Friday, July 21, 2017

New collection: Crohn's support groups of yore

by Rachel Fellman 

Crohn's-Colitis Chronicle, from collection 2017-005
We are all archivists, though some of our collections are more organized than others. This is an important concept to hold onto if we’re ever tempted to think of archives as a rarefied job practiced only by serious people in dust masks. Librarians and archivists do take our work seriously, and we do wear dust masks on especially awesome days, but what we do is only the professional side of a universal practice: organizing the records and artifacts that make up our stories.

I was thinking about this as I processed my first collection today. It came to us as a small (0.25 linear feet) binder of information about Crohn’s disease, collected by the donor over a thirty-year period, with the majority dating from the eighties and nineties. There are folders of national and local newsletters, newspaper clippings, articles, and pamphlets.

The binder is like a personal medical textbook, the ephemera of many years of living with a painful and unglamorous illness. But it also provides many fragments of intriguing medical history. How did support groups see and present themselves in the early eighties, when a community of the sick was still a new idea? How did people in the local groups feel about their illness, and what attitudes did they urge on each other? How did they use the local and national organizations to advocate and bond? (The various newsletters include both member profiles and personal ads.) How did '80s and '90s doctors explain Crohn’s to newly diagnosed adults and teenagers, and how did they counter assumptions that it was psychosomatic? (One pamphlet even explains that “this brochure can be offered as a reference when friends and colleagues seem to think that ileitis or colitis are caused by being 'overly emotional'”).

It’s easy to let the less concrete parts of history disappear. A person born in 1990 would be only 27 today, and yet that world still seems very distant – especially the parts about how people talked to each other outside the world of books and glossy magazines. A lot of that is locked up in memory, which is notoriously unreliable and prone to overwriting. With collections like this, we can take a more accurate look at how people felt about illness before the Internet, and we’re grateful to our donor for maintaining it for all that time.

You can read the full finding aid for this collection here (via Archives West).

Thursday, July 20, 2017

Highlight on Dr. Ann Becket, Ph.D., R.N.


by Jaime Bogdash

Dr. Ann Becket, circa 1990 (School of Nursing Archives)
We recently shared a new oral history about School of Nursing faculty member Ann Beckett, Ph.D., R.N. In case you haven’t been able to read this interesting oral history interview, I thought I would highlight some of her achievements and her impressive work and academic history.

Dr. Beckett started in public health nursing in the Maryland and Washington, D.C. areas. Although she was one of only a few minorities at her university at the time, she found a large cultural community within Howard University and the greater D.C. area. She entered into academic teaching serendipitously when a member of her church, who was a faculty member at Howard University called to ask for teacher recommendations for their new baccalaureate program. While working as faculty at Howard University, Beckett began her Master’s degree at Catholic University. She was also a parent to one child and pregnant with her second while teaching and working on her Master's. Although she fell into academia almost by accident, she worked at Howard University for a total of twenty-one years.

In Dr. Beckett’s oral history interview, she talks about her experience with diversity in her student population. As she explains:
“I learned a lot. I had a lot of experience. I met a lot of students. We had international students there. And so I think my experience was really broadened culturally. We had students from Africa. We had some Asian students. Hispanic students, not a whole lot. Our largest, probably, group, international group, was African students from Nigeria, Kenya, and some of the other countries. So I did, I was exposed to different, you know, the cultural differences. And was made more aware of that. Because working at Howard University, as people know, I mean, it’s predominantly an African American school. So I found that very interesting, that I had that opportunity.”
Dr. Beckett really embraced diversity in teaching and socially so her move to OHSU was a bit of an adjustment. When she came to OHSU, she began teaching in the Department of Psychiatric Mental Health Nursing. At the time she “was probably ... the only African American in the group. But after a while, that didn’t seem to be such a big issue. I believe there was one other faculty member that had been here for a very long time that was African American. And she, I was introduced to her and she was sort of helping me, you know, sort of navigate the campus and find things I needed to know and meet the people that I needed to meet.”

