Organizers had planned to throw the student-run music festival, which is slated to begin at 4 p.m. on Saturday, on Old Campus. Although it will now be held indoors, the lineup — including R&B artist Ravyn Lenae, French DJ Dombresky and rapper Pusha T, as well as student acts PJ Frantz, Tired of Tuesday and DJ Leon Thotsky — will remain unchanged.

On Friday morning, Dean of Student Affairs Melanie Boyd wrote in an email to students that the distribution of Spring Fling wristbands and the sale of merchandise would be put on hold until further notice. Three hours later, the Spring Fling Committee wrote to students that inclement weather conditions had forced the festival to relocate from Old Campus. High winds, heavy rain and temperatures around 50 F are currently forecasted for Saturday. 

“Given these conditions, we cannot proceed with Spring Fling as planned,” members of the Spring Fling Committee wrote in the email to students. “This isn’t a judgment call made by the Spring Fling Committee: these are non-negotiable regulations set by the stage production company and Yale Emergency Services.”

Dean of Student Affairs Melanie Boyd told the News that Yale’s Spring Fling operations team had been closely monitoring the weather forecast all week, and concluded when predictions worsened on Thursday that the winds were too high to safely hold the event on an outdoor stage. The Spring Fling stage was dismantled and removed from Old Campus on Friday morning.

In their email to students, members of the Spring Fling Committee wrote that they learned of the decision Thursday afternoon and had been “scrambling to find a solution” since then. 

“It seemed we would have to cancel the event altogether, but the students on the Spring Fling Committee have done an amazing job of creating a fallback plan,” Boyd told the News. “I’m grateful to College Street Music Hall for their willingness to accommodate us at the last minute, and to many Yale colleagues for their speed and flexibility.” 

The wristband distribution process, which began on Wednesday, has been canceled, with the committee voiding all wristbands which have been distributed. Tickets for the event, which remain free for all students, will now be distributed on a first-come, first-serve basis using Eventbrite. Ticketing will begin at 5:00 p.m. on Friday for graduating and first-semester seniors, and will open to the rest of the student body at 5:30 p.m. 

College Street Music Hall, however, has a capacity of 2,000 patrons, meaning that the majority of Yale’s 6,500 undergraduate students and 14,500 total student body will not be able to attend. According to the email from the Spring Fling Committee, College Street Music Hall will admit students on a rotating capacity system, admitting more students as people leave. 

Though the festival remains free, admission is first-come, first-serve. Wristbands that were handed out earlier in the week are no longer valid. The festival is using Eventbrite to distribute electronic tickets beforehand. However, on the day of, a rotating capacity system will allow for more attendees to be admitted as others leave. If a student with a ticket exits the concert early, they will not be allowed back in.

Although students were previously allowed to each bring one guest to the festival, it is now only open to enrolled Yalies.

“I was planning on having a friend come that goes to school in Canada,” Joaquín Fernandez-Duque ’25 told the News. “She changed her train to come here for Spring Fling and to get here in time to pick up her guest wristband. She’s now in Connecticut having spent the money to get here, but with no show to attend.” 

Alvin Delgado ’23 said he was glad to have guaranteed tickets as a senior, but noted that many of his friends were considering not attending due to the lack of re-entry, which limits the flexibility that the event usually provides. 

Delgado also said that College Street Music Hall  is not an ideal place for Spring Fling for the “crowd and energy” typical of Spring Fling. Having the festival indoors at all, Delgado said, would make it difficult to recreate the same chaos that Spring Fling usually brings. 

“I would’ve still been fine going if it was outdoors and raining and would’ve had the luxury of leaving, drying off, getting warm and coming back,” Delgado said. 

Cade Napier ’23 acknowledged the Spring Fling committee is doing their best, and said it is hard to do the right thing given the circumstances. 

Napier told the News he doesn’t want to stand outside in the rain waiting, given that the tickets do not guarantee entry, so he is undecided on whether or not he will attend. Friends of his, he said, joked about setting up a tent outside the venue. 

“Why bother giving tickets if getting a ticket doesn’t mean you get to go?” Napier told the News. 

In their email to students, the Spring Fling Committee acknowledged the inconvenience that the last-minute switch posed to the student body. 

“We know that this information is coming too late,” they wrote. “It’s coming too late for us as well.”

Neither the Spring Fling Committee, nor Yale’s Director of Emergency Management George Hines responded to immediate requests for comment. 

This is a developing story and will be updated.

The post Spring Fling moves indoors, capacity drops by thousands appeared first on Yale Daily News.

Since then, he’s moved into a slightly bigger lab at Yale to study telomeres. As a physician scientist and professor of laboratory medicine, pathology and molecular biophysics and biochemistry, Chang also serves as the Yale College associate dean for science & quantitative reasoning education. He founded the Science, Technology and Research Scholars program, or STARS, for underrepresented minorities in STEM, revamped STEM recruitment, teaches first year seminars and diagnoses cancer patients as a pathologist, all while running his NIH-funded lab. 

“When I came to Yale, I knew I always wanted to be a scientist, and that passion never changed,” Chang said. 

Chang immigrated to the United States from Taiwan when was seven. Though he grew up eyeing astronomy, molecular biology ultimately hooked him. He was fascinated by rapid advances in cloning research — as if “a new era of biological science was happening.” He came to Yale College for its Molecular Biophysics and Biochemistry Department, where he met a FroCo pursuing an MD/PhD program. Realizing how physician-scientists could bridge research with clinical application, Chang started on the same path. 

After spending his undergraduate days doing research at two Yale labs, Chang went on to receive his PhD in cell biology from Rockefeller University in 1996. A year later, he finished an MD at Cornell University Medical School before a postdoctoral residency in Boston and a medical job at the Anderson Cancer Center in Houston. After 22 years of country-trotting, he found himself back at Yale, recruited as a professor in the Department of Laboratory Medicine, where he then spent his days working toward tenure.

“The academic rat race is getting tenure,” Chang said, with a laugh. “But once I got tenured, I felt like I could now have the ability to do … something else.”

So he expanded beyond working with medical students: he helped teach a first-year seminar called “Perspectives in Biological Research,” which brought in professors from STEM fields to talk to students about their research. Realizing his fondness for interacting with undergraduates — especially as a Yale College alum himself — Chang later went on to direct the class.

But Chang also recognized that the Perspectives class was not accessible to everyone. For one, students had to have high school research experience to secure a spot.

“What if you are a late bloomer, what if you never had the ability to do high school research?” Chang asked. “So I said, ‘why don’t I start a class targeting students who…  may not have any kind of research background?’”

In response, he began the class “Topics in Cancer Biology,” an open first-year seminar in which students learn to read scientific papers and write their own grant proposals. This class marked just the beginning of Chang’s journey toward expanding STEM education at Yale. 

When Chang started his deanship, only 70 undergraduates opted to stay at Yale over the summer to conduct research. Over his tenure, he’s expanded that number to around 300. 

Now, over a hundred of those students come from underrepresented backgrounds. Today, Chang’s STARS program aspires to elevate students from diverse, disadvantaged backgrounds — especially those who have never done research. Through STARS, Chang aims to improve performance and persistence rates of historically represented students in STEM through mentorship, research funding, networking and career planning.

“I think the legacy I would love to leave is that for my short time here, I made Yale undergraduate research much more egalitarian,” Chang said.

On Mondays, Wednesdays and Fridays, Chang can be found having an 8 a.m. breakfast at Silliman. He might be joined by a student, or multiple, who sit across from him listening to his animated conversation. Hannah Cevasco ’23, one of Chang’s mentees, emphasized his lighthearted humor during these conversations.

“He bought a bearded dragon from someone on Craigslist,” Cevasco said of Chang, “and it reminded me of Hagrid in Harry Potter when he got that dragon from a guy down at the pub.” 

Cevasco recalled how Chang emailed her about his new pet named “Scar” and urged her to pay a visit to see him. Students characterized his mentor-mentee relationship as one marked by  familiarity and friendliness.

“He’s very approachable to students, and I think that’s why they feel very comfortable [around him],” Donalee Slater — assistant director of science and quantitative reasoning — told the News. 

Devin Lin ’24 said he was “very lucky” and “truly honored” to have met and learned from Chang — someone he calls a teacher, friend and mentor — through various courses and programs. 

In spring of 2021, Lin took Chang’s course, Topics in Cancer Biology, before participating in the STARS I program and STARS Summer Program. Eventually, Lin became a STARS Mentor in the STARS I program.

“Dean Chang has left lasting influences on me,” Lin said. “His Topics in Cancer Biology class is still one of my favorite classes that I took at Yale. … He achieved what I called a ‘delicate balance’ as an instructor, being able to challenge us and help the students grow, while simultaneously making sure we are not overwhelmed.”

Lin further described the broader impact Chang has made on the Yale community with regard to the STARS programs. The 2022-23 STARS I cohort, he noted, is 200 students — double the number of students from the 2020-21 cohort.

According to Lin, Chang advocated for the expansion of the program and raised funding. As a result, Chang was able to accept around 95 percent of the applications to the Yale College First-Year Summer Research Fellowship in the Sciences & Engineering — a program that provides first-years funding for a summer of research at Yale.

But Chang’s relationships with his mentees run deeper than classes, research programs and advising meetings. 

“He was the first professor I had at Yale that made an outward effort to really get to know his students beyond just the surface level,” one of his mentees, Caitlin Brown ’25, said.

Cevasco emphasized how Chang invites his students to attend basketball games and to grab dinner at Ezra Stiles, his residential college when he was an undergrad. Chang even knew all the players by name, Cevasco remarked. At games, he transforms “from a super intellectual professor to the loudest fan,” and tells his students to remain standing and cheer until Yale scores. 

He was not always this way — Chang described himself as “a geek” growing up, “antisocial” and buried in his microscopes. But college taught him to embrace both the academic and the fun. Chang reflected fondly on the “amazing dance parties,” which he attended every weekend, hosted by the Asian American Student Alliance.

Today, Chang hopes to enliven the STEM community in the same way. From offering pre-med advice over Whale Tea boba, and to weighing in on students’ aspirations at Geronimo, Chang emphasizes how a simple meal can bring people together. 

