Editor's note: This is part of our continuing series of stories about Bruce Kramer, the former dean of the College of Education, Leadership and Counseling at the University of St. Thomas, as he copes with life after being diagnosed with ALS, also known as Lou Gehrig's Disease. You can read all the stories in the series by clicking here.
This is finals week for many college and university students. It's a stressful time, but some first year students in the University of Minnesota Medical School recently had a bit of a break from their focus on body parts and biology and received a real life lesson from a couple of patients. It was a very personal lecture designed to teach students about the humanity behind the medicine.
The two guests at the front of the large, amphitheater-style classroom are all too familiar with ALS. One of them is Bruce Kramer, the Twin Cities man we've been following as he lives life with the disease. Joining him is someone Bruce calls his "comrade in ALS," Pat Conway, and Pat's wife Kathy. Pat, Kathy and Bruce were invited to tell their stories to the nearly full lecture hall.
"There is this point where you think that this is about the person with the disease, but it's not," Kramer told the students. "ALS splashes all over your family. It gets all over your friends. It gets all over your colleagues."
Conway added: "This also affects the emotional part of our brain. When we both struggle with tears it's not so much we are sad but it's part of the disease that also chases people away."
The lecture is presented to first year med school students, in part, by Dr. Ezgi Tirayki. She's a neurologist and educator at the University of Minnesota and Hennepin County Medical Center. She also directs the ALS Center of Excellence at HCMC. The lecture is partially medical in nature, but mostly personal reflections that go beyond the textbook and lab work.
Take this most sacred moment when you're delivering to somebody very, very bad news and try and make it as human as possible.Bruce Kramer
"When I first started practicing, I just freaked out when I went to clinic and had to see a new patient, because [my work] really depended on my being right and it depended on me saying it in a way that people could hear me. And it was a very, very steep learning curve and not something that comes naturally," Tirayki said. And that extended to delivering news to patients that might not want to hear. "The thing about it is it can be learned, and if you pay attention to it, you can practice it and you can get better at it and you should really make it a goal in medical school to get better at talking about bad news."
Tirayki says medical students have so much information to wade through that very little time is spent reflecting on why a student chose the field in the first place.
"There's a lot of research out there about empathy in physicians, and how it drops from their time in training. We make sure that people remember to do it for the right reasons and to have the fun and the pleasure and the privilege and to FEEL that privilege. That's what this lecture is all about," she said.
Dr. Sam Maiser, a neurology resident, sat in Dr. Tirayki's lecture just a few years ago and based, in part on that lecture, decided to go into neurology, making ALS his specialty.
"I think the thing that struck me most was the willingness of the patients to be so open and honest what their life is like living with a disease like ALS," Maiser said. "Because we always hear about the symptoms and what not from a lecturer but to actually hear a real person tell us what their disease is like and how it's affecting them is I think what struck me the most."
Tirayki calls lectures like this the "hidden curriculum" in a medical school and the best teachers are the patients themselves. Patients like Bruce Kramer, who says:
"If I were counseling you, if I could tell you, I would try to take this most sacred moment when you're delivering to somebody very, very bad news and try and make it as human as possible, and think to yourself, 'What makes this human experience so beautiful? To reach out and touch a hand. To be quiet. Just be quiet. What is there to say once you've said this, but to be there in solidarity and to say "we can move through this?"
"I think those are healing stories that you can tell as physicians, those are things you can give hope to people, even though there's not a cure and if you stop to think about it, really in medicine, there are no cures," Kramer said. "We're all on the same pathway. We're all going to die. We just keep trying to put it off, right? And if you can figure out a way to just be there with that person and to remember that it's not just about them.That is what I would tell you. Try to make this as human as possible."
It isn't often that a classroom lecture concludes with a standing ovation but that's exactly what happened. Even the guests seem a bit surprised and deeply touched, including Dr. Tiryaki.
"I cry every time, as you can see. It is truly a learning experience. I don't think you ever stop learning and every single patient, time after time, teaches you something different," he said. "The patients I invited today, I feel very privileged that they agreed to come. They're very special people. You heard their stories. You heard how many times they've been part of research studies. Whenever I have a physical exam course, these are the patients who volunteer and do this because they believe in giving back and in paying it forward and those are the kinds of patients that inspire medical students to be the best doctors they can be."