New Opera on a Gender-Affirmation Pioneer Is Authored by Mount Sinai Neuroradiologist

A new opera, Lili Elbe, tells the story of one of the earliest recipients of gender-affirming surgery in 1930. The opera is a collaboration of Grammy Award-winning composer Tobias Picker and Aryeh Lev Stollman, MD, a neuroradiologist at Mount Sinai, who wrote the story and lyrics. Photos: Edyta Dufaj

“It’s a love story,” says Aryeh Lev Stollman, MD, a neuroradiologist at Mount Sinai, and the librettist for a new opera, Lili Elbe, which tells the story of one of the earliest recipients of gender-affirming surgery, in 1930. The opera, commissioned by the Theater St. Gallen of Switzerland, was named “Best World Premiere of 2023” at the OPER! AWARDS ceremony on January 29 at the Dutch National Opera in Amsterdam.

Lili Elbe focuses on a successful Danish painter who was married to another painter, Gerda Wegener. Though their marriage was eventually annulled by the King of Denmark and Lili’s name and sex were legally changed, they remained in love with each other. Lili’s case drew international attention, and a semi-autographical account of her story was captured in a book, Man Into Woman: An Authentic Record of a Change of Sex. Another book, The Danish Girl, was loosely based on her story and has become an important text in LGBQT+ literature and the basis for a film.

“We based our story on historical sources,” emphasizes Dr. Stollman. “The Danish Girl was highly fictionalized. But Lili Elbe was quite famous in her day, so we relied on her own writings and news accounts from the time.”

The opera Lili Elbe, in addition to being acclaimed for its artistry, is a significant milestone. It stars Lucia Lucas, a baritone, in the first grand opera for and about a person with trans experience. The Grammy Award-winning composer Tobias Picker, who is married to Dr. Stollman, befriended Lucia when he cast her in Don Giovanni in a Tulsa Opera production—the first time a transgender singer had played the leading role in an American opera. Mr. Picker, Dr. Stollman, and Lucia wanted to collaborate on an original project, and the story of Lili Elbe was chosen.

Tobias Picker, left, and Aryeh Lev Stollman, MD, taking a bow after a performance of the new opera at the Theater Saint Gallen in Switzerland. “This resonates with our work as physicians, health care workers, and support staff, because behind our work is love for humanity,” says Dr. Stollman. “We serve people, no matter their physical appearance, their background, or gender identity. And we do it through all types of difficult times and situations.”

“Tobias asked me to write the libretto—or the story and lyrics,” Dr. Stollman says. “But I worked very closely with Lucia as the dramaturg, to gain the insight of her experience and authenticity.” This is the second time Mr. Picker and Dr. Stollman have collaborated. The first was the inspiring opera Awakenings, based on the story of Oliver Sacks, MD, and his efforts to treat patients with sleeping sickness. That opera opened in June 2022 at the Opera Theatre of Saint Louis.

“Like Awakenings, we wanted Lili Elbe to have a mythic undercurrent,” Dr. Stollman says. “In Awakenings, we used the story of Sleeping Beauty. In Lili Elbe, the myth of Orpheus leading his lover, Eurydice, out of the underworld is a motif that reoccurs. I believe that myths have a strong emotional truth. In the myth, Orpheus is saying, ‘Don’t look back, you cannot return to your old life, but you are coming into a new life.’ And our characters are always moving to the future, to a new life, a new realization. And that’s the mythological underpinning.”

Lili Elbe discovers her true nature as a woman when her wife, Gerda, asks her to stand in for a female model who was delayed for a painting session. Gerda is entranced with the beauty of her husband, then called Einar Wegener, and it is she who bestows the name Lili. And as Lili embraces her identity, she says, “When you paint me now, I feel I have always been her.” Lili becomes a muse to Gerda, whose paintings of Lili win acclaim. But Gerda wrestles with how much space to allow Lili in their marriage. At first, she insists that Lili transition back to Einar in the evening. But as Lili makes her true identity known among their circle of friends, Lili wants to experience all the feelings of womanhood, including marriage and motherhood. And even though their marriage is annulled and they become involved with other lovers, their love for each other endures.