In fact, Chang met his wife, Anna, while he was working through his MD/PhD and she was in business school. Set up by a mutual friend, they chatted over dinner and then watched a Chinese movie called “Liang Zhu.” Called “The Butterfly Lovers” in English, it’s the most famous Chinese love story, said Chang.

At Yale, he placed into graduate level Chinese and took a course on Chinese poetry. Chang loved reading Wuxia novels and recalled reading the whole selection of Kung Fu books at Sterling Library.

“[My first year], I was totally burnt out before my final exams, so I bought all these Kung Fu novels,” Chang said. “I said, ‘I’m going to read these during reading period, I’m not going to study.’ So, thank God for my roommate, they hid it and said ‘you better go get your work done.’”

Slater described Chang as one of the “most energetic” people she knew. Slater, who has worked alongside Chang for six years, reiterated his dedication to each student’s journey. 

“Students are always asking him, ‘Can you be my advisor?’” Slater explained. “He just makes a huge investment in every student and wants to help them succeed.”

Chang’s office, where his bearded dragon resides, is located in Sheffield-Sterling-Strathcona Hall at 1 Prospect St. 

The post PROFILE: From Taiwan to Yale, Sandy Chang shoots for the STARS appeared first on Yale Daily News.

The woman did not necessarily know if she was pregnant, but worried about being in the early stages. She was scared that if something went wrong with a potential pregnancy while in Nashville, she would not be able to get the reproductive care she needed. 

The woman and Kaminski were both part of the American College of Chest Physicians, but Kaminski — the Boehringer-Ingelheim Endowed Professor of Internal Medicine and chief of pulmonary, critical care and sleep medicine at the Yale School of Medicine — was a more senior doctor. Last October, he wrote an open letter to the ACCP calling on the society to only hold meetings in places that protected access to healthcare. Not places, like Nashville, that had “draconian abortion bans,” he maintained.

Kaminski worried about young female members of the society who had to choose their safety over the advantages these meetings offered to their careers. He said “almost every step” of his career happened at a conference.

“These societies are like their bread and butter,” Kaminski said. “You give talks, you get elected to roles that help you in your academic career. The people who review your papers go to these conferences. This puts an undue pressure on younger people, mostly women.”

Kaminski reflected on a patient he saw in medical school. A young woman came in with an ectopic pregnancy — a life-threatening condition where a fertilized egg grows outside the uterus — and had to be rushed to the operating room. If the doctors had waited for a judge to make a ruling on whether surgery could be performed in that case, the woman would have died, he explained.

“Going to a place where injustice is happening and pretending that everything’s okay is unacceptable,” Kaminski added. 

On June 24, 2022, the Supreme Court ruled that there was no constitutional right to abortion. The case, Dobbs v Jackson Women’s Health Organization, overturned 50 years of precedent established by Roe v. Wade, giving states the authority to decide abortion rights. 

As of April 19, 13 states have banned abortions while several others have introduced strict gestational limits.

In response, the American College of Obstetrics and Gynecology, which represents 60,000 obstetrician-gynecologists, changed their 2023 annual meeting location from Louisiana to Maryland due to the former’s strict anti-abortion laws.

“My concern is that other societies are not following ACOG because they don’t see as much of a direct relevance to them,” said Cary Gross, professor of general medicine and epidemiology at the Yale School of Medicine. “I think that’s a colossal mistake because [of] the physician-patient relationship, access to appropriate health care and frankly, concerns around state legislators dictating what type of care people can and can’t receive — all these things should worry members of any and every [medical] professional society.”

Kaminski partnered with Kathleen Akgün, associate professor of pulmonary medicine at the Yale School of Medicine, to write an article in the journal of the American Thoracic Society. Akgün clarified that the views she expresses are hers, not of the ATS Ethics and Conflict of Interest Committee, which she currently chairs. The two Yale physicians called on medical professional societies to not sponsor large meetings in states that strongly restrict access to abortions. 

Kaminski emphasized that Equity Florida, the largest LGBTQ+ organization in the state, recently issued a travel advisory suggesting that Florida is unsafe for people who can become pregnant, communities of color and LGBTQ+ people. He called on medical societies to take a similar stance.

Drawing on her background in clinical ethics, Akgün emphasized the field’s four main principles: beneficence, nonmaleficence, autonomy and justice. She felt that the Dobbs decision violated the principle of autonomy by eliminating a person’s ability to control what happens to their body. Akgün said it was “inexcusable” that a patient would be forced to carry on with an unwanted pregnancy, and argued that restricting healthcare for half the population would set the country back by decades. 

“When patients are put in positions beyond their control due to state control, that’s certainly a bridge too far,” Akgün said. “I felt as though human rights were under attack.”

In deciding to not host events in states that ban abortion, Akgün hopes that medical societies can put pressure on states in an organized fashion and counter anti-abortion groups. Akgün acknowledged that some societies may not be able to change contracts already made with convention centers without paying a penalty, but emphasized the importance of advocating through boycotts.

Medical societies attract thousands of medical professionals to their days-long annual meetings. Money does not just go to the convention center they reserve — by patronizing local businesses, society members offer a substantial financial incentive for states. According to Akgün, one argument against their boycott has been the potential losses faced by community members in anti-abortion states, but she emphasized that in general, it is not guaranteed that every state will get to host a meeting. As Gross put it, if you put your medical conference in one state, you are already not putting it in 49 other states.

“As far as the idea of ethical consumerism, why would you bring these tremendous resources to states that are enacting these [anti-abortion] laws?” Gross said.

Gross is a primary care doctor who has been on the Yale School of Medicine faculty for 20 years. In an editorial written with Yale Law School professor Katherine Kraschel, he laid out the clinical and ethical considerations for holding society meetings in states that protect abortion rights.

Gross acknowledged that not every member of a professional society will agree about access to abortion. However, medical professional organizations should have a mechanism for reaching a consensus. Though unanimity is unlikely in any case, he argued that organizations need to take a stance, and said that “frankly, to not act, is acting.” 

Some people have expressed to Gross that taking a stance on abortion could lead to a “slippery slope,” in terms of then having to address the “myriad” of other political issues. However, he argued that this argument is used as a “wedge” to avoid making tough decisions and having contentious conversations.

“It sounds very reasonable on the surface, but also it can be used by people in positions of power to never make a stand on anything,” Gross said. “[Against] any potential egregious law or human rights violation because ‘that might be a slippery slope.’” 

Gross argued that societies need to reflect on what professional norms and values they hope to espouse. If those norms include a desire to preserve the doctor-patient relationship, then it matters that patients have a right to choose, and that there is not disproportionate harm posed to women of color and people with fewer resources, he said. 

Gross urged societies to “vote with their feet” and hold meetings in locations consistent with those values.

“I do not have the expectation that every single physician is out there marching in the streets, getting really active politically,” Gross said. “However, it is naive to think that medicine is not a political undertaking. It is detrimental to the profession if physicians recede into the woodwork when there are critical public health and societal issues that affect the wellbeing of people and patients in our society.”

In 2021, the American College of Obstetrics and Gynecology, alongside 24 other medical organizations, submitted an amicus brief in the Dobbs case that opposed abortion restrictions and emphasized the potential harm to patient wellbeing and the patient-clinician relationship.

The post Yale physicians call on medical societies to boycott states that ban abortion appeared first on Yale Daily News.

I’ve seen “the talk” on TV, but I’ve never heard of an Asian parent giving one. To be clear, this is not a scientifically robust observation — I’m sure there are outlier Asian parents who talk about sex with their kids freely. But that is overwhelmingly not the case. Though the silence often comes from a place of protection and love, the stigma around women’s health is frankly outdated.

It’s hard to become a woman, but even harder when shame and secrecy surround it. In this generational cycle, the potential for inherited wisdom evaporates in place of stigma-laden silence. 

I spoke to women from a range of Asian backgrounds to compare our lived experiences and start (finally) opening up conversations. 

Menarche: the start of it all

Girls typically get their first menstrual period — called ‘menarche’ — between ten and fifteen years old. It’s the first sign of womanhood as hormones hijack the body. Nikita Paudel ’25 described her first period as “very traumatic.”

“What I understood when I was a child was that when you get your period, you kind of don’t really have your freedom anymore because bad men, bad people can abuse you and you can become pregnant,” Paudel said. “I vividly remember not wanting to have my period because I was afraid that my freedom would be stripped from me.”

That’s what she understood from family and the general chatter around periods in her Nepali culture. Paudel, like me, attended Baltimore County public schools, so she said she also had the “little course” in elementary school where they give you deodorant and explain what a period is biologically. But she recalled still not fully understanding what it meant “socially” to have a period.

From a young age, Paudel noticed the taboo and shame that came with menstruation, “at least in [her] Nepali household.” Her period came when she was 11. Unsure if it was her period or not, she showed the stain to her mother.

“I kind of remembered seeing an angry or disappointed face on my mom’s face,” Paudel said. “And I started bawling my eyes out in front of her, just realizing that like, ‘Oh, I don’t know, is my mom disappointed in me?’ I was just confused.”

Paudel said that in the western parts of Nepal, there is a practice called “Chhaupadi,” which restricts a woman’s activity while on their period. The most extreme versions involve sending women to an outside hut. According to the UN, the practice continues, perpetuated by myths surrounding menstruation, even though the Supreme Court of Nepal banned chhaupadi in 2005.

Though Chhaupadi is technically banned, Paudel noted that some of those practices and the stigma that surrounds menstruation “still linger on.”

For the first couple days of her period, she was not allowed to eat at the family table, come into the kitchen, or go near the prayer room. For around three days, she tried to follow these rules, until her dad interjected and said, “At that point, why don’t you just throw her out?”

Paudel said that at age 11 and through high school, she would have interpreted her mother’s reaction to her first period as “disappointment.” But at 20 years old, knowing her mother better now, she would say her mother was more “scared” than anything. 

“Because now, I am going into a different phase of my life where people can hurt me,” Paudel said. “And my body changing and me turning into a woman, I think that had a lot more to do with it than disappointment […] Upon a lot of reflection, I do think it was just her being worried or her not fully understanding what was going to happen.”

Paudel noted that taboo around menstruation is seen around the world, but she suspects it to be “more concentrated” within Asian families and immigrant families in general. She compared it to topics such as mental health, which aren’t really discussed among immigrant families.

