We as healthcare professionals have a need and obligation to care for others. Whether in academic, research or clinical practice, laboratory medicine or diagnostic imaging, the healthcare professionals' role is to bring comfort and to heal. From such healing comes self-reward, self-fulfillment and honor. If we are surrounded by despair and inequities and have the opportunity to help with their dissolution, it is our obligation to do so. Such has been my mission as a physician, an obstetrician, through my work and my poetry. If one person, one family, can be helped or can gather hope through the words we write and say, it can bring reward equal to the healing with our hands and minds. Hope is a singular gift we must never destroy in ourselves. Poetry is its instrument whose music can be its enabler. Words we write, words we read, and words we hear can serve as an invaluable source of healing. Words are songs from our hearts and can be "songs of hope, songs for hope"
It is my hope that providing this platform, you may read of my personal journey and experiences through my poetry and share yours.
My poetry is about hope and despair; about celebration and sorrow. But mostly, it is about hope. Forms of expression implicit in symbolic language; poetry and verse, song, prayer and ritual, have served a role in all cultures and societies to dispel the tears and foster the healing of death and human loss, suffering and despair. Why does poetry triumph as a source of enduring inspiration and hope?
Though our spirits may fade and our viscera bleed, we are enabled by the agents of our humanity empowered by ancestral song and promise (Berman, 1999)
Comfort may be achieved through the transfer of the poet's feelings into the reader or listener's mind. It transports the reader from the distractions and influences of the outside world inward to the internal rhythms and solace of the personal soul. The poet becomes a healer and his poetry his staff. Through verse and meter, free of inhibition yet full with expression, the poet may articulate a sensitivity and empathy and provoke this introspection and inner peace. A poem is transformed into a message of hope. There is wonderment and magic in the words of a poem. Each word is selected for its individual meaning within the context of the entire poem. A few properly selected words can move the reader to tears and awaken the primal emotions of joy, promise, despair and hope. A poet should evoke emotion in his work and write as if each poem is written with the poet's last words.
The language of poetry, within the broader context of its 'parent body' (literature,) has always had as its great themes, love, loss and death. The inclusion of hope to these thematic elements is worthwhile if not essential for, (as humans) we have the capacity to bring hope to a despair that is uniquely created by our humanity and our human conditions.
As an Obstetrician, my professional career has involved a striving to bring comfort and healing to children, born and yet to born, and to mothers through their years of childbearing and beyond. It has been the cause in my life. I have been uplifted by the triumphs of birth and healing and depressed by the failures. Yet I have always tried to look beyond the failures in search of the triumphs. I have counseled patients at the darkest times of their lives, when their children have died, and I have turned to the comfort of personal reflection, poetry and self-expression to better help me help my patients. I have learned that by writing down thoughts which might elucidate my feelings more clearly than the spoken word, I have become a better physician.
"By making us stop for a moment, poetry gives us an opportunity to think about ourselves as human beings on this planet and what we mean to each other." Rita Dove
"Only those within whose own consciousness the suns rise and set, the leaves burgeon and wither,can be said to be aware of what living is." Joseph Wood Krutch
The soul of my career
When the outcomes of our patient's pregnancies end in miscarriage, stillbirth or infant death, we struggle to find the right approach to break the news to them, treat them medically and/or surgically, help them recover physically and emotionally, and console them in their grief. Most of us have not been taught to provide this bereavement care. We learn fast that there are hospital nurses and social workers, bereavement counselors and therapists, support groups and religious ministries to whom we can refer our patients for immediate bereavement care and subsequent follow-up. We can do the D and C and we can attend and assist in the birth of the baby who has experienced an intrauterine death. But then, for many Obstetricians, we refer our patients for bereavement care. When we hold in the palm of our hand an 18 week fetus immediately after our patient miscarried or attend the stillbirth of a term pregnancy, our intellectual knowledge and rational thought fade as we struggle to find the right words to say. Unlike the repetition of performing a surgical procedure, no matter how many times we have experienced a loss with our patients, it does not become easier.
Although the stillborn baby which might have been born viable represents the greatest emotional and management challenges, we must recognize any loss in pregnancy as a life-altering event for our patients. The care of the patient experiencing a Pregnancy Loss is a paradigm for what we do as physicians. It tests not only our clinical skills and judgments but stretches the fibers of the human aspect of caring very thin. Although we might ask, "how can we heal when our patients' children are incurable, when they are suffering or when they die or what do we do when the advanced technology that has become a part of our black bag fails", we must understand that we can heal by providing comfort , empathy and hope. As bad as this experience is for our patients, we can make it better. If we remain aware that we are the link between the stillborn baby and the bereaved family, that we were the first to touch and hold their child, albeit their stillborn child, then we can share this with them, remember this with them, and from this point forward, heal with them. The bond we form becomes the unbreakable fiber, which strengthens and indeed cements our role in the doctor-patient relationship.
Moses Maimonides, "the most important Jewish philosopher of the Middle Ages" wrote "The eternal providence has appointed me to watch over the life and health of Thy creatures... my lofty aim of doing good to Thy children...may I never see in the patient anything but a fellow creature in pain" 2
Both citations above speak of patients as "fellows" and "human[sic] creatures and children...". This must commit us who have taken the "Oath" to practice our sacred profession(s) of medicine with an imperative to respect the sanctity of life and health for all those we treat-with a sense of high privilege- for they are the flesh and blood and souls of all humanity - past, present and future-and we, by our choice, their guardians.
There is no place for bias or prejudice or disparate care in our healthcare systems. I have tried in my half-century of caring for patients to follow this philosophy.