Lili becomes engaged to Claude LeJeune, a young man whose passion is creating perfumes from flowers through a delicate process called enfleurage. The symbolism of the flowers living on becomes a motif as Lili dies as a result of complications of one of her surgeries. And the life and story of Lili Elbe still resonate today.

“The opera is more than about love with a transgender person,” Dr. Stollman says. “It’s about love and transcending difficulties. It’s about a tragic heroine’s journey that starts with self-knowledge. And it’s about loss, because Gerda loses Lili. But also because Lili dies in the end, as many tragic heroines do.”

The staging and choreography of the opera are innovative, witty, and symbolic. As Gerda exhibits her paintings of Lili, they are symbolized by actors suspended above the stage, swirling in evocative poses. The prominent German newspaper Die Welt gave it an enthusiastic review, calling it “emotionally gripping, a delicate work of musical theater that unfolds as an Art Nouveau arc, amidst a bright, symbolist stage.” A leading Austrian paper, the Voralberger Zeitung, called it “an emotionally charged masterpiece.”

Dr. Stollman related the theme of love transcending all to the mission of Mount Sinai, which was founded to care for underserved people and is home to the Center for Transgender Medicine and Surgery, a world leader in gender-affirming care. “This resonates with our work as physicians, health care workers, and support staff, because behind our work is love for humanity. We serve people, no matter their physical appearance, their background, or gender identity. And we do it through all types of difficult times and situations.”

Your Guide to Colorectal Cancer Awareness and Prevention

A colorectal cancer awareness event at The Mount Sinai Hospital. Click here to learn more about colorectal cancer and early screening with Mount Sinai’s CHOICE Program. To discuss your screening options or if you have a referral, call 212-824-7887.

Colorectal cancer is the second leading cause of cancer deaths in both men and women in the United States. Although this cancer is highly treatable and preventable, about 140,000 Americans are diagnosed and more than 50,000 people die each year, according to the Centers for Disease Control and Prevention (CDC). In 2021, the United States Preventative Task Force updated its guidelines and lowered the starting age of screening from 50 to 45.

More than 93 percent of colorectal cancer cases occur in people 45 years old or older. More than 75-90 percent of colorectal cancer cases can be avoided through early detection and removal of pre-cancerous polyps, and as many as 60 percent of colorectal cancer deaths could be prevented if men and women over the age of 45 were screened routinely.

In the United States, more than half (55 percent) of all cases of colorectal cancer are attributable to lifestyle factors, such as an unhealthy diet, insufficient physical activity, high alcohol consumption, and smoking. Increasing screening to 80 percent of people could reduce the number diagnosed with colorectal cancer by 22 percent by 2030. But survey data indicates that screening prevalence among adults remains low in those aged 45 to 54.

In an effort to increase awareness and screening, Mount Sinai has expanded colorectal cancer awareness initiatives across all eight hospital sites during March to provide patients with access to health professionals to discuss prevention, screening options, and risk factors. Mount Sinai experts will be available to answer questions on diet, genetic counseling, the colonoscopy procedure, and ways to schedule and offer support after diagnosis.

Here are some prevention tips:

Schedule a Screening

A colonoscopy is the preferred screening method as it allows for both detection and removal of precancerous polyps during the same procedure. Other screening options include a flexible sigmoidoscopy, CT colonography, and home-based stool tests, including the fecal occult blood test (FOBT), fecal immunochemical test (FIT), and a combined fecal immunochemical test with DNA test (FIT-DNA test). Individuals should discuss all of these options with their doctor to find which method works best for their lifestyle.

Know Your Risk Factors 

Age: More than 90 percent of colorectal cancer cases occur in people 45 years old or older and death rate increases with age. In New York, 44 percent of those 45 to 54 are up to date with colorectal screening.

Family history:  As many as 1 in 3 people who develop colorectal cancer have other family members who have been affected by this disease. The risk is even higher if a relative was diagnosed under age 50 or if more than one first-degree relative (parent, sibling, or child) has been affected.