But things have gotten “much better” since, Paudel said, and menstruation is no longer a taboo in her house. She found that living in America influenced her parents’ thinking, in terms of understanding of what it means to be on your period. 

Ngọc-Lynn ’25, who is Vietnamese American, and Ariel Kim ’25, who is Korean American, both said that periods are considered “natural” and “normal” things to talk about in their households. However, Kim mentioned that it is considered good “manners” to hide menstrual products, such as by wrapping a pad in toilet paper when throwing it out, so that others can’t tell when you’re menstruating. Aeka Guru ’25, who lives in India, said that when someone buys a menstrual product, it’s often wrapped in newspaper or an opaque black bag. Across different Asian cultures, there seems to be a sense of wanting to hide when you’re on your period due to stigma.

Karley Yung ’25, who is Chinese American and the president of the menstrual equity group YaleBleeds, connected the stigma surrounding women’s health in Asian cultures to women still being seen as “the inferior gender” whose issues are “not considered worthwhile” to discuss. Her experience with menstruation was speaking about it in hushed voices and hiding her pads. 

“It took an incredible amount of convincing for my mom to get me tampons and let me eventually use a menstrual cup, given the stigma and ‘relationship’ of using internally inserted menstrual products with virginity,” Yung said. “I found this to be very frustrating.”

Guru said that her household is a little more progressive, in terms of her talking openly about her period with her parents. She also brought up how in her culture, there is a religious ritual conducted when a girl gets her first period. It’s a beautiful celebration of a girl becoming a woman, that gathers the whole family to give you gifts and to throw rice and flowers on you. Guru sees progress in breaking down the taboo around menstruation — some companies in India are even offering period leave. 

“But I still think just in general, becoming a woman is really difficult,” Guru said. “Especially in households where even some mothers may not feel comfortable talking about their own lives, it could be difficult for daughters because they feel like they don’t have an ally.”

Menarche is the first step in becoming a woman, and the silence around it foreshadows the greater shroud of mystery around women’s health topics in Asian families.

So you want to get on birth control?

Paudel’s best friend from home used to throw up every time she had her period. So, the friend’s parents, who are white American, got her on birth control when she was around 11, and that was that. But when Paudel started having symptoms “degradative” to her health, she knew it would not be the same for her.

In her junior year of high school, Paudel had to be taken to the nurse’s office because she almost fainted from the severity of her period symptoms. Her doctor agreed that birth control would be a suitable next step for managing her symptoms. But Paudel’s family was very hesitant.. 

“Why do we need to be on it? This is for grown women, this isn’t for kids like you,” Paudel recalled her mother saying to her. 

The general sense was that the only reason to use birth control was to prevent birth, Paudel said. According to her, there is plenty of misinformation around birth control within Asia. Common concerns are that birth control causes infertility, or that birth control is only an excuse to have sex. 

Though Paudel eventually convinced her mother to let her get birth control, she noted that many of her Asian friends have had to do “some crazy things” to get birth control. One friend tried going to her doctor to get birth control confidentially, but the insurance bill was sent to her home, landing her in trouble. 

Yung had a similar experience. In her Asian household, discussion of birth control as a method to control heavy or painful periods gets shut down, as it would be “unnatural.” 

Huynh said that there is often an educational barrier when it comes to Asian parents’ understanding of birth control. Her parents did not have sex education in Vietnam, and they grew up in a time when birth control was not common or accessible. This makes birth control a more taboo topic. 

In my women’s health seminar this week, our guest speaker said “the pill” freed women from the chains of their biology. Likewise, Asian friends have expressed to me that their parents should be happy they were “being safe,” but the stigma is pervasive. Even when away at college, the newfound independence and bodily autonomy comes with anxiety you can’t seem to outgrow.

I asked Guru, who has experience in educating on sexual health-related issues, for advice on asking Asian parents for permission to get on birth control. Her personal advice was to demonstrate to parents that you’ve done your research on birth control, including potential side effects and risks, and emphasize that you want the kind of relationship that enables open conversations.

I still could not imagine asking my parents for birth control. But I agree with Guru that most Asian parent-child relationships do not enable talk about contraception and sex. And to me, that’s dangerous.

If you’re not giving me ‘the talk,’ who will?

When you ask an Asian parent where you came from, a common joking response is “we found you in the trash.” For Huynh, this answer represents the greater mystery around sex education and women’s health topics in Asian families.

Huynh mainly relied on her older sister to teach her about periods. But when it came to birth control and sex, even her sister didn’t want to discuss it for fear of encouraging sexual activity.

The problem is that a parent, armed with the wisdom of lived experience, is naturally the best guide for a child. However, in Asian families, when mothers can go as far as to cover their child’s eyes during kissing scenes in movies, physical affection is not so normalized.

Paudel never saw people kiss in South Asian media during her childhood, whereas she had heard of non-Asian friends watching sex scenes (embedded in Western movies/TV) with their family. 

“As an Asian woman, college comes with a lot of unlearning and relearning what sex is and how to talk about it,” Guru said.

It was “nerve-wracking” and a bit “crazy” for Guru to see sex talked about during first-year workshops with CCEs. She could not believe that there were condoms openly on display in laundry rooms. But she eventually became more comfortable. When Guru told her parents she became a CCE, they were surprised at how okay people were with talking about sex. Guru has made an effort to talk to her family more about the sex-positive culture here. Now they’re a “bit more open” to it, though she said they probably see her more as adjacent to the culture or “at least watching it” then involved in it.

Guru emphasized that immigrant parents who did not go to college in America may assume that the often sexualized depictions of college life in TV shows and movies mirror reality. Guru has not “had those conversations” with her parents yet. She thinks it is better to try “chipping away” rather than “shattering” their norms when it comes to sex. One day, maybe you could even ask about a parent’s first time and advice for safe communication surrounding sex — but that takes time. 

If you don’t get the talk, your ideals and norms of sex may not be realistic, Guru said. It may come from the movies or porn, which contain behavior that is not always healthy and shouldn’t be emulated. Even peers may have misconceptions when it comes to ideals for sex, so talking to them isn’t always the best resort.

Huynh found it comforting to go through the Communication and Consent workshop as a first-year, since most conversations she had around sex and consent beforehand were from the internet.

“It was affirming in a way,” Huynh said. “It felt like we were all on the same page, and we all agree that this is how it should be. I can’t believe it took me till I was 18 to have this talk. I wish I could have had this when I was younger.”

She said sex education provides important knowledge about consent and healthy conversations — whether you are currently sexually active or not.

“We rarely talked about sex explicitly in my family, and when we did, it was only spoken about in a way that told me that sex was only for procreation,” Yung said. “At no point was pleasure or intimacy discussed; in fact, I was taught that as a woman, it was supposed to be painful but something I needed to do to have kids.”

Huynh noted the nuance of growing up with two different cultures as Asian American women. One culture may be “telling you not to talk about this” while another is saying “speak out, learn about this.” Parents who grew up in Asia may not understand that experience, growing up in a time where hypersexualization happens at a young age, Huynh said. She recounted already being insecure about her body in fifth grade.

To Huynh, in the age of social media it feels “almost inevitable” that children will find out about sex. It’s either internet sludge or a mature adult to guide a child through this phase of life.

Breaking the cycle

Though the job of raising a girl into womanhood should fall on both parents, a mother is a daughter’s natural role model and mirror. And if we’ve learned anything from the Oscar-winning Everything Everywhere All at Once, it’s the complexity of mother-daughter relationships in Asian culture. It’s hard to judge our moms for their silence or their perpetuation of stigma because they too endured it all.

“My mom also had a very, very rough coming of age into womanhood,” Paudel said. “And I didn’t really fully understand her story. At the end of the day, she went through her own struggles and battles to get where she is today. While it would have been nice to have been able to talk about it, I also fully understand if she was not ready to unpack her own trauma coming into those conversations.”

Paudel said that if she ever has a daughter, she hopes to be a resource for her. 

Huynh also wants to break these cycles of silence, and personally show her kids how to go about things safely and feel supported. 

“My parents have been through so much, especially as refugees,” Huynh said. “But they just keep going and they don’t look at the past. I think that that’s why conversations about women’s health are still taboo, because there is a very dark history behind it.”

Huynh’s mother had her older sister at a young age, around 19.  

“She has told me like nothing about it,” Huynh said. “She’s never warned me about getting married, having kids younger — she never warned me against that either. That’s like a part of her life that she just does not talk about.”

I also only have a fragmented understanding of my mother’s upbringing. I know she was the youngest of seven daughters, and that she wore high heels while waitressing. I know she once had the “perfect golden tan” when she was ten, and now the sun just burns her. But when I ask her deeper questions, she often acts as if her history were irrelevant to me. 

Our mothers had to become women once too. It’s not fair to blame our mothers for deeply-entrenched cultural stigmas around womanhood that they too are confronted with. And it’s too late to be raised any differently. So, perhaps the most important part of opening up these conversations about Asian womanhood, is learning who our mother was before she was our mother. What did becoming a woman mean to her? 

Moreover, what did becoming a woman mean to you?

The cycle ends with us. Let’s talk.

The post Becoming a woman when you’re Asian in America appeared first on Yale Daily News.

On March 7, the Connecticut Hospital Association, which represents hospitals and health-related organizations across the state, released an analysis of the pandemic’s impact on the financial health of the hospitals they represent. Commissioned by the American Hospital Association, the report revealed that the median operating margin dropped nearly 67 percent from pre-pandemic levels across Connecticut hospitals, compared to a national average decline of 20 percent.

“This is not a sustainable situation,” Syed Hussain, chief clinical officer of Trinity Health of New England, told the News. “Ultimately … we will be forced to look at programs and offerings and initiatives that we’re currently able to offer to the community and say, ‘Okay, what can we not offer?’ Because we can’t continue running in the red.”

Trinity Health of New England, Yale New Haven Health System and Hartford Healthcare are the three largest health systems in Connecticut, controlling the majority of acute care hospitals in the state. Citing the economic repercussions of the COVID-19 pandemic, Connecticut Health Association explained how plateauing revenues and soaring labor expenses have resulted in unprecedented financial strain for these health systems. 

While Connecticut Health Association leaders argued that under-reimbursement for Medicaid and Medicare, inflation and expensive temporary labor were to blame for the losses, health policy experts weighed in with alternate perspectives on the situation. 

