(5):176-179.

Dr. Mike Steinman of Geriatrics 1) Brandt N, Steinman MA. Optimizing Medication Management During the COVID-19 Pandemic: An Implementation Guide for Post-Acute and Long-Term Care. J Am Geriatr Soc. 2020 Jul;68(7):1362-1365.

2) Anderson TS, Lee S, Jing B, Fung K, Ngo S, Silvestrini M, Steinman MA. Prevalence of Diabetes Medication Intensifications in Older Adults Discharged From US Veterans Health Administration Hospitals. JAMA Netw Open. 2020 Mar 2;3(3):e201511.

3) Anderson TS, Steinman MA. Antihypertensive Prescribing Cascades as High-Priority Targets for Deprescribing. JAMA Intern Med. 2020 Feb 24.

4) Steinman MA, Perry L, Perissinotto CM. Meeting the Care Needs of Older Adults Isolated at Home During the COVID-19 Pandemic. JAMA Intern Med. 2020 Apr 16.

Dr. Geoffrey Stetson of Hospital Medicine. 1) Stetson GV, Kryzhanovskaya IV, Lomen-Hoerth C and Hauer K. Professional identity formation in disorienting times. Med Ed April 2020 https://doi.org/10.1111/medu.14202

2) A series of Blog Posts on how to use questions effectively in the clinical learning environment:

https://blog.mymedutopia.com/index.php/2020/05/27/asking-questions-in-the-clinical-learning-environment/

https://blog.mymedutopia.com/index.php/2020/06/03/asking-questions-in-the-clinical-learning-environment-2/

https://blog.mymedutopia.com/index.php/2020/06/18/asking-questions-in-the-clinical-learning-environment-3/

Dr. Rebecca Sudore of Geriatrics 1) Nouri S, Ritchie C, Chen P, Volow A, Li B, Tellez I, Sudore RL. Supporting In-Home Caregiv-ers in Symptom Assessment of Frail Older Adults with Serious Illness: A Pilot Study. J Palliat Med. 2020 May 22.

2) Freytag J, Street RL Jr, Barnes DE, Shi Y, Volow AM, Shim JK, Alexander SC, Sudore RL. Empowering Older Adults to Discuss Ad-vance Care Planning During Clinical Visits: The PREPARE Randomized Trial. J Am Geriatr Soc. 2020 Jun;68(6):1210-1217.

3) Suen LW, Leyde S, Min K, Volow A, Rabow M, Sudore RL. Thinking Outside the Visit: Primary Care Patient Perspectives on Helpful

Advance Care Planning Methods. J Gen Intern Med. 2020 Jun;35(6):1903-1905.

Dr. Victoria Tang of Geriatrics Kata A, Cenzer I, Sudore RL, Covinsky KE, Tang VL. Advance Care Planning Prior to Death in Older

Adults with Hip Fracture. J Gen Intern Med. 2020 Jul;35(7):1946-1953.

Dr. John Teerlink of Cardiology. Psotka MA, Teerlink JR. Assessing the lifetime benefit of heart failure therapies. Lancet. 2020 Jul 11;396(10244):75-77.

Dr. Sunny Wang of Hem/Onc Berchuck JE, Meyer CS, Zhang N, Berchuck CM, Trivedi NN, Cohen B, Wang S. Association of Mental

Health Treatment With Outcomes for US Veterans Diagnosed With Non-Small Cell Lung Cancer. JAMA Oncol. 2020 Jun 4;6(7):1–8.

Dr. Rabindra Watson of GI Thiruvengadam NR, Hamerski C, Nett A, Bhat Y, Shah J, Bernabe J, Kane S, Binmoeller K, Watson RR. Effectiveness of combination endoscopic therapy for colonic anastomotic leaks. Endoscopy. 2020 Jun 10.

Dr. Mary Whooley of GIM 1) Krishnamurthi N, Schopfer DW, Shen H, Whooley MA. Association of Cardiac Rehabilitation With Survival Among US Veterans. JAMA Netw Open. 2020 Mar 2;3(3):e201396.