Racial and ethnic background: Colorectal cancer affects people of all races and ethnicities. However, colorectal cancer disproportionately affects the Black community, where the rates are the highest of any racial/ethnic group in the United States. Black individuals are most likely to be diagnosed with late-stage colorectal cancer. The incidence of this cancer in Black individuals is 15 percent higher than in white individuals. Death rates have declined in Black individuals by 3 percent. Colorectal cancer screening rates are now lowest among Asian Americans and Hispanic/Latino communities.

Lifestyle factors: Common lifestyle factors that may increase colorectal cancer risk include obesity; cigarette smoking; lack of exercise; overconsumption of fat, red, and processed meats; not eating enough fiber, fruits, and vegetables; and drinking alcohol excessively.

Pre-existing health conditions: Inflammatory bowel diseases (IBD), such as ulcerative colitis or Crohn’s disease, and less common genetic syndromes, such as familial adenomatous polyposis (FAP) or Lynch syndrome, significantly increase the risk of developing colorectal cancer. These patients are recommended to start screening at a younger age and more frequently.

Warning Signs and Symptoms 

  • A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, lasting for more than a few days.
  • Rectal bleeding, dark stools, or blood in the stool.
  • Cramping or abdominal pain.
  • Weakness and fatigue.
  • Unintended weight loss.

Two Employee Resource Groups, Mount Sinai Interfaith and Islamic Community at Mount Sinai, Hold a Silent Vigil

Rowaida Farraj, PharmD, left, and Rabbi Jo Hirschmann, BCC, FACHE

The Mount Sinai Interfaith and the Islamic Community at Mount Sinai employee resource groups gathered to hold space for collective grief and to express their shared humanity, love, respect, and understanding on Wednesday, January 10.

About 90 Mount Sinai employees, students, and trainees joined the virtual vigil held via a Zoom call.

The event, titled “Our Shared Humanity: A Silent Vigil for Mourning,” was led by Rabbi Jo Hirschmann, BCC, FACHE, Senior Director of Education, Center for Spirituality and Health at the Icahn School of Medicine at Mount Sinai, and Rowaida Farraj, PharmD, Executive Director of Pharmacy, Mount Sinai Downtown.

“We spend so much of our lives talking. We wanted to create a quiet space where we could connect with ourselves and each other,” said Rabbi Hirschmann. “Together, we made space for our grief and for the hope and comfort that can come from simply being together. It was very meaningful to do this as Mount Sinai colleagues.”

Dr. Rowaida shared similar sentiments.

“It is clear many people are hurting during this difficult time,” she said. “We all needed a safe space to be together to feel that pain but also feel the presence of our community at Mount Sinai Health System which acknowledges that pain, respects all people, and hopes for a better future. We are so grateful we were able to create this space for everyone.”

Mount Sinai-Harlem Health Center: Elevating Health Care Through Comprehensive Services

The Mount Sinai-Harlem Health Center has officially opened its 12-story, 85,000-square-foot facility, symbolizing a transformative moment in the delivery of health care to the Harlem community.

The $80 million investment reaffirms Mount Sinai’s commitment to providing inclusive, equitable, and high-quality health care. Key figures, including Evan L. Flatow, MD, President of Mount Sinai Morningside and Mount Sinai West, Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and Kelly Cassano, DO, Chief Executive Officer, Mount Sinai Doctors Faculty Practice, emphasized the significance of the state-of-the-art outpatient facility during a ribbon-cutting ceremony on Tuesday, December 12.

“In an era where accessibility and comprehensive care are paramount, Mount Sinai-Harlem Health Center will play a pivotal role in ensuring that community members, our neighbors, receive the care they deserve,” said Dr. Flatow. “The Center stands as a beacon of hope, embodying the spirit of inclusivity, innovation, and a commitment to the health and wellness of Central Harlem.”

Input from patients, families, care team members, local leaders, and community organizations was integral to the development of the Center, providing input to the design and care teams. The goal was to ensure the Center met the needs of the stakeholders. A video, with reflections from current patients, helps prospective patients learn more about the Mount Sinai-Harlem Health Center.