Beckett decided to pursue her doctorate two years into her teaching position at OHSU. Although she was content with her work, she decided to pursue an advanced degree simply as a personal goal. She continued to focus on diversity and found a need in African American psychiatric health. She focused her graduate and doctoral thesis work on the mental health of African American adolescents, specifically those who had been affected by homicide and drug related crime. Her dissertation, Surviving an Adolescent Violence Trajectory: An African American Perspective, can be found online in OHSU's Scholar Archive. In her thesis, she was able to work with African American adolescents who had witnessed homicide and their trauma around their experiences. Dr. Beckett talks about her experience doing this important qualitative study and the trauma and stress she felt through conducting it.

Dr. Beckett also discusses her committee work and the amazing work she has done at OHSU in the nursing department and to better develop the teaching curriculum and practicums of the students in the nursing department. You can read more about Dr. Beckett’s impressive work and career by examining her oral history online.

Wednesday, July 19, 2017

Life-saving pants! (Or are they?)

Hi all – it’s me, the Archivist – frequent blog reader/reviewer, infrequent blog writer. I’ve been quite busy since starting here back in October, but we recently received an interesting donated artifact that I felt like writing about.

The Rogue Regional Medical Center contacted us a while back as they were cleaning out some holdings and had a pair of pants they thought we might want. “Pants?,” you ask. Yes. But not the type you would wear on a normal day. These pants are Medical Anti-Shock Trousers, or MAST (alternatively referred to as Military anti-shock trousers or pneumatic anti-shock garments). These pants open up and are placed around the pelvis and legs of a trauma victim, and then inflate – applying pressure to the lower half of the body.

MAST: Medical anti-shock trousers
MAST: Medical anti-shock trousers, MMC.2017.001

The concept of the MAST came about early in the 1900s, first described by Dr. George Crile. His device was used during World War II. Further development was overseen by NASA in the 1960s, with their product being used during the Vietnam War. Later in the 1970s, they were introduced into general hospitals and emergency medical services (EMS) for civilian use. The idea behind them is that severe blood loss could be treated in the field to prolong the life of the victim during transport to a medical facility. They would also help immobilize the patient and provide some support and comfort during transport. MAST became regularly used by EMS in the 1970s and 1980s.

MAST: Medical anti-shock trousers case
The trousers come in a handy travel case
However, how the MAST actually helped save lives was little understood and evidence of the effectiveness of the trousers was generally anecdotal. Later in the 1980s, researchers in Houston, TX conducted a 2½-year-long study to examine patient outcomes when MAST were used. In the end, they concluded that the trousers offered little towards saving lives or reducing hospital stays; in fact, they may actually be detrimental overall. As time passed, use of the MAST decreased and they are now seen as a relic of past medical practices. And thus – they end up somewhere like our Archives.

Unfurling these from the cool and vintage-science-looking case they came in, I was tempted to try them on – mostly for the photo opportunity, but the strange mediciney-rubbery smell emanating from them curtailed that somewhat-unprofessional idea. However, they are an interesting technological innovation from medical history and should you or a friend wish to research the history of trauma care, these pants may offer you some tangible benefits.

Links:

Bledsoe, Bryan. “EMS Myth #1: Medical Anti-Shock Trousers (MAST) autotransfuse a significant amount of blood and save lives.” EMS World. November 30, 2003. Accessed July 18, 2017. Archived version: https://web.archive.org/web/20170718151509/http://www.emsworld.com/article/10325078/ems-myth-1-medical-anti-shock-trousers-mast-autotransfuse-significant-amount-blood-and-save-lives

“Military anti-shock trousers.” Wikipedia. January 10, 2017. Accessed July 18, 2017. https://en.wikipedia.org/wiki/Military_anti-shock_trousers (see references here for more information)

Tuesday, July 18, 2017

Tuberculosis Germs Surround Us

by Rachel Fellman 

Recently, while working on a project in one of our many storage areas, I spotted this large sign. It was listed on our spreadsheet simply as “framed tuberculosis poem” -- but it’s not a poem, it’s a warning to patients not to come near their visiting children.

photo by the author

The design of the sign fascinated me: the stern Gothic lettering, applied by a skilled hand, combined with surprisingly jolly cartoon drawings of “tuberculosis germs.” The drawings seem like an attempt to lighten the mood, but for the children in question -- standing awkwardly on the forbidden floor, unable to accept their sick parent's gifts or look at them from closer than six feet away -- I doubt it helped much.

photo by the author

The only further clue to the sign's provenance was a small label: “Medical Science, January 1967-February 1968.” It might have hung in the Oregon State Tuberculosis Hospital in Salem, which operated until 1969; it might also be a relic of the tuberculosis hospital on OHSU’s Marquam Hill campus, which closed in 1963. The sign also features two Crosses of Lorraine, symbol of the fight against tuberculosis. (Today, these might have been awareness ribbons: the one for tuberculosis is bright red.)