First year of deficits

After 50 years of profit, Yale New Haven Health System faced their first financial deficit in FY 2022. Last year, former YNHH vice president Vin Petrini said that YNHH was budgeting for a $250 million deficit in 2023. Dana Marnane, YNHH director of public relations and communications, confirmed that Yale New Haven Health System projected a deficit for FY 2023, but declined to comment on the specific estimate. 

“I cannot speculate at this point on how the year might end, but we are working hard to reduce costs to mitigate the deficit,” Marnane said.

According to Marnane, Yale New Haven Health System’s mitigation efforts include reducing the numbers of more expensive traveler employees, such as traveling nurses. She also cited the Prospect acquisition of three hospitals as an example of the health system’s investment in long-term growth and expansion of their clinical services across a broader geography. Some health advocates have expressed concern about this hospital consolidation, while Yale New Haven Health System continues to seek state approval of the transaction. 

Marnane cited COVID-19’s negative impact on the hospital system’s finances, pointing to increases in labor costs, supply costs, average lengths of stay in the hospital and medical complexity of patients who may have deferred care during the pandemic. 

However, Paul Kidwell, Connecticut Health Associations’ senior vice president of policy, explained that hospitals negotiate commercial contracts to acquire pharmaceuticals, medical supplies and goods like electricity on a three to five year basis, meaning quick rises in inflation are not immediately factored in.

Additionally, hospital losses were driven by the erosion of federal relief funds. While government policymakers formerly provided hospitals with CARES act funding and disaster relief payments from the Federal Emergency Management Agency, relief funds have now “dried up,” according to Hussain. 

In the case of Trinity Health, the Catholic health system operating 92 hospitals nationally, total revenue from the Provider Relief Fund grant decreased from $618 million in 2021 to $141 million in 2022. Kidwell emphasized that the lack of federal assistance will continue to drive margins downward in 2023. 

Trinity Health of New England, which is housed under the national organization and comprises four Connecticut hospitals and one Massachusetts hospital, emphasized challenges with workforce retention. Trinity’s dependence upon contract labor has been costly — traveling nurses, according to Hussain, can be paid up to three times the salary of normal nurses. 

While revenue has remained mostly flat, increased costs associated with sicker patients, labor shortages and inflationary supply chain costs have taken their toll on the hospitals’ operating margins.

Hussain declined to provide the specific deficit amount for Trinity Health of New England. Nationally, Trinity Health’s FY 2022 audit reported a net loss of $1.4 billion, compared to its $3.8 billion net profit in FY 2021. 

Hussain emphasized the need to invest in workforce growth and retainment. Leveraging newer forms of health delivery, such as telehealth and home-care service, has allowed Trinity Health of New England to supplement and support its current workforce. Hussain also pointed to a recent partnership with local colleges and schools to create a stronger recruitment pipeline. However, such investments require collaboration with the larger communities they serve, Hussain said. 

“We need all folks at the table to be able to ensure that we’re able to continue to invest in our healthcare systems and services and programs that ultimately benefit the community,” Hussain said. 

Hartford Healthcare did not respond to multiple requests for comment.

Some health policy experts expressed skepticism about the factors cited by Yale New Haven Health System and Trinity Health of New England. One study attributed the bulk of hospitals’ financial struggles to poor investment performances. As the economy declined in 2022, large health systems, which invest heavily in stock markets, faced similar losses. Nationally, Trinity Health, which saw positive returns of 26.0 percent in fiscal year 2021, ran a negative 8.4 percent investment return in fiscal year 2022. 

As a result, the Health Affairs report urged caution in pursuing large-scale policy decisions to offset health systems’ losses from “risky” investments, which it stated will likely be recovered in future years.

Hospitals, policy experts debate Medicaid/Medicare reimbursement

According to the Connecticut Health Association’s report, Connecticut hospitals lost $1.12 billion from Medicare and $993 million from Medicaid, with Medicaid paying hospitals “68 cents on the dollar” for healthcare costs. In a press release, Connecticut Health Association further argued that Medicare and Medicaid payment updates are not matching inflation rates, while commercial insurance contracts will take years to catch up to increases in expenses post-pandemic. 

Nonetheless, Henry Dove, lecturer in health policy and former director of Yale University-West Haven Veterans Health Services Research program, cautions against taking the Connecticut Health Association’s numbers at face value. While Medicare/Medicaid reimbursements indeed pay less than those of private insurance companies, the discrepancy may be “overstated” in the report, according to Dove.

As Dove explained, each hospital sets a gross charge for each service provided to a patient, which they tally in the bill submitted to insurers. However, insurers have their own allowed amount that they negotiate with the hospital, representing the maximum amount they are willing to pay. As a result, the gross charge is hardly ever paid in full — it becomes a “meaningless number,” Dove said, which hospitals can set arbitrarily. 

“The hospital will claim ‘Oh, this patient cost $20,000,’” Dove explained. “It makes it look like they lost a ton of money on these patients … While they truly did lose money on the Medicaid patients, whenever they count up their losses, they often use gross charges, which is a fictitious number.”

According to Connecticut Health Association’s March 7 press conference, Connecticut ranks 48th in the nation for Medicare/Medicaid reimbursements. Kidwell argued that hospitals compensate for financial loss to Medicaid/Medicare by negotiating with commercial insurers to subsidize the deficit. As Dove explained, they depend heavily upon these privately-insured individuals to turn a profit. 

However, this means that hospitals that cater to underserved patient populations find it more difficult to cover their costs, according to Hussain. He noted that the problem would worsen with the May 11 expiration of the federal Public Health Emergency, declared under Section 319 of the Public Health Service Act, as some individuals auto-enrolled in Medicare may lose access to insurance altogether.

“We need increases both from a payer side, as well as other key players that are part of this problem,” Hussain said. 

However, Ted Doolittle, the state healthcare advocate, said that “significant scholarship” has shown that increasing the price of Medicaid “does not ever” result in a decrease in commercial prices. He cited an article that showed that a 10 percent reduction in Medicare rates in a given region reduced private insurance prices.

Further, unlike commercial reinsurance rates, Medicare reimbursement rates are “rooted” in the hospital costs, Doolittle argued. Medicare sets its rates based on annual cost reports filed by all hospitals in the program. 

“It is very often the case that [when] negotiating rates, the insurance companies really don’t care that much about the hospital costs,” Doolittle said. “In fact, the insurance companies generally, by the larger systems, get dictated what the price will be.”

Kidwell additionally emphasized the impact of low reimbursement rates on access to care. Specialists, for example, may not accept Medicaid patients based on pay, he explained. Kidwell reasoned that patients without access to specialty care may end up using emergency departments more frequently as opposed to seeking a continuum of care at the hospital.

“For a long time, the state has very proudly talked about how they have limited the growth of their Medicaid program,” Kidwell said. “And that means really restricting payment for hospital and specialty care. That’s how you maintain such a low spending rate in your Medicaid program.”

The deficit continues

Kidwell said the first fiscal quarter of 2023 is “not looking better” than 2022. Hussain alluded to having to cut programs and initiatives in the future, if the deficit were to continue indefinitely. However, he said that Trinity Health of New England has not made any immediate changes because of the deficit. 

YNHH wrote to the News that they have made significant investments in “recruitment and retention” as a result of staffing shortages, but did not specify if the deficit had forced them to change operations in any way. Likewise, Connecticut Health Association called for financial assistance to meet workforce needs across the state’s healthcare systems.

Kidwell emphasized that a positive margin allows systems to go beyond just maintaining current operations. Prolonged deficits threaten the ability of hospital systems to expand services offered to the community, he said. 

However, Doolittle called the extent of the financial strain into question, pointing to the raft of new facilities that continue to be built across the state.

“Does that scream of a system that is strapped for cash? I don’t think so,” Doolittle said. “If I start seeing ‘for sale’ signs in front of those buildings, then I’ll start to believe that there’s a financial strain that they are coming under.”

Doolittle said he regarded skyrocketing healthcare prices as a problem in itself, noting the heightened revenue expectations of large systems. He contrasted this with the small independent hospitals in the state that run their hospitals “more efficiently” while charging lower prices. While large hospital systems may emphasize their deficits, Doolittle urged them to learn from these smaller institutions. 

The Connecticut Hospital Association represents 27 of Connecticut’s acute care hospitals.

Correction 3/27: A previous version of this article incorrectly stated that financial figures from the national Trinity Health system were from Trinity Health of New England.

The post Connecticut hospitals face record financial losses appeared first on Yale Daily News.

The Spring Fling music festival will take over Old Campus on Saturday, April 29. The day-long event will kick off with performances by the three student acts that win the upcoming Battle of the Bands on April 8. Ravyn Lenae will open the line-up, followed by Dombresky. Pusha T, this year’s headliner, will close the show. Students will each be allowed to bring one guest to the festival.

“I personally was shocked when [Pusha T] said yes,” said Renée Theodore ’24, one of the four Spring Fling committee co-chairs. “Because he, in my mind, is such a legend. I’ve been listening to him since I was a kid with my parents… It’s a huge honor to have someone like that who is so storied in the world of rap and hip hop come play for Spring Fling.”

The lineup selection process began in September. The Spring Fling committee, composed of 27 undergraduates, sent a survey to all Yale students to gather feedback on last year’s festival and note current trends of student preference in terms of genres and artists. 

This year, committee members built a website that compiled Yale students’ Spotify information. Called “Yale Wrappd,” the database summarized Yale’s top Spotify artists and created a playlist of the most popular songs among students. The committee then used those trends to predict the artists and genres that students were most interested in hearing. The pop and hip hop genres saw the most listeners.

With this year’s three-artist lineup, the committee hopes to create a musical journey for attendees. Tess Levy ’25, committee co-chair, said she envisions people swaying and singing along to Lenae’s “more relaxed sound.” She then hopes that Dombresky will rally the crowd with electronic dance music, followed by a “high energy” performance from Pusha T. 

The opening artist, Ravyn Lenae, is “one of the biggest rising stars” coming out of Chicago, according to committee co-chair Paula Toranzo ’25. The 24-year-old singer-songwriter is signed to Atlantic Records and the Three Twenty Three Music Group. Her music fuses R&B and soul.