A brief personal thought:
"I am first a physician, a distant disciple of Aesculapius and Hippocrates3; a clinician, a teacher, and a student. I am an Obstetrician. I stand before my patients4 and facilitate their births. I share their joys; I feel their pains. Yet, caring for the well-being and the illnesses of patients and their families is to accept that medical science in all its depth and possibilities is not precise and that the human mind and flesh are perishable. We are today steeped in myriad medical technologies that in themselves bring hope to previously hopeless conditions and pathologies. Yet there remains inexorable suffering which accompanies failures and tribulations not only of these new medical technologies but of pervasive disparities which exist to deny access to and recipient of one standard of care for all, disparities defined by the social determinants of health:5 the paradox of our societies to both cure and cause pain which is real and evident.
I believe that we as practitioners and guardians of humanity's health, have been granted by oath and by ethic the privilege to examine and treat, to counsel and advise our fellow human beings and we must never abandon the souls of all patients seeking our care.
Going forward (l)
Today are times of much despair
Yet times of great hope
To affirm our oath
As unfiltered reason and purpose
Rush in our blood
Every pulse a wave
Approaching distant shores
To leave our prejudice behind
To fade into vapors
As common as fog
And guide us to plant
Roots to bond our humanhood and
Vines to grow our brotherhood
As we go forth into tomorrow.
Michael R Berman, MD, MBI, FACOG
Founder, Ephemeris Project
1 Sherwin Nuland, MD. From Preface, Parenthood Lost. Berman, 2001.
2 Excerpted from Dalhousie University Libraries: https://dal.ca.libguides.com/c.php?g=256990&p=1717827
3In Greek mythology, "Aesculapius, son of Apollo, the god of healing, was a famous physician. Hippocrates, was a member of the Asclepiadae- priest physicians whose origins may be traced to the mythical personage, Aesculapius"
4Obstare from the Latin meaning "To Stand before"; the root word of Obstetrics
5 "The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries." https://www.who.int/social_determinants/sdh_definition/en/
6 A poem defined by our times, September, 2020.
My Brief Bio
I received my Doctor of Medicine Degree from New York Medical College and my Masters Degree in Biomedical Informatics from Oregon Health and Science University (OHSU) with an area of concentration on Personal Health Records.1 I completed my Post Graduate Residency Training in Obstetrics and Gynecology and one year fellowship in Maternal and Fetal Medicine at the Yale School of Medicine and Yale New Haven Hospital. I am currently Clinical Professor of Obstetrics, Gynecology and Reproductive Science and former Associate Dean for Quality and Patient Safety for Graduate Medical Education at the Icahn School of Medicine at Mount Sinai(retired), and former Chief Quality Officer and Ombuds at the Mount Sinai Health System in New York, New York(retired). Prior to joining the faculty at Mount Sinai, I was in Clinical Practice in Obstetrics and Gynecology and Clinical Professor of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine. I founded the Hygeia Foundation for Perinatal Loss and Bereavement 2 (now Hope After Loss) and am the author of numerous poems and essays documenting the human condition. I am also author of the book, Parenthood Lost, Healing the Pain After Miscarriage, Stillbirth and Infant Death. As Chief Quality Officer, I had oversight for Quality and Safety at Mount Sinai Beth Israel Medical Center, New York Eye and Ear Infirmary, the Mount Sinai Downtown Ambulatory Care and Surgery facility at Union Square and the The Blavatnik Family Chelsea Medical Center. I joined the faculty and attending staff of the Mount Sinai Beth Israel Medical Center in 2012 where, as the medical director of the Labor and Delivery Unit, I implemented the hospital's first full-time laborist program, which provided a structured, collaborative, patient-centric approach to improving the quality, safety, and patient experience on the labor floor. In 2017, I was appointed Chief Patient Safety Officer for Mount Sinai Beth Israel Medical Center and Associate Dean for Quality and Patient Safety in Graduate Medical Education. In this role, I led efforts at the Icahn School of Medicine at Mount Sinai (ISMMS) and the Health System to meet the goals of the Clinical Learning Environment Review Program developed by the Accreditation Council on Graduate Medical Education.
Significant areas of organizational interest and specialized training, which I have acquired, are in the domains of Just Culture, Adverse Event Disclosure, 'Second Victim' Counseling, Physician Communication Skills, Ombuds, Patient Experience and Healthcare Disparities. I also served in the Ombuds Office for the Icahn School of Medicine at Mount Sinai and the Mount Sinai Health System, a resource for faculty and students in the Graduate Medical Education programs, providing an impartial and informal venue for promoting fair and equitable conflict resolutions for those who have identified problems in their workplace or studies.
With my collective interests in informatics, quality and safety metrics and information technology, I developed several quality improvement software programs optimized for both in-hospital and community / ambulatory organizations. These programs can be customized and licensed to in-kind organizations. Information is available at Hygeia Health Systems, LLC
1 Master's Thesis: A PERSONAL PRENATAL HEALTH RECORD FOR A CULTURALLY DIVERSE URBAN COMMUNITY: A portable, secure and interactive electronic personal health record, designed specifically for pregnant women in underserved, urban communities.
2 The Hygeia Foundation for Perinatal Loss and Bereavement was a non-profit, tax-exempt organization whose mission was to comfort those who grieve the loss of a pregnancy or newborn child (from all causes; e.g. Miscarriage, Stillbirth, Genetic Disorders), to address disparities in access to healthcare services for medically and economically underserved families with respect, dignity and advocacy and to provide advocacy and resources for maternal and child health.
Full Curriculum Vitae 2020