“In an era where accessibility and comprehensive care are paramount, Mount Sinai-Harlem Health Center will play a pivotal role in ensuring that community members, our neighbors, receive the care they deserve. The Center stands as a beacon of hope, embodying the spirit of inclusivity, innovation, and a commitment to the health and wellness of Central Harlem.” — Evan L. Flatow, MD, President of Mount Sinai Morningside and Mount Sinai West

The Center provides primary care, surgical specialties, mental health care, dentistry, imaging, and pharmacy services, and also houses the Institute for Advanced Medicine (IAM), known at this site as the Jack Martin Fund Center. This specialized center offers health care in a safe and welcoming environment, catering to individuals regardless of background, sexual orientation, or age.

The Jack Martin Fund Center within the Mount Sinai-Harlem Health Center goes beyond conventional health care, providing social and support services to ensure comprehensive well-being. IAM patients, from infants to older adults, have access to primary care, mental health care, in-house specialty services, radiology, laboratory, and pharmacy services—all seamlessly integrated to offer holistic care.

Other noteworthy services provided by the Institute include acupuncture and massage; dentistry; dermatology; gynecology; nutrition; nephrology; neurology; obstetrics/gynecology; pain management; and prevention of anogenital cancer, which includes cancers of the anus, penis, and vagina.

The Center also provides HIV/AIDS care, LGBTQ+ care, transgender care, social work guidance, and access to clinical trials.

“The Institute for Advanced Medicine has its roots in providing care for people with HIV/AIDS,” said Michael Mullen, MD, Director of the Institute. “We offer special programs specifically for this population, for example to help them adjust to their medications, to ensure HIV-negative patients take PrEP to keep them from becoming HIV positive, addressing uncontrolled viral load in patients, and coordinating care for patients who do not have enough, or any, insurance.”

“Mount Sinai Health System has made an enormous commitment to equity in health care,” said Dr. Charney. “Not only is this Center home to a wide range of health care services, it also houses the Discovery and Innovation Hub, a unique community-driven incubator that tackles disparities resulting from social determinants of health.”

The commitment to mental health is further supported through the behavioral health services provided at the Mount Sinai-Harlem Health Center. A dedicated team of psychiatrists, psychologists, and social workers offers a range of behavioral health programs, including the Child and Adolescent Psychiatry Outpatient Program, the Adult Outpatient Service, the Partial Hospital Program, and the Center for Intensive Treatment of Personality Disorders.

“We’re reaffirming our commitment to providing accessible and evidence-based mental health services to those in need,” said Prameet Singh, MD, Director of Behavioral Health Services at Mount Sinai Health System. “Our team is experienced in caring for New York City’s diverse population.”

In addition to these groundbreaking initiatives, the Center is set to open a specialty pharmacy, open to the Center’s patients and members of the community, and a multispecialty practice in 2024. This practice will offer a diverse range of services, including care for digestive and kidney issues, eye care, orthopedics, and podiatry, enhancing the accessibility of specialized care within the community.

Unsung Security Officers Participate in Resilience Educational Program: For Some, a First Introduction to Helpful Strategies

Wayne Powell, Security Training Manager, and Reverend Zorina Costello, DMin, MDiv, MS, who helped create a resilience program specifically for security officers.

Hospital security officers are often our first human contact when we walk into a hospital. While they share the job description of “front-line worker,” along with doctors and nurses, they are both highly visible and yet “unsung” for all they do.

As the pandemic swept through New York City hospitals in 2020, their jobs transformed overnight as they became enforcers of new COVID-19 rules. One of the toughest rules: telling some visitors they could not come in. “Visitors to The Mount Sinai Hospital were not happy to hear about that. They wanted to see their loved ones, and we had to tell them ‘just one of you can go up,’” says Wayne Powell, Security Training Manager at The Mount Sinai Hospital.

One year into the pandemic, the faculty of Mount Sinai’s Center for Stress, Resilience, and Personal Growth took notice of the unique strain security officers were shouldering and created a resilience program, specifically tailored to officers like Mr. Powell. And more recently, they published a paper describing their approach and results.

