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Resident Physician Magazine Breaks Silence and Stigma through Creative Expression

“SubQ Secrets” pencil drawing by Danielle Couture, MD

When he was approached by a colleague about writing for a magazine with the theme “unspeakables and ineffables,” Lary Campbell, BSN, RN-BC, a psychiatric emergency nurse at Pennsylvania Hospital, had one idea for a personal essay that kept coming to mind. He had doubts about sharing it, though.

The colleague, Lisa Jacobs, MD, MBA, then a psychiatry resident at Penn, knew that Campbell was an accomplished playwright and filmmaker who would be a talented contributor to the second issue of the magazine she had founded, Penndulum. She didn’t know that Campbell was HIV positive; a lot of his colleagues didn’t know.

After discussing it with some friends, he resolved that disclosing his HIV status in his essay, “Broken Boundaries,” was the right thing to do. “Since I do work in LGBT care, encouraging other people to fight stigma and give voice to lived experience, it would be hypocritical not to share when that’s what I encourage others to do,” he said. His essay describes an encounter with a young woman in the psych ER who felt she had no reason to live after being diagnosed with HIV. Though he had been trained not to cross the line between personal and professional worlds, he broke that boundary and comforted the patient with his own story: Living with HIV wasn’t easy. His diagnosis in 1991 had strained his relationship with his dying mother, whose initial reaction when he told her was to ask him not to call her again — but he’d gone on to live a full life.

Since the essay’s publication, a lot of people have called Campbell brave. For Campbell, that descriptor told him he’d done what he set out to do. Social bravery in truth-telling, he said, only exists where stigma makes a secret much safer to keep than to tell. “Because there is stigma, it is brave. The greater the stigma, the greater the bravery. It’s part of my role as a nurse, when I’ve worked with clients who are positive, to set an example to try to reduce the stigma for the individuals so they can start healing.”

By that metric, it’s fair to say that Penndulum itself is a platform for bravery. The magazine’s story begins at the start of Jacobs’ residency in psychiatry at Penn a few years ago. When she arrived, she realized she was surrounded by a lot of creative people — or formerly creative people, from writers like herself, to comedians like her best friend Behdad Bozorgnia, MD, and visual artists. But she found that her busy life as a physician, and the intensive demands of the intern year in particular, drained those creative qualities away along with the time formerly spent engaging in those activities. Intern year was more than just creatively draining. It was hard. As she wrote in an essay for Penndulum’s first issue, “I fumbled with wartime and boot camp analogies to relate my experience. I was met with blank stares. No one understood. Soon, I stopped trying, and came to the terrifying realization that in doing an impossibly difficult job where I spent most of my waking hours with patients on the worst days of their lives, I was very much alone.”

By taking a head-on approach to breaking the silence around important but rarely discussed topics in medicine, Penndulum is part antidote, part exposé for these ills. From the often-secret struggles of young physicians coming to terms with the challenges of their profession, to the heavy, humorous, tragic, and deeply human moments that occur in a health-care setting (like Campbell’s encounter with the despondent HIV-positive woman), health care providers live in a world that is emotionally complex in ways that are difficult to express.

“We suffer from so many good stories,” said Bozorgnia, the chief resident of Penn Behavioral Health outpatient practices, who Jacobs enlisted as co-editor-in-chief. “But we didn't have a platform to get them together, so we made something to do that.”

It’s a common need that springs up from many corners of medicine. As Yun Rose Li, MD, PhD, a 2016 graduate of the Perelman School of Medicine, commented in a story about creativity in the new issue of Penn Medicine magazine, “We talk about patient care a lot in the medical sense: which tests to run or what medications to give. But I rarely ever have an occasion to talk to my attendings or my colleagues about the care of a patient emotionally. I see my love for writing and doing creative writing in the medical community as an outlet for the lack of that in my day to day life.” As a medical student, Li co-founded Stylus, a literary magazine featuring written and visual work from members of the Penn Medicine community.

Though Penndulum could also be thought of as a literary magazine, Jacobs and Bozorgnia see their magazine as particularly helping to destigmatize many aspects of medicine that are often hidden, just as Campbell’s essay helped chip away at stigma about HIV. One of these hidden and stigmatized issues is mental illness itself. “I've had so many patients tell me they canceled their weddings, they missed their parents' funerals, and they made up these wild excuses because they were so embarrassed by these psych situations, and that silence is disrespectful to their suffering,” Jacobs said. “None of them, if they had a heart attack or had cancer or something else, would have lied in that way.”

Another major target for stigma-busting is the emotional hardship that is prevalent in medical training, such as Jacobs’ feeling of struggling alone as an intern. Bozorgnia attributes the crisis of physician burnout to a widespread feeling that day-to-day work in medicine isn’t contributing to making things better, despite the altruistic ideals that drove many people to enter health care. “Especially when you're a resident, it's sometimes hard to see the broader picture,” he said. “One of the reasons I think Penndulum has worked so well is because this is a space of meaning. The meanings are good and bad. They're not necessarily all positive things, but it allows people to explore some of the connections of their day-to-day experiences to bigger themes, and then that allows them to connect to other people and have a sense of community.”

The community that is engaged with Penndulum is experiencing rapid growth from people discovering that connection on Penn’s campus and worldwide. Though they conceived the magazine as an outlet for psychiatry residents, by psychiatry residents, Jacobs and Bozorgnia also accepted submissions from medical students and attending physicians for the first issue, which was published in print and online December 2016. It included nonfiction, humor, poetry, and artwork from Penn contributors. The editors initially publicized Penndulum only through posts on their personal Facebook pages, yet they were soon surprised to find they were receiving comments from strangers on their posts. The online version racked up thousands of hits from 46 countries on six continents.

Jacobs and Bozorgnia both believe that much of the appeal comes from the magazine’s intentional focus on unvarnished truthfulness (though it’s worth noting many of the details in nonfictional accounts, particularly those involving patient stories, are partly fictionalized for privacy). Jacobs described the magazine’s style as gritty — anything but fluff. “We're trying to give people a space to work through conflicts that especially our generation of physicians is inevitably being faced with,” Bozorgnia said. “The conflict is the good stuff. That's actually where it gets interesting, even if it's not necessarily a happy ending.”

For the second issue, published this spring, psychiatry resident Danielle Couture, MD, joined Jacobs and Bozorgnia as co-editor-in-chief and art director. The team also expanded outreach to more contributors from more corners of the medical field, including nurses like Campbell and contributors from outside of Penn. Because Penndulum is a personal project and not a University or departmental publication, Jacobs, Bozorgnia, and Couture have the opportunity to keep it growing and changing even after they each complete their training at Penn — something that Jacobs just did. She is beginning a fellowship at Stanford, where she plans to enlist more contributors there, and hopes to ultimately expand to build a broader network of contributors from other academic medical centers. The magazine is currently accepting submissions for the next issue on the theme of “revelations.”

To page through Penndulum is to begin to discover untold stories. Find them online at ThePenndulum.org. For further exploration of the themes of physician workload and work/life integration, see the cover story of the Spring/Summer 2017 issue of Penn Medicine magazine, and see the issue’s feature story on creativity for more examples of Penn medical students and young alumni pursuing interests in writing, painting, podcasting, and more.

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