2) Schopfer DW, Nicosia FM, Ottoboni L, Whooley MA. Patient Perspectives on Declining to Participate in Home-Based Cardiac Reha-bilitation: A MIXED-METHODS STUDY. J Cardiopulm Rehabil Prev. 2020 Feb 19.

Dr. Eric Widera of Geriatrics 1) Newport KB, Malhotra S, Widera E. Prognostication and Proactive Planning in COVID-19. J Pain Symptom Manage. 2020 Aug;60(2):e52-e55.

2) Widera E. Primary Palliative Care. Med Clin North Am. 2020 May;104(3):xvii-xviii.

3) Martin EJ, Widera E. Prognostication in Serious Illness. Med Clin North Am. 2020 May;104(3):391-403.

Dr. Brie Williams of Geriatrics Cloud DH, Ahalt C, Augustine D, Sears D, Williams B. Medical Isolation and Solitary Confinement: Balancing Health and Humanity in US Jails and Prisons During COVID-19. J Gen Intern Med. 2020 Jul 6:1–5.

2) Barnert E, Ahalt C, Williams B. Prisons: Amplifiers of the COVID-19 Pandemic Hiding in Plain Sight. Am J Public Health. 2020 Jul;110(7):964-966.

Dr. Charlie Wray of Hosp Med , Dr. Sanket Dhruva of Cardiology, and Dr. Gurpreet Dhaliwal of GIM. Wray CM, Dhruva SS, Dhaliwal G. The Art of the Deal: Negotiating Consult Conflict. Am J Med. 2020 Apr 18:S0002-9343(20)30239-4.

Dr. Charlie Wray of Hosp Med. Anderson TS, Wray CM. Web Exclusive. Annals for Hospitalists Inpatient Notes - Inpatient Hyper-tension-To Treat or Tolerate? Ann Intern Med. 2020 Apr 21;172(8):HO2-HO3. .

Dr. Michi Yukawa of Geriatrics. Yukawa M, Gansky SA, O'Sullivan P, Teherani A, Feldman MD. A new Mentor Evaluation Tool: Evidence of validity. PLoS One. 2020 Jun 16;15(6):e0234345.

I READ IT SOMEWHERE….CONTINUED

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**We regret any inadvertent omissions of your work. We have limited this list to first and last author publications. If publication

listed in a prior issue, it was not reprinted here. Congratulations to everyone for tremendous efforts! **

SUBLIME TO RIDICULOUS NOTES

Editor: Heather Nye (if no byline, I wrote it)

Please send us your news, ideas, and photos. And remember, we are only trying to make you chuckle a bit….

DOM Leadership Team Heather.nye@va.g0v

RELEVANT DATES

COVID-19 Surge Planning August

COVID-19 Recovery Planning September

COVID-19 Surge Planning October

COVID-19 Recovery Planning November

COVID-19 Surge Planning December

COVID-19 Recovery Planning January

Meetings, marathons, walks, virtual concerts, sporting events, school, or vacations, everything else postponed

COVID-19 Vaccine TBA

KEN’S KORNER

We Hold These Truths to Be Uncomforta-ble…But Can Hide From Them No Longer

It’s difficult to know which crisis should capture our attention at any time: the COVID-19 pan-demic; the economic recession that now threat-ens; the pressure upon families to provide su-pervision, education, and stimulation for their

children while schools are in recess; the vocal segment of our society that rejects science, scorns public health experts, and embraces con-spiracy theories; the uncensored social media that foster this ele-ment and undermines democracy; the failure of leadership at so many levels; or the threats to our upcoming election (and our de-mocracy) – just to name a few. In the midst of this existential chaos, there is a sense among many that attention has been distracted from the critical issues raised by the Black Lives Matters movement. Let me state emphatically: this must not happen.