“It was like a counseling session where you take a time out and reflect and think about the positive things and channel that to something great,” Wayne Powell, Security Training Manager, said of the program.

The Center opened in 2020 to serve as a resource for all Mount Sinai Health System staff and students. Staffed by social workers, psychologists, psychiatrists, and a healthcare chaplain, the Center provides educational workshops, confidential behavioral health care, and a resilience-building mobile app to faculty, staff, and trainees. Center faculty and staff also regularly publish peer-reviewed scientific articles about their findings, so that other health systems may benefit.

Reverend Zorina Costello, DMin, MDiv, MS, played a key role in creating the security officer program during the height of the COVID-19 pandemic in 2021. In addition to her Doctorate of Ministry in Pastoral Counseling. Rev. Costello has training in counseling, providing the skills to develop workshops tailored to security personnel that would have an impact.

“They often work alone and have few opportunities to socialize with their colleagues. In addition, they face myriad physical hazards and long working hours, making them susceptible to psychological stress, fatigue, and occupational burnout,” says the Rev. Dr. Costello.

During her 10 years at Mount Sinai, she has had the opportunity to meet the security team beyond just “hello” or “good morning.”  During her lengthy tenure in Mount Sinai’s chaplaincy, she had become the main point of contact for staff when colleagues passed away, giving her an intimate connection with hospital staff, including the security team.

While facilitating services for security personnel over the years, she started to understand their unique culture. “I was beginning to see how their isolation was affecting them and how the services presented unique opportunities for isolated workers to come together,” says Rev. Dr. Costello.

Rev. Dr. Costello served as co-author of a paper titled “A Resilience Program for Hospital Security Officers During the COVID-19 Pandemic Using a Community Engagement Model,” published in the Journal of Community Health in September 2023.

The paper describes how she and colleagues at the Center first conducted a pilot program and then launched a second program based on feedback they received, the latter comprised of twelve short briefings in which faculty and staff at the Center provided education around psychological first aid (PFA). PFA is an evidence-based approach to providing emotional support and ensuring safety in the acute aftermath of a stressful event. The program was well attended, reaching 107 officers who identified mostly as male (86 percent) and people of color (95 percent).

Viewed as a success, and fully embraced by security personnel, the program will be replicated at Mount Sinai West and Mount Sinai Morningside, according to Rev. Dr. Costello.

Security officers participated in 20-minute briefings that included a visual presentation with discussion focused on acknowledging the officers’ contribution to workplace safety and their exposure to violence; educating officers about clinical services available to them through the Center; and, discussing basic psychological first aid and coping skills. In a follow-up survey, the team found that the majority of officers (71 percent) felt that the workshops gave them the tools to do their jobs well and that the skills they honed were relevant (72 percent) to their lives outside of work.

“An important aspect of the briefings was to share resources at Mount Sinai for additional support, due to the officers’ limited knowledge of how to access mental health supports. While little is known about these kinds of interventions for security personnel, we do know from studies of police officers that two key impediments to getting help include not knowing how to access help and concerns about the stigma,” said Rev. Dr. Costello.

This work was funded in part through the support of the Aronson Family Foundation and by grants from the Health Resources and Services Administration and the National Center for Advancing Translational Sciences.

Mr. Powell, who is looking forward to his 60th birthday in December, has served Mount Sinai for 27 years. Yet this was his first exposure to these beneficial mental health concepts.

“For me personally, it was very successful, especially coming off the COVID-19 pandemic. It was like a counseling session where you take a time out and reflect and think about the positive things and channel that to something great,” says Mr. Powell. As he onboards new security personnel, he has made it a priority to sign his employees up for this training program.

Reflections From an Ethics Fellowship at Auschwitz

Students attending the Fellowships at Auschwitz for the Study of Professional Ethics at a library in Charité–Universitätsmedizin Berlin, where several specimens, including casts of body parts of some famous scientists and skulls of people from Namibia during German colonization, were displayed.