“She has a velvety voice,” Toranzo said. “Genuinely it puts you into a trance. Her latest album is literally called ‘Hypnose’ and that embraces exactly what she is.”

To Toranzo, Lenae’s music is about self-love, with songs that promote “being confident in your own body” and “embracing your life.” Toranzo predicts that Lenae will bring together the crowd at her sunset performance. 

The committee judged potential artists based on their ability to connect with their audience, using videos of past performances as a metric, Toranzo explained. 

“Stage presence is huge,” Toranzo said. “And Ravyn Lenae, she has that. She connects with her crowd, she makes them sway, like cry. It’s really beautiful.”

A serendipitous event followed Lenae’s selection: one day, Levy and Toranzo were eating in the Commons Dining Hall when a group of students approached them with a list of Black artists they hoped to see represented at Spring Fling. Ravyn Lenae was one of them. Though the committee had already picked her out for the lineup, this feedback made them feel affirmed that they had made the right choice.

Levy emphasized that when admitting new students to the Spring Fling committee, they aim to create a group that represents the whole Yale community, in terms of both genre interest and identity.

“I think it will be very powerful to bring a Black woman artist onto this campus and really show the communities here on campus that might not always feel seen, that they can be on that stage, that they can be a big name,” Toranzo said. “That they don’t have to follow any typical trend or stereotype.”

Dombresky will follow Lenae with a set of electronic dance music. The French DJ has been mixing and producing music for around 15 years and belongs to the Insomniac record label. 

Levy credited last year’s lineup with EDM’s return to Spring Fling. She recalled students “dancing and feeling very free” during EDM artist Sofi Tukker’s set. Toranzo corroborated this, describing the genre as one with “undeniable energy.”

“One of the big takeaways from last year… was the power of having EDM artists or a DJ where people don’t need to come in knowing any lyrics,” Levy said. “All we need is people to come in with the energy to dance.”

Levy emphasized Dombresky’s knowledge of music production and his popular EDM tracks, “Down Low” and “Soul Sacrifice.” Based on videos of his past performances, she said she’s excited for him to rally the crowd.

Pusha T, the festival’s headliner, has been in the music scene for three decades, ranking as one of Billboard’s top 50 rappers of all time. Compared to previous lineups, which have tended to feature up-and-coming artists, Theodore noted that Pusha T is “very established.”

“I’ve never seen him live, [but] every video I’ve ever seen of him gives me chills,” Theodore said. “When I think about his name up on the screen, I literally start sweating a little bit. I think a big part of the reason we decided to go with him is because there’s an undeniable quality to his music that is pretty much unmatched by anybody working today.”

According to Toranzo, the committee wanted to bring someone to campus whose work they respect and whose legacy was widely known. Zack Hauptman ’25, committee co-chair, praised not just Pusha T but also the artists with whom he collaborates. He cited Lauryn Hill, who Pusha T has a song with, and the Pharrell feature on the rapper’s recent album.

Hauptman, who is also an associate editor of the Yale Daily News magazine, said Pusha T will bring energy like “almost no other artist or rapper” could.

In light of last February’s student movement advocating for Pitbull to headline the festival, the four co-chairs recommended reaching out to the committee with recommendations early, particularly around September.

“It’s really helpful to have that student feedback, and we take it seriously because at the end of the day, our job is not to satisfy our music tastes,” Levy said. “It’s really to make Yale happy and to give them the day that they want.”

The event welcomes all with no specific target audience in mind, said Levy, who praised the event’s accessibility. Students will not have to pay for tickets or food, and ASL translators will be present to ensure that everyone can enjoy the experience.

Throughout the school year, the Spring Fling committee builds excitement for the event through “Tiny Dorms” — a set of filmed concerts that take place in student’s rooms in the style of NPR’s “Tiny Desk” series — and Battle of the Bands. Their goal is to give art the space it deserves on campus, Levy said. 

Theodore said that Spring Fling, as Yale’s biggest student-planned event, comes at the perfect time of year, when classes have ended and reading week has just begun. 

For students less familiar with Pusha T, Toranzo’s message is “trust us.” She said that when Pusha T comes to campus, even if a student enters the festival unable to name any of his songs, once they hear him perform, it’ll click.

“He’s King Push, he’s everlasting,” Theodore added. 

This year’s Battle of the Bands will be held on Apr. 8 at the Yale Farm.

The post Pusha T to headline Spring Fling appeared first on Yale Daily News.

The symptoms started when she was 16. Things felt cloudy during these episodes. She chronically vomited and was unable to walk. Then a high school sophomore, she sought out doctors for help. They gave her Tylenol. Her blood tests were normal, her scans were normal — nothing seemed out of the ordinary, so she left the doctor’s office, unchanged, and the episodes persisted.

Garzon recalled being “shut down a lot” when she visited doctors. From a low-income background, she turned to clinics for patients with low-incomes, where she was repeatedly told to take pain relievers like Tylenol or Midol. They told her “you’ll be fine… like, you’re not gonna die, basically,” Garzon said. Even when she went to the hospital, she was told her pain was just “the menses” and was “normal.”

Then when she was 18, she collapsed in the shower.

“It was the start of my menstrual cycle, and again, I couldn’t see, I started shaking,” Garzon recounted. “It’s just a pain that I can’t necessarily describe to you. It’s just horrible. Like, even looking back, I can’t even imagine the pain myself.”

Her boyfriend drove her to the hospital, where doctors performed scans and ultrasounds. Everything came back normal. They referred Garzon to a gynecologist, who — noting that her pain coincided with her menses — wrote her a prescription for birth control. She still didn’t have a diagnosis.

It takes an average of seven to 10 years to diagnose endometriosis, a condition where tissue that usually lines the uterus grows outside of it. Endometriosis affects one in 10 women worldwide.

When endometrial-like tissue sprouts in irregular places, from the ovaries to the intestines, common symptoms include painful periods, excessive menstrual bleeding, pain during bowel movements and intercourse, chronic fatigue and infertility. These growths can also cause inflammation, leading to scarring and adhesions between organs. 

The recently launched endometriosis working group of the Connecticut General Assembly hopes to ease the burden of this disease. Since their first legislative session in September 2021, the group has passed and proposed bills, ranging from establishing a biorepository to training school nurses. Three patients, two doctors and the working group’s chair lawmaker weighed in on key priorities for endometriosis advocacy and action in the state.

Patient stories inspire state policy

State representative Jillian Gilchrest has now heard hundreds of women’s stories of endometriosis, but it all started with one. A female colleague reached out to Gilchrest about her experience being told that her symptoms were “all in her head” and were “normal.” 15 years into these symptoms, the colleague found out that she could not have children due to her endometriosis.

“As a feminist who has worked on women’s health and safety issues for quite a while, I was angry,” Gilchrest said. “I then started doing my own research and realized that endometriosis impacts one in 10 individuals with a uterus and that, as a predominantly women’s disease, is under-researched, underfunded and there’s just a complete lack of knowledge amongst healthcare professionals about what endometriosis is.”

This motivated Gilchrest to form a working group in 2021 to promote awareness of the condition and try to pass policy to improve patients’ experiences.

The working group meets once a month with a composition that ranges from patient advocates to associations like the Connecticut Hospital Association. According to Gilchrest, state agencies such as the Department of Mental Health and Addiction Services also participate because many individuals with endometriosis turn to self-medicating, linking chronic pain to suicide risk. This year, the working group introduced two policies in front of the state legislature’s public health committee.

Training school nurses

On Jan. 19, Gilchrest introduced a bill before the Connecticut General Assembly to require endometriosis training for school nurses. The proposal called for school nurses to be taught about endometriosis, including information on systemic racism, bias and racial and gender-based disparities related to the condition.

The policy would establish a school nurse training program through which nurses would receive continuing education credits. The program was designed by an organization of patient advocates, known as Endo What? According to Gilchrest, the intent behind this legislation is to build awareness of the condition and get individuals into treatment sooner.

“Our hope is that if school nurses can have this knowledge when a young person presents in the nurse’s office because they’re doubling over in pain, or is missing a lot of school because of the pain associated with their period, they might be able to say to them, ‘Hey, you might have endometriosis. You might want to get that checked out,’” Gilchrest said.

Garzon remembered going to her school nurse for menstrual pain, who “wouldn’t know what to do.” She was offered an Advil, ice pack or heating pad or asked if she wanted to call her parents. Garzon found it invalidating for her pain to be treated “as if it were any other thing.” The pain was draining, and would take her out of school for two days each cycle. She learned from these experiences to avoid the school nurse altogether. Instead Garzon would call her parents to take her home.

“So many young girls are just sent home from school because of severe period pain usually, and they’re told that it’s all normal, but they keep missing school, they keep missing out on social life,” Veronika Denner ’24, an endometriosis patient advocate, said. “There’s currently a lack of education, not just among nurses but also of the students.”

Given how common the condition is, Denner believes that if a school nurse knows about diabetes and asthma, then they should also know about endometriosis. 

Terri Huynh, a Yale Medicine obstetrician-gynecologist and assistant professor at the Yale School of Medicine, emphasized that endometriosis symptoms tend to present in women starting in their teens or early twenties, with painful periods that could stop them from attending class. In dealing with this pain, their first line of access may therefore be the school nurse, she explained.

Huynh thinks it’s reasonable for school nurses to be educated on endometriosis as a possible source of painful periods and pelvic pain. Rather than nurses managing the condition alone, they could realize when a student’s experience is concerning and recommend them to a gynecologist, hopefully shortening the typical lag in care.

“It’s such a complex disorder that it may be out of their scope,” Huynh said. “But it’d be reasonable for them to have some understanding of maybe ‘this is the source of why you keep coming in all the time to see me for pain around your periods and you should be referred to a gynecologist or provider who’s comfortable with managing endometriosis.’”

Yonghee Cho, a Yale School of Medicine obstetrician-gynecologist and assistant professor, emphasized the variability of the disease’s presentation as a cause for delay too. Often patients may get diagnosed with conditions like irritable bowel syndrome or fibromyalgia, when really they have endometriosis. 

Denner echoed this, having previously only heard of endometriosis in the context of periods and reproductive issues. She found endometriosis is commonly misrepresented as a “menstrual disease,” which is not always the case. Her own cyclical symptoms were never the worse during her menses — they primarily struck during ovulation and coincided with gastrointestinal symptoms. Her doctors did not even consider that she could have endometriosis, and instead say she was just “bloated” or perhaps had a stomach ulcer. 