Since the George Floyd murder and the national demonstrations it galvanized three months ago, I have conferred with many School of Medicine and Department leaders on DEI issues, hospital leaders and section chiefs, faculty, staff, and medicine residents to inform and guide me as to what we as a Medical Service can and should do to promote a more inclusive, equitable, and diverse culture here at the VA. In parallel there are many other groups in the SOM, DOM, hospital, and residency program who are advocating for needed changes. My belief is that Medical Service activities in support of DEI and the BLM movement should complement and support these hospital and campus-wide activities - not duplicate them. Coordina-tion among these groups is imperative to promote and support meaningful and sustainable changes in our policies and culture.

We now are assembling the Medical Service Committee to Pro-mote a More Diverse, Inclusive, and Equitable Culture. A call went out last week for interested participants, and I will be working with some of our DEI leaders (Denise Davis, UCSF SOM Specialist for Minority Students; Meshell Johnson, PCCM Chief, DOM Director of Faculty Diversity and Dean’s Office Diversity Lead-er for Differences Matters Initiative; Lenny Lopez, Hospital Medi-cine Chief) to select our initial members and leaders, who will serve on a rotating basis. Up to 0.3 FTE will be used in support of the committee leader(s). The committee will be charged with establish-ing a mission statement and prioritizing activities, but I anticipate their involvement with the following:

Recruitment, retention, and mentorship of a diverse faculty

Outreach to trainees (students, residents, fellows) from under-

represented backgrounds to promote a more inclusive culture, offer

mentorship, and provide information on VA career opportunities

Assure DEI Championship Training to all VA Medical Service faculty;

review/address concerns raised by trainees pertaining to microaggres-sions, differential treatment, overt racism on VA rotations

Engage/support the Residency Diversity Committee and other student

or resident advocacy groups to foster requested programmatic changes at the VA

Development, support and review of educational program at the service,

section, or trainee levels to assure greater attention to racial and health-care disparities, systemic racism, and mechanisms for promote anti-racism. (To this end, I have committed partial financial support for an Anti-Racist Symposium that is being organized by the resident Solidary Coalition.)

Support/organize “Anti-Racist Allyship Book Groups” at the service or

section level to allow interested people to come together in a safe, open, and supportive environment to discuss readings, movies, or podcasts that deepen our understanding of our history of racial injustice, overt and covert racism, and white privilege and provide greater insights into how to work towards antiracism.

In closing I ask you to reflect upon the following painful quotations which deserve your attention and reflection. I hope you’ll join me and others throughout the service as we work towards a more just and equitable culture.

“…I must confess that over the past few years I have been gravely disap-pointed with the white moderate. I have almost reached the regrettable conclusion that the Negro’s great stumbling block in his stride toward free-dom is not the White Citizen’s Councilor or the Ku Klux Klanner, but the white moderate who is more devoted to “order” than to justice…” Martin L. King, Jr, Letter from a Birmingham Jail

“Where the really sincere white people have got to do their ‘proving’ of themselves is not among the black victims, but out on the battle lines of where America’s racism really is – and that’s in their own home communi-ties…That’s where the sincere whites who really mean to accomplish some-thing have got to work.” Malcolm X

“Every white person in this country – I do not care what he says or what she says – knows one thing…they know that they would not like to be black here. If they know that, they know everything they need to know. And whatever else they may say is a lie.” James Baldwin, UC Berkeley speech, June 15,1979

“…understand that there is a difference between being uncomfortable and being threatened. There is no way to tell the truth about race in this coun-try without white people being uncomfortable…The only reasons for rac-ism’s persistence is that white people continue benefit from it.” The assump-tions of white privilege; Bryan N. Massingale

Dear George

Sunday afternoon at the gym

reading about home funerals

and laying bodies on ice

I thought of my father

recently passed

and began to see

beauty in the young white man on the rowing machine

and the Afro-Caribbean dad lifting weights

while his sunlit daughter

pedaled the elliptical.

We are all trying so hard.

Bless us.

UCSF DOM Shelter-in-Poetry Winning entry Denise L. Davis

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