For many pursuing a path in medicine, a fellowship is an opportunity to learn and hone specialized skills in their chosen subspecialty. But medical education encompasses so much more than just medical skills and knowledge—compassion and ethics are just as important for a physician during medical training.

A group of students and graduates from the Icahn School of Medicine at Mount Sinai got to explore those values more deeply at the Fellowships at Auschwitz for the Study of Professional Ethics (FASPE), a two-week program in Berlin, Germany, and Krakow, Poland, exploring ethical atrocities committed in medicine in the past and opportunities for improvement today.

“The immersive experience it offers, allows participants to learn about some of the professional responsibilities of physicians,” says Rosamond Rhodes, PhD, Professor of Medical Education and Director of Bioethics Education at Icahn Mount Sinai.

When guided by humanitarian commitment, medicine can achieve great things, but when doctors lose sight of the profession’s fiduciary responsibility, horrors can come from it, says Dr. Rhodes. Students benefit tremendously from learning about critically important pieces of history in medicine, she adds.

Over the years, seven people from Icahn Mount Sinai have participated in the fellowship. Browse the slideshow and read from three recent fellows on their accounts of the program, and how it has reshaped their perspectives.

Käthe Kollwitz’s statue Mother With Her Dead Son in the Neue Wache building in Berlin, Germany.

“I found myself able to make myself vulnerable in sharing my thoughts and being transparent when discussing the fellowship’s fundamental themes, namely: what is inside us that makes us prone to becoming perpetrators or complicit in flawed systems, despite our most noble intentions?”
Krishna Patel, student, Class of 2025

Humboldt University of Berlin, in which some 20,000 books were burned during the Nazi regime.

“It is no secret that both health care and education, especially in the United States, are flawed systems—to say the least—yet how can this be reconciled with the vast majority of individual agents, including teachers, nurses, doctors, and aides who devote themselves to a career of helping others during times of high need and vulnerability?”
Krishna Patel, student, Class of 2025

A memorial on Rosenstraße in Berlin, commemorating women who protested for their Jewish husbands to be released.

“In my work as a physician, this experience compelled me to consider the ethical challenges of addressing histories of collective harm and health-related trauma in underserved communities. In particular, this lesson from FASPE shaped my career interests in gender equity and preventive health.”
Esha Bansal, MD, MPH, Class of 2023

FASPE fellows at Charité–Universitätsmedizin Berlin.

“In discussing how to memorialize the remains of victims of the Holocaust and Germany’s colonial campaigns in West Africa, we confronted challenges around the use of human specimens in research without consent. Having previously worked with digital forms of clinical data and understanding its growing ubiquity in health care technologies, I was struck by similar implications that are increasingly posed by digital data.”
Anish Kumar, student, Class of 2025

A lecture hall at  Charité–Universitätsmedizin Berlin.

“Here, we traced the steps of pioneers of medicine, where figures like Rudolf Virchow and Carl Wernicke elucidated concepts that have become integral to modern clinical practice. But it was in these same hallways where academics contributed to and benefited personally from the atrocities of the Nazi regime, gaining easy access to human subjects and cadavers for their research efforts.”
Anish Kumar, student, Class of 2025

Anish Kumar, Class of 2025
Krishna Patel, Class of 2025
Esha Bansal, MD, MPH, Class of 2023

Anish Kumar is currently on a Scholarly Year project—a yearlong research training—at RubiconMD, a New York-based digital health company that aims to improve access to specialty care. Professional interests include how clinical medicine and artificial intelligence intersect and resulting ethical questions, and using digital technologies and policy solutions to improve access to health care for LGBTQ+ and limited-English-proficiency patients.

As part of the FASPE program, our group had the opportunity to visit the Charité–Universitätsmedizin Berlin, a university hospital and medical school in the center of Berlin. Here, we traced the steps of pioneers of medicine, where figures like Rudolf Virchow and Carl Wernicke elucidated concepts that have become integral to modern clinical practice. But it was in these same hallways where academics contributed to and benefited personally from the atrocities of the Nazi regime, gaining easy access to human subjects and cadavers for their research efforts.