“Like most people with endometriosis, I was told that it’s all in my head,” Denner said. “That cyclic pain is just part of being a woman, that my problems are just really trivial, and it’s not really pathological for many years until in December 2021 I had so much pain that I could not get out of bed, some days. I couldn’t eat, some days. I was just absolutely incapacitated.”

To Cho, despite the disease’s prevalence, it remains under-discussed across “all medical education.” Some of her patients may have never heard of endometriosis prior to diagnosis. Others had done their own research and had been suggesting it to past providers for years, but “couldn’t get somebody to listen to [them] about it,” Cho said.

“It is an incredibly painful and crippling disease for some patients, but I don’t think it’s viewed in the same way that you would view other chronic conditions,” Cho said. “I think these women are also stigmatized, when they’re having these really significant episodes of pain and it’s bleeding into other areas of their work.”

Gilchrest has met with the Connecticut School Nurses Association, who she says understands the issue of the lack of endometriosis training. She hopes to partner with the organization in efforts to expand the quantity of continuing education credits nurses are required to have. 

Last year, the working group successfully passed a policy to require physicians to receive continuing education on endometriosis. The group also hopes to eventually integrate endometriosis into the statewide sex education curriculum.

Establishing a biorepository

On Jan. 20, Gilchrest introduced a bill to establish an endometriosis data and biorepository program. Biorepositories are collections of biological samples used for research. This proposed program would enable research to promote earlier diagnosis of endometriosis, new treatments for the condition and early access to therapeutic options for patients in Connecticut.

Last year, the working group passed legislation to create a study on how a biorepository program could be created.

“We’re hoping that Connecticut can be a hub for innovation with regards to diagnosis and treatment of endometriosis,” Gilchrest said.

According to Gilchrest, the biorepository would be a partnership between University of Connecticut Health and Jackson Laboratory with the hopes of expanding to other hospitals in the state. They will collect tissue samples from individuals who have endometriosis. 

To Dora Koller, a postdoctoral scholar at the Yale School of Medicine, the diversity of the United States makes it an ideal place to start a biorepository. She had previously done research on endometriosis through the UK Biobank, which she found had around 9000 endometriosis patients. However, she noted that the majority of major biobanks with endometriosis patients are based in Europe. This means most samples come from people of European ancestry, leading to inequality across other ancestry groups, she explained. 

“I think the US is the perfect country to actually collect samples from different ethnicities,” Koller said. “Because if you think about Europe, it’s getting more and more diverse, but many countries are quite white only … We really need to make an effort to also make this inclusive.”

Koller had researched the psychiatric comorbidities of endometriosis. She noted that funding for endometriosis is “really, really low,” despite its high prevalence among women. She did not receive funding to do this study — it was a side project. To her, the most important policy would hold government leaders accountable for opening discussion of endometriosis.

“Many times they call these diseases invisible, [but] they are not invisible, we make them invisible,” Koller said. “Because they make us feel uncomfortable …This is an epidemic, and it has to be talked about. If we talk about it more, if we advocate for it more, more money will be available for this research.”

She noted that the same situation happened with breast cancer, which was “also invisible.” But when people started to advocate for it, money and awareness increased.

Koller herself has endometriosis, and faced a diagnostic delay of 15 years before finally receiving surgery. 

According to Cho, the gold standard — and only definitive option — for diagnosing endometriosis is laparoscopic surgery, which entails removing and pathologically diagnosing lesions of tissue from the abdomen and pelvis. Understanding the biology of the disease could enable better and earlier diagnoses, especially given the disease’s heterogenous presentation. Gilchrest hopes research using the biorepository could inform new diagnostic tools.

Yet even with a diagnosis, there remains no cure. Huynh described the disease as a chronic pelvic pain disorder. Treatment options for the disease all revolve around managing pain.

“Regardless of medicines and surgeries and other interventions out there to treat the symptoms of endometriosis, it is not a curable disorder,” Huynh said. The array of treatment options is for symptom management, in terms of achieving whatever quality of life, whatever pain goal the patient may have.”

Koller endured 15 years of symptoms and a series of contraceptives and pain medication before having to receive major surgery to remove the severe endometriosis lesions that spread to her intestines. Denner revealed that she had to go on a 10-month medical leave from Yale due to excruciating pain, after birth control failed to alleviate her symptoms. Garzon remains on birth control, but despises the side effects and hopes to get surgery after graduation. 

Gilchrest hopes Connecticut can be at the forefront of developing and implementing endometriosis treatments — upping the state’s available expertise on the issue. According to Gilchrest, the biggest challenge would be getting the funding for this policy, but she does not think it is “insurmountable.”

The story continues

Last October, Garzon received a call from her gynecologist that she most likely had endometriosis. It was “very emotional,” she recalled.

“I was scared because again, I’m low income — I don’t have many resources to go off and get the best surgeon in New York City or California to fix me,” Garzon said. “And it was also really scary because I want to have all the kids like I want to have a big family …so to see that that could potentially be affected and I could maybe never have kids.”

Huynh noted that many of her patients are on Medicare or Medicaid, which makes it hard for them to get treated for infertility. She hopes the working group pushes to expand coverage to infertility treatments. Gilchrest’s goal is to have endometriosis patients explicitly referenced in a state law that covers infertility treatment for cancer patients.

Gilchrest is also working with the Connecticut Hospital Association to figure out the insurance coding for endometriosis treatment. Currently there is only one code for endometriosis treatment, meaning doctors would only get paid for ablation surgery — where the endometriosis is burned off with a high chance of regrowth — and not excision surgery — where the endometriosis is excised with a lower risk of recurrence. Patients may have to go out of network to find a doctor willing to do excision surgery. Some doctors will not accept patients’ insurance because they cannot afford to be paid “so little” to do the excision, Gilchrest said.

Denner said she is “still in a lot of financial difficulty” from having endometriosis, especially as a first-generation, low-income student. Without insurance, she had to take out a loan to pay $5,000 dollars for her first surgery — and will need another surgery soon for remaining endometriosis on her diaphragm.

Garzon herself had a job in high school. It was the only way she could flush out $400 to $500 dollars each visit to the gynecologist every four weeks. Koller noted that not everyone has the “luxury” of being able to deal with endometriosis symptoms, let alone reach a diagnosis. 

“I experienced menstrual poverty myself,” Koller said. “I didn’t have money to buy tampons, and I had extremely heavy flow because I have endometriosis.”

The working group has seven priorities listed in total, from menstrual equity to access to medical care. Though the other proposals will take time to build for future years, Gilchrest believes the two current policies have momentum behind them, and are “ripe” to pass.

“Many of the women do finally feel heard,” Gilchrest said. “But it’s also just so sad that so many women have experienced a life of being denied care and made to feel like they’re crazy…a lot of my colleagues who didn’t know what the disease was [have shared] that they themselves maybe had experienced or were experiencing endometriosis or their wives or their children. It does seem like a disease that most people know someone it’s touched.”

The endometriosis working group’s next meeting is on Mar. 13 on Zoom.

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Bilott hesitated. As a corporate defense attorney of eight years, Bilott didn’t sue chemical giants — he represented them. But the situation was suspect. Diving into Tennant’s evidence, Bilott uncovered a tale of corporate corruption and its hazardous consequences. In a class action lawsuit against chemical company DuPont, Bilott represented 70,000 people whose drinking water had been contaminated with PFOA, a toxic chemical used to produce Teflon chemical coating. Perfluorooctanoic acid, or PFOA, is a man-made chemical used in non-stick and stain-resistant goods, from non-stick pans to fire-fighting foam. 

Not only were Tennant’s cattle drinking contaminated water, but the health of the West Virginia town’s residents was being endangered. Bilott ultimately secured a $671 million settlement for residents who developed kidney and testicular cancer from drinking the contaminated water. But when Bilott first filed the lawsuit, the Environmental Protection Agency was not even aware that PFOA was hazardous. Despite DuPont knowing of the risk as early as the 1970s, that information was hidden. It was not communicated to the regulators who could take action.

“It’s critically important that people be able to get outside of their little silos,” Bilott said. “When I started my work, I was focused on what lawyers are supposed to do, and we’re supposed to lay this all out in a legal brief … but it’s going into a court where it’s all being presented in legalese with case citations, and nobody else is reading any of that or paying any attention to it.”

Bilott, who became a lecturer at the Yale School of Public Health in 2021, wants to help public health students translate their work to the “real world” and defend against exposure to toxic chemicals. On Feb. 24, Bilott lectured and had lunch with students in a YSPH course called “Public Health Toxicology.” In his current role, Bilott also advises MPH and doctoral students in the Environmental Health Sciences department.

PFOA belongs to a larger class of chemicals called perfluoroalkyl substances, PFAS. Dubbed “forever chemicals,” PFAS compounds have a strong carbon-fluorine chain which makes breaking down the chemical challenging. However, that persistence also enables its favorable properties — PFAS are hydrophobic, allowing them to repel water and other liquids. This makes the chemicals effective for use in nonstick pans and firefighter foam, but near-impossible to eliminate fully from the environment or the human body. 

According to a study by the Centers for Disease Control and Prevention, 97 percent of people in the United States have PFAS in their blood.

In August 2022, 23 years after Bilott filed the lawsuit against DuPont, EPA proposed to designate two chemicals of the PFAS class as hazardous. Bilott hopes students learn from his decades-long battle against DuPont and find a way to communicate public health information effectively across different fields.

“He really is a pioneer of protecting public health,” said Vasilis Vasiliou, professor of the toxicology course and chair of the YSPH department of environmental health sciences. “All his work has caused awareness, globally, regarding these compounds and how this could be harmful to human health.”

When Bilott realized that regulators had “no idea” that PFAS were hazardous, he knew he had to translate his “legalese.” Digging further, he found that the scientific world was working on the same issues as he was, but “in their own little world” — much of which was not being translated back to lawyers or regulators. Bilott said that the research on PFAS was generally only presented in long scientific articles with dataset analyses of p-values and concepts that were foreign to lawyers. 

Bilott spoke to students about the need to translate the science behind public health threats to not only the people exposed, but to the legal and regulatory spheres. 

