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Resident’s weekly missives help support fellow interns

Med-peds residents find messages from Nicole Damari, MD, filled with encouragement and support

Last July, three weeks into her UC med-peds residency, Nicole Damari, MD, texted some words of encouragement to her seven fellow first-year residents:

Hey, you know that thing you did recently that didn’t go as well as you hoped and has now moved into an apartment in the back of your mind where it whispers doubts to the rest of your brain? Forget that thing! Evict it. You are awesome and making medical magic happen. Welcome to day 21 of doctoring! If days were years, our doctoring skills would be having their first drink today! Can you believe how much they’ve grown?

Her colleagues liked the message and the writing process helped Damari, so she continued them. Every Wednesday since then, she has shared a little bit of herself with her colleagues to help them get through difficult moments and brighten their days.

portrait of woman wearing glasses

Nicole Damari, MD

“It felt like we were all pretty stressed out the first few weeks of trying to be a doctor and I sent something short to the group. It got a pretty positive response,” she recalls. “Residency is challenging and sometimes what you need to face those challenges is just someone else to say they have your back or they’re experiencing the same thing. I’m pretty lucky to have a pretty magnificent residency class, so if the messages are something they like to hear, I like sending them.”

At the urging of Daniel Song, MD, one of her fellow residents, her writings are now being shared with a broader audience as they are being tweeted each Wednesday on the Department of Internal Medicine’s med-peds Twitter account (@CincyMedPeds) with the hashtag #WednesdayWisdom. The first one tweeted last week, a short passage about the heart and times of stress, received positive reviews. The passage, coupled with artwork from Song, read:

I don't want to make any assumptions, but you may be familiar with the heart. It's pretty famous, mostly for shooting blood around your body. Continuously. Systole's its job -- exerting itself to pump blood everywhere but itself. It works basically all the same.

But it can't sustain that. It needs its diastole to refill, to take a moment to feed itself. And even with a job as high stakes as *pump blood everywhere*, it spends twice as much time resting as working. And you know what? Everyone gets blood. It all works out fine.

In times of stress, the heart can cut into its rest time and work harder. It can maintain this for a while, but eventually, if it cuts down on its rest time too much, it can't perform as well And when it can't perform as well, things look bad for everyone.

Speaking purely physiologically here, of course.

So, on an unrelated note, take a moment to breathe. Take your days off, your minutes between admissions, your seconds between pages, and relax. Let yourself refill.

All the healthiest hearts are doing it.

“Phenomenal! These need to be sent into a journal for publication,” read one Twitter response. “Love this!” was another.

Without Song’s encouragement, Damari says, she does not think she would have agreed to have them shared on the med-peds Twitter account. She is excited by the collaboration she has undertaken with Song to add his artwork to her words.

drawing of a heart

Drawings by resident Daniel Song, MD, that accompanied a passage by Nicole Damari, MD.

drawing of a heart by resident Daniel Song

Damari says her colleagues’ response since she started sharing her messages last summer has been “very sweet and positive.”

Dustin Walter, MD, another first-year med-peds resident, says he is always excited to read Damari’s weekly messages.

“They have been unbelievably amazing. Nicole is a wonderful person and a gifted writer who will often take conversations that she has had with us during the week and incorporate them into her writing to make it even more relevant,” he says. “These pieces have been great, especially after a hard day or even to go back and reread them if the week has been especially difficult. They remind us that we are doing a good job and make us stop to reflect on the many difficulties of being a resident; they are reminders that we are not alone which is always needed. We all really appreciate Nicole for taking time to encourage and uplift us. Her focus on helping our well-being is more proof that she is a great writer and an amazing friend!”

Damari sometimes receives an immediate text back about her messages. Other times, someone will mention something she wrote several weeks before. “It’s very humbling,” she says. “It was nice to get feedback, whether it was that they liked a particular piece or they just liked receiving something that was a reminder that they’re being thought of and that someone was with them in solidarity. They’ve been very sweet and positive, which is largely why I’ve kept doing this,” she says.

Most of her writings relate to anatomy or physiology, but some take a different path depending upon the stresses of the week. Others have been spins on “cliched encouragements, delving deeper and tipping them on their heads. And every once in a while, it’s something random that just popped into my head.”

Damari is hopeful others find comfort and encouragement in her writing. She has never been published, but enjoys writing for herself. "I write mostly for me. I haven’t pursued publication. I really like writing fiction short stories, plays and comics, but I do that for myself ​as a hobby.”

Despite her hectic schedule, she enjoys having a deadline each Wednesday to share something.

“It’s something that I’ve just decided is a priority that I’m going to make time for. There have definitely been Wednesdays where the entire week leading up to it I’ve been working on something and it’s had seven days’ worth of edits and rewrites. And then there are days when I get off of call at 11:30 p.m. and I realize it’s Wednesday and I write something shorter.”

Damari likes the reflective practice of writing and appreciates the stress relief it provides her.

“I think the process of reflecting on what are the things that cause stresses in our lives and how can we work to overcome those or what are the insecurities that we might be struggling with and how can we get a more healthy perspective is really important and productive. I am sure the process of thinking through these on my own behalf and on the behalf of people I care about has made me more positive and reflective on the whole," Damari says.

The additional stress of coronavirus (COVID-19) during the last two months has not seemed to have altered her writings, she notes. The messages continue to be filled with encouragement and short meditations on life’s challenges.

“While (the challenges) might be bigger right now for a lot of us, or more at the forefront with all the additional stresses of COVID, I think a lot of the things that have been important for me to say have been the same. They’re just at the forefront of our thoughts right now.”