Monday, July 10, 2017

Oral history: Susan Tolle, M.D.

By Rachel Fellman

Susan Tolle photograph
Dr. Susan Tolle (courtesy of the Center for Ethics)
Another of our new oral history interviews is with Dr. Susan Tolle, director of the Center for Ethics in Health Care. Dr. Tolle is a founding member of the Center for Ethics and has spent much of her career fighting for improved end-of-life care for Oregonians.

An internist and longtime OHSU faculty member, Dr. Tolle had a formative experience early in her career here. It was her first shift as an attending physician. She was conscious of the fact that she was younger than all of her students, partly due to an unusual undergraduate experience – she had finished in just under three years to save more of the household budget for her younger siblings. Because of her youth and drive, she pushed herself to be the ideal faculty member, “trying to look older and be the attending and study very hard at night and work very hard.”

Just before this first shift, a patient in her late twenties was admitted and seen by an intern. Dr. Tolle took over at midnight, and at five in the morning, the patient was found dead. She’d had a benign tumor that had bled out internally, but nobody knew it that night, and in the meantime, Dr. Tolle found herself concerned by the way the hospital handled the matter. “Handing [the patient’s husband] a bag of pink plastic belongings. Being told at the time with legal, we don’t know what happened, don’t share information. Having the intern leave medicine. She was so worried that she had made a mistake, and permanently left medicine.” The hospital didn’t follow up with the family or offer adequate emotional support for the staff, and the only real discussion of the case came in the form of a lawsuit.

The experience led to a lifelong interest in ethics. Soon, Dr. Tolle and Dr. John Benson began a major study about end-of-life care. They contacted the families of patients who had died, and asked what the hospital had done well and where they'd fallen short. The families, they found, complained “much more often about how their loved one received too much care than that their loved one received too little care.” (This was in the 1980s, when patients were much more likely to die in the hospital rather than in hospice or at home.) Some family members had asked the doctors to stop treatment, to spare their loved ones pain, and had felt a deep sense of anguish and inner conflict. Often, they felt like “murderers,” and the experience left them scarred. Poor communication from doctors was a problem too – the families would get good news from some specialists and bad news from others. Dr. Tolle and her team recognized that clarity was especially important: “Good ethics relies on good facts.”

In 1989, Dr. Tolle and her colleagues founded the Center for Ethics. Her salary was initially cobbled together from grants, small budgets from the various medical schools, and private philanthropy – but not private philanthropy as it’s usually pictured. This was a grassroots project, and funding often came from those family members of terminal patients who’d had traumatizing experiences with their loved ones’ end-of-life-care. One professorship, the Miles J. Edwards Chair in Professionalism and Comfort Care, was endowed by 322 people. This unusually strong, democratic connection to their donors gave the Center a mandate to work on a broad range of questions.

Their flagship program has been the POLST form (Physician Orders for Life-Sustaining Treatment), which they began developing in 1991. It’s now used in 47 states to give very sick patients control over their own end-of-life care: they can opt in and out of CPR, intensive life-saving measures, and artificially administered nutrition. This lets the patients decide the big questions – life and quality of life – before the crisis comes. The Center remains very focused on updating the form, educating the public about it through dramatized documentary videos, and making sure that it’s used correctly and sparingly. They also teach within OHSU, most recently with a course called Living With a Life-Threatening Illness, in which the students meet six times with a “patient-teacher,” a seriously ill person who can help them understand the practical and emotional consequences of illness. The class is intense and mutually therapeutic, and the student’s goodbye letter is often read at the patient’s funeral.

As usual, there’s much more in the oral history than I could ever fit into this post. Medical ethics is such a rich and complex topic, and Dr. Tolle has played an active part in its evolution. Over more than twenty-five years, the Center has helped to take medicine from an unintentionally chilly and bureaucratic place to a much more immediate, conscious, and empathetic one. If you’re interested, you can explore the entire interview here.