In the courts, the judges and the lawyers need to know why something is toxic, he said. Regulators who develop the appropriate safety guidelines and standards for chemicals, along with policymakers, need to understand the significance of that health threat.

“You have to be able to not create a panic to the public, but also explain,” Bilott told students.

During the PFAS lawsuit, Bilott realized his ultimate goal was to translate scientific information to the public. As media outlets started covering the legal battle, Bilott recognized the power of conveying this public health crisis to the people. 

In 2019, the film “Dark Waters,” which depicted the battle against DuPont with Mark Ruffalo playing Bilott, was released to widespread media attention.

“Now what we’re seeing is this group of chemicals that nobody could understand or pronounce or say, people are now talking about regulating them,” Bilott said. “The EU is going to completely ban them now. The president of the United States is talking about this now. So it works and it could be something that has dramatic consequences.”

Many of the students’ questions surrounded how chemicals are produced and made available to the public. Students wondered how regulatory policies could be improved to protect human health, and what role public health professionals could play. 

Vasiliou said he plans to propose a new YSPH class on how research can be translated to regulatory policy through effective science communication. He believes Bilott will make the department’s curriculum “more transformative” using his background in science communication and regulatory policies for the environmental health sciences.

For Clare Loughlin SPH ’24, a first-year master’s of public health student, Bilott being a guest lecturer was a huge factor in her decision to come to YSPH. She said she hopes to study PFAS contamination and climate change.

Loughlin heard Bilott speak at a conference in 2017, which she said “completely just changed [her] life.” She ended up working on a community project in Merrimack, New Hampshire, where she went door-to-door asking people to fill out a health survey. The community had been unknowingly drinking water contaminated with PFAS for over 20 years. 

“I was meeting people who said, ‘What do you mean my water is contaminated? I just moved here’ or ‘I have young kids’ or ‘My whole family has cancer,’” Loughlin said. “That was really emotional and I felt committed to studying PFAS for my career.”

Loughlin said she enjoyed learning about Billot’s vision for cleaning PFAS from drinking water and other environmental sources of exposure. She is interested in remediating PFAS from the environment and our bodies and pursuing justice for communities facing contamination.

“He wanted to inspire us to be persistently curious and follow the science,” Loughlin said. “There’s so much work to be done … and we are grateful to be in the fight with other people who are so thoughtful, willing to come speak with students, speak with community members [and] communicate through film, through books, through articles [to] get the message out because we’re all contaminated by PFAS.”

Bilott’s battle against PFAS continues: now representing states all over the US, Bilott is trying to ensure that the people responsible for state water supplies with PFAS are held accountable. He doesn’t want costs of cleaning the water to get pushed down to “the victims,” he said, including city and county governments and taxpayers. 

Bilott also wants companies to pay for the studies on the dangers of PFAS. The only way to establish policies regulating PFAS is to prove its toxicity through scientific studies. 

Without them, companies producing PFAS can continue to claim that the toxicity has not been proven yet. 

“Right now, [chemical companies] are sitting back saying ‘there’s no evidence,’ which the public interprets as meaning studies have been done and it’s been proven to be safe,” Bilott said. “But no. ‘No evidence’ means ‘we’re not doing the studies.’”

Amid these health concerns, the PFAS class continues to grow, as second-generation PFAS with different carbon chain lengths are developed. Despite PFAS being “one of the most comprehensively studied chemicals ever,” said Bilott, chemical companies have created a game of “Whac-A-Mole.”

As companies design new PFAS compounds, scientists must rush to study them all, he said. Bilott hopes to create a mechanism to have these studies done without the federal government having to pay for them — this cost, he believes, should fall on the companies at fault.

Yale School of Public Health is located at 60 College St, New Haven, CT.

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Growing up, she witnessed the health inequities faced by her mother and father, who were frequently in and out of the hospital. Her advocacy stems from the belief that if her parents had been able to advocate for themselves to receive proper medical care, they would still be alive today. Opara — an assistant professor of social and behavioral sciences at the Yale School of Public Health — is on a mission to reduce health disparities faced by Black people. 

From leading the Substances and Sexual Health Lab at the School of Public Health to running the Dreamer Girls Project for Black teenage girls, Opara devotes herself to advocacy, research and outreach. She invited nine-year-old Bobbi Wilson on a Black female scientist led tour to help her heal from a viral profiling incident, where Wilson’s neighbor called the cops on her while she was protecting trees from lanternflies. She created the Activist-in-Residence Program at YSPH. When she joined Yale in July of 2021, she knew it would not just be a win for her, but for her community.

“I often reflect on my own positionality, my own identity as a Black woman, as somebody who’s a Yale professor who grew up in an urban under-resourced environment,” Opara said. “When I was a child, I never foresaw that I would even get to this level of education or even this career of being a professor at Yale — it wasn’t even something that I dreamed about because I never saw anyone that looked like me accomplish these things.”

Opara was raised in a predominantly Black area of Jersey City, New Jersey, by parents who immigrated from Nigeria. Growing up, she recounted wanting “to be everything”: a lawyer, a physician — Opara was an advocate from childhood, with a love for defending and debating people. 

She was the complete opposite of her mother, who Opara described as “timid” and “submissive.” Unlike Opara, her mother felt that she did not have the power to advocate for herself. She didn’t talk back to her doctors or ask questions. She believed the doctors knew everything.

Opara spent most of her childhood dealing with her mother’s illness, as her father worked two jobs, one as a security guard and one as a child and family state worker. Her mother went back and forth from the hospital, being blind and paralyzed from her condition. When Opara was 17, her mother passed away from diabetes complications. 

“People shouldn’t be dying from diabetes at 46, but she did,” Opara said. “I blame that a lot on racism and we see this today, that Black people fare worse when it comes to diseases like diabetes, heart disease, et cetera … racism is a public health issue. Racism kills, and racism can be done by simply ignoring your Black patients or not acknowledging their fears or not acknowledging their concerns, or not being culturally competent enough to be aware of [the need to] reach this patient through a different lens.”

As immigrants, English was not Opara’s parents’ first language. They did not receive guidance on how to prevent chronic diseases or how to advocate for themselves in front of doctors. They didn’t know how to navigate the healthcare system. The medical system did not give Opara’s mother the help she needed to not only prevent, but to properly treat diabetes.

When Opara was 23, her father, who also had diabetes, passed from a heart attack at 57 years old. Before he died, he told Opara that he didn’t care what she wanted to do as long as she had an impact on the world. To this day, Opara follows her father’s advice. 

“I was constantly researching ways to be healthy, questions to ask my doctor and unfortunately, my parents had to die for me to know this,” Opara said. “I don’t want people to go through that. I want us as a healthcare system to be more aware of how intimidated patients are, especially black patients, when it comes to medical care.”

Opara knew that whatever she did was going to be health-focused. She earned her bachelor’s degree in psychology and then a master’s of public health from New York Medical College. Then she got her master’s of social work from New York University, followed by nearly three years as a youth and family social worker. 

As a therapist, she worked in an agency for Alternatives to Incarceration, which is an alternative punishment to time in prison or jail given to a person who commits a crime. She spent sessions meeting her clients at their level, inviting them to open up to her in whatever context they felt comfortable, whether that was on a quick drive to a train station or in a booth at McDonald’s. 

As she worked with mostly Black and Hispanic girls in New York City, she noticed common challenges they faced around engaging in substance use and sexual risk behaviors. They had trouble managing and identifying healthy relationships and lacked support at the community level. Opara realized the importance of contextualizing Black lives in medicine. A person’s intersecting identities can impact a person’s health, their risky behaviors, how the world views them and their related coping mechanisms. 

Drawing on her personal experience as a woman affected by the poor health of Black communities too, Opara realized that she was being pulled towards public health research.

“I wanted to be able to combine my public health background, but also my social work background to be able to be a professor and have this interdisciplinary lens to issues like substance use, sexual health and even mental health — all these issues that impact youth of color uniquely,” Opara said.

Opara earned her doctoral degree in family science and human development from Montclair State University. Now at YSPH, having founded the SASH Lab, Opara’s research targets the prevention of HIV/AIDS, sexually transmitted diseases and substance use among urban youth. 

Opara investigates what positive factors can be developed in youth to achieve better health outcomes for youth of color. This may be acknowledging ethnic pride in community, connecting youth to their neighborhood and empowering them through this level of social support. Positive attributes may be honed through programs, such as encouraging young Black youth to have pride and joy about being Black.

Opara’s work as a therapist aided in her empathetic understanding of the difference between human lives and statistics and in her present research, she continues to implement what is called “Community-Based Participatory Research,” or CBPR: a method of study where researchers and community members operate equally in the research process. 

In CBPR, trust and comfort are key. This research method is a way in which researchers like Opara are given the unique opportunity and responsibility to begin restoring trust between the historically marginalized and the research field. Opara pursues CBPR with urban youth to create race- and gender-specific interventions for Black girls. 

“Black people have a historical mistrust of researchers, as they should, because of the way that they’ve been taken advantage of and abused for generations,” Opara said. “CBPR was created as a way to bridge this gap between academics and community members, but even deeper than that, too, we’re working with the community members to solve things that they are seeing as problems and to do it in a way that is meaningful to them being as transparent as possible, literally having them have a seat at the table.” 

Opara teaches a popular class on CBPR at YSPH. Sitara Weerakoon, a postdoctoral fellow in the SASH Lab, frequently hears students call it “one of the best” courses they’ve taken at YSPH. Weerakoon described Opara as someone who cares deeply about her community, advocacy and mentorship. Opara received a Distinguished Student Mentoring Award from YSPH in 2022.

“She’s so funny and positive and optimistic and bright,” Weerakoon said. “Not only is she a superstar on social media, but she’s just as down-to-earth and welcoming and personable in person.”

Emmanuella Asabor MED ’24 GRD ’22, a graduate student in Opara’s lab, described her as “the kind of scholar and leader [she wants] to be.” Asabor highlighted not just Opara’s ambition and drive but her awareness and transparency in researching the challenges that uniquely affect youth of color. 

Opara feels a commitment to helping youth of color, not just because of her own experiences, but also because she recognizes the importance of displaying just how possible it is for them to gain a seat at the table. The visibility of a Black women carrying out valuable research is something that will push more youth of color to realize that they could one day hold these types of positions too.

Opara never had opportunities to go on college tours or imagine herself at an Ivy League school as a teenager. Now here, she wants to create a space for Black girls to feel comfortable in institutions like Yale. Ultimately she hopes to strengthen the pipeline of Black youth to the field of public health research. 

Opara invites Black girls to Yale every semester to see her lab, meet her graduate students and get a taste for the field. The first group of girls invited were through her research-community partnerships in urban communities in New Jersey — such as Paterson, East Orange and Newark — which are all predominantly Black and Hispanic. Opara also does outreach work in New Jersey, hosting community health events around substance use, mental health and HIV prevention. 

“I wanted to be in a field where I can educate the next generation of public health researchers so that they can understand what it means to be culturally competent, to work with girls of color, specifically Black girls,” Opara said. “So acknowledging their strengths, acknowledging what are the beautiful things of being Black and being a girl in society and [asking] how can we foster this level of strength and infuse that in prevention?”

One of Opara’s prospective projects is a conference where Black girls can come to Yale and get exposure to STEM and public health related fields. This would be a space where Black girls could come from all over the country together in sisterhood and obtain mentorship and learn about careers centered around STEM and public health. Her even bigger vision is to have a research center for public health issues related to Black children. This center would be able to produce evidence-based programs to support Black youth. 

Trace Kershaw, chair of the department of social and behavioral sciences at YSPH and one of Opara’s faculty mentors, lauded her brilliance, innovation and ability to mobilize her ideas to conduct research that has large community and social impact. According to Kershaw, she integrates scholarship and theory while also listening to the participants and communities which she serves.

Howard Forman, another of Opara’s faculty mentors, called it a privilege to be in “her orbit.” Describing Opara as “an extraordinary person,” he recognized her willingness to go above and beyond her job description in order to elevate even a single person. 

“She’s a reason why you come to Yale, either as a faculty member or as a student,” Forman said. “Because she is the best of us and she brings both scholarship to an area that needs more investigation as well as providing solutions to challenging issues that really affect all of society and particularly urban areas.”

The Yale School of Public Health is located at 60 College St, New Haven, CT 06510.

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The two-day intensive writing workshop returned fully in-person in November, with lively group discussions and writing exercises. Anna Reisman ’86, professor at the School of Medicine and director of the Program for Humanities in Medicine, and Lisa Sanders MED ’97, associate professor of medicine, co-directed the workshop. 

Many pieces featured experiences that were traumatizing to the residents or that bore witness to a patient’s traumatic event, Reisman noted. To Sanders, this year’s pieces all address some kind of “moral injury,” capturing moments when the limits of medicine were reached. 

“It’s like if you’ve ever seen a dog on a chain, run, run, run, and then they get to the end of the chain and they stop,” Sanders said. “Often that’s something that happens in medicine, as you’re going as far and as fast as you can, and then you reach the end of what we can do — either emotionally or physically for a patient. It’s a terrible shock so many times.”

The annual reading on Feb. 2, when residents share their pieces aloud, is Sanders’ favorite day of the year. These pieces are also collected in a booklet called “Capsules” to be distributed to the medical community. Four of the participating residents — Victoria Lewis, Anna Delamerced, Katherine Feder and Preetha Hebbar — organized the theme of the booklet and reading.

“We all found ourselves together stuck with the image of water, and particularly the idea of the ocean shore and the way that the shore can be a sight of reflection, of remembrance, of grief, longing and joy,” Lewis said at the event. “The order of the pieces you’ll hear today were intentional and intended to mimic the flow of a wave, starting with a crash and then pulling us back into the ocean’s eternal ebb and flow.”

The reading, and booklet, launched with the story of a car crash, then flowed through various water metaphors expressed in the pieces. It ended with a resident’s reflection on visiting a seafood restaurant recommended by a patient who had passed.

Nathan Maris, a pediatric resident, took the stage first with his short story of a car crash. In the piece, his words take two paths: first the literary style of a third person narrative, then the dry, technical jargon of a medical record. Maris said he hoped to articulate the “inherent gap” between the patient’s experience of illness and the physicians’ perception of that experience. 

“The human mind is not meant to process catastrophe with such haste,” Maris wrote. “A vodka-sodden SUV clips her rear fender … Her world is a tangle of pavement and sagebrush and steel and snow and bone and blood.”

The structure of Maris’ story is circular, beginning with the patient’s plans to take her GRE and start an MBA, and ending with the patient’s final day of inpatient rehabilitation. After injury and recovery, she leaves with GRE prep books loaded onto an iPad and eventually an acceptance packet in the mail. 

“Aside from treating patients directly, one of the most important parts of being a resident is bearing witness to our patients’ experiences and affirming their innate human dignity in spite of their suffering,” Maris told the News. “Every physician does this in different ways, but writing just happens to be one method that I employ.”

Natasha Freeman, an internal medicine resident, studied comparative literature in college and narrative medicine in graduate school. She was grateful to find medical colleagues who were interested in the humanistic side of medicine. 

Freeman called it “a testament to the workshop’s popularity” that she only got into it during her third and final year of residency. Her story was about a patient care experience her mind kept revisiting. 

“I took care of this man with advanced cancer and schizophrenia who was forsaken by the system and everyone in it,” Freeman told the News. “He lost his ability to advocate for himself in words that made sense, and therefore his needs were not attended to — the system did not allow for it.”

In her piece, Freeman details how the patient has not been outside for nearly 300 days. Scribbling zig-zags on colored construction paper, the patient asserts to her that he is writing medical research. He tells Freeman that he does not have metastatic cancer, that his own research cured cancer. When she tries to bring him to reality, the patient tells her that he wants to leave, that he has not been allowed to eat or drink in five years — currently hooked up to tubes — and all he wants is orange juice and a breakfast sandwich.

The ethics committee had recommended months ago to stop the chemotherapy, needles, restraints and prohibition on eating — all the treatment that extends his life while deteriorating his quality of life — but the patient’s conservator refuses to authorize the change in treatment plan. Without a court order to override the conservator, the patient is stuck.

“[The patient] knew exactly what he wanted, it was obvious if you read between the lines of his psychosis and saw his emotions,” Freeman said. “Knowing how he felt and being forced to contradict those feelings by the system was somewhat of a traumatic experience, and that compelled me, despite my exhausting schedule, to write about it.”

To Freeman, creative writing can and should be used as a tool for advocacy — to give a voice to herself, peers and patients. Delamerced, a pediatric resident, also writes to advocate for patients, and has published op-ed pieces in the past that shed light on health topics in the community.

Delamerced’s piece was a short memoir in which she found resilience reflecting on her mother’s strength. Her mother had immigrated from the Philippines to Connecticut as a teenager, and had also endured the trials of medical residency.

“I will tell her about my time in New Haven. The tearful nights, the 24 hour shifts, the unexpected heartaches,” Delamerced writes. “Hugs from children leaving the hospital. Sunrises and sunsets … If I should have a daughter, I wonder what she will think when she hears these stories.”

Delamerced reflected on the feelings of inadequacy and otherness that her mother must have felt but endured with grace.

Laila Knio, a psychiatry resident, valued sharing lived experiences with her fellow writers. It would be hard to feel true to herself, she said, if she disconnected from her creative side. There were periods of her medical education where Knio recounted losing herself to the learning of medicine — they were “the darkest.”

According to Reisman, people often write their narratives from a detached perspective at first. The workshop encourages them to reflect on what it felt like to be in the room where an experience happened — how all of the senses felt, how the body reacted to a particular emotion. 

“We talked about the normal [writing] workshop stuff like opening in medias res and plot and what we wondered about,” Knio wrote to the News. “But we also talked about how to honor our patients in our writing, about what disclosure looks like as physicians, about how to tell the truth without doing harm. It felt like a rare and precious space.”

Hebbar delivered the reading’s final piece. To her, she said, writing can be a form of processing and escapism, whether exploring challenging emotions or patient cases. An internal medicine second year resident in the primary care program, Hebbar’s piece came from her first year of residency. 

“Mr. R,” Hebbar’s patient, was an overnight admission. His prostate cancer had spread to his skull, “wreaking neurologic havoc,” Hebbar wrote. He could no longer walk. To her, Mr. R looked too young to be in his 50s and this sick. 

“I stared at his shaved head and imagined cancer burrowing into bone underneath,” Hebbar wrote. “It felt improbable that something so catastrophic could hide under the smooth contours of his skin.”

Mr. R and his wife were thrilled to hear that Hebbar was new to Connecticut. One summer afternoon, staring out at the ocean, Mr. R marveled about the best fried fish in the area, insisting that Hebbar check out Stowe’s Seafood in West Haven.

Though Hebbar moved to a new rotation and was no longer his physician, she kept tabs on him. One day, when checking on his chart, Hebbar discovered that Mr. R had died. Nearly a year later, Hebbar and her fellow intern drove in 85 degree heat to West Haven Beach.

“There was a physical intensity to the moment which allowed for reflection upon the life we had lost and the doctors we were becoming,” Hebbar writes. “Then, as we had long promised, we crossed the street to Stowe’s and ate the best fish in the world.”

Reflecting on the workshop, Hebbar said she enjoyed seeing how people’s brains work outside the hospital. When people who previously had just been “somebody [she] worked with” unveiled their writing and stories, she formed a deeper appreciation for who they were as people.

Ann Soliman, chief resident in internal medicine, returned to the workshop as a facilitator after taking part in the 17th annual workshop. The workshop being her first taste of narrative medicine, Soliman welcomed the chance to step back, reflect on what affected her and enjoy “a fundamental human thing.”

Soliman noted the workshop’s value for doctors at the residency stage. Resident physicians embark on a new role, entering people’s lives in a way not previously welcomed or expected before.

“I think a lot of people really resonate with experiences at that time because it’s very much a transformation in responsibility,” Soliman said. “It’s the first time they are directly caring for a patient who died or pronouncing a patient who died.”

Each year, a doctor-writer is invited to speak at the School of Medicine’s “Writing and Medicine” Grand Rounds, which takes place the same day as the annual resident reading. Physician and writer Anna DeForest, an alumna of the workshop, delivered the talk “Language for an Infinite Distance: Art as Work in Medicine” as this year’s visiting speaker. 

The Yale Department of Internal Medicine established the Writers’ Workshop in 2003.

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