Our cohort visited a facility in Brandenburg, Germany, that was part of the Aktion T-4 campaign, in which medical professionals selected patients with serious illness or disability for systemic execution. Many of these clinicians were swayed by arguments that caring for such patients was excessively resource-intensive and that these patients represented “life unworthy of life.”

I was horrified to learn that doctors had signed up their own patients to be killed—a realization made even more chilling by witnessing the remnants of a gas chamber prototype that was used, which eventually became the notorious killing machines used to execute mass murder in concentration camps. I saw that rank-and-file physicians had been compelled to corrupt their core ethical values and murder their own patients, all in the name of public health.

In discussing how to memorialize the remains of victims of the Holocaust and Germany’s colonial campaigns in West Africa, we confronted challenges around the use of human specimens in research without consent. Having previously worked with digital forms of clinical data and understanding its growing ubiquity in health care technologies, I was struck by similar implications that are increasingly posed by digital data. Inspired by my experiences at Charité, I am currently writing an opinion piece arguing that certain forms of medical data should be considered “digital specimens” and that their use in research should be regulated in similar manners to physical samples.

I realize that part of my duty as a physician is to stay vigilant and speak out against claims that blindly dismiss the importance of an individual patient in alleged deference to the greater good. I am grateful for the opportunity to participate in FASPE and to walk away with a new vocabulary, refined perspective, and a deeper confidence in my ability to recognize and engage with the inevitable ethical dilemmas that will face me as a physician.

Krishna Patel is currently on a Scholarly Year project, and started a 501(c)(3) nonprofit called Health and Education Alliance, supported by Mount Sinai’s Discovery and Innovation Hub Fellowship. The nonprofit builds partnerships between health care organizations and school districts to maximize access to health care and education opportunities through holistic community centers.

Before arriving in Berlin and Krakow for the two-week fellowship, I found myself grappling with a lot of excitement but also some element of concern. Having lacked any prior ethics background and knowing I would be in a cohort of folks with much more knowledge than me in this domain, I couldn’t help but worry about how I might be judged. However, I am so thankful to say that all of the other 41 fellows, who challenged me to break down and realize my own biases and weaknesses, were among the kindest, most insightful group of people I have had the pleasure of meeting.

In particular, it turns out that spending entire days in close proximity with everyone at historical sites, where some of the greatest horrors in history have been memorialized, is one of the best ways to bring people together, albeit in a way that I could not have comprehended prior to this experience.

I found myself able to make myself vulnerable in sharing my thoughts and being transparent when discussing the fellowship’s fundamental themes, namely: what is inside us that makes us prone to becoming perpetrators or complicit in flawed systems, despite our most noble intentions?

As a future physician who is currently in the midst of a Scholarly Year, where much of my work focuses on improving health care and education inequity for underserved neighborhoods and families with special needs, I have been unable to stop myself from ruminating on this question since the conclusion of the fellowship. It is no secret that both health care and education, especially in the United States, are flawed systems—to say the least—yet how can this be reconciled with the vast majority of individual agents, including teachers, nurses, doctors, and aides who devote themselves to a career of helping others during times of high need and vulnerability?

Truthfully, I still do not have the best answer to this question. However, without FASPE, I would never have been able to come away with the ethical framework to engage in self-introspection and evaluate my own biases and shortcomings as much as possible. Moreover, I do not believe I would have the courage or even the words to articulate some of my frustrations, which have encouraged communication with people I speak to for my Scholarly Year work in my hometown, Pittsburgh.

I could not be more grateful for my FASPE experience and I’m optimistic it will stay with me throughout the remainder of my professional career. It reinforces the notions that as physicians who have the great privilege of having roles and rights in patients’ lives not otherwise granted to most other professions, there is always more that we can advocate for as a collective profession to minimize harm and hold ourselves accountable.

Esha Bansal, MD, MPH, is currently a resident physician in internal medicine at Hospital of the University of Pennsylvania. Professional interests include reducing preventable morbidity and mortality through population health research and public policy, particularly in cardiovascular disease, and advancing gender equity by designing equitable, sustainable health interventions that reduce sexual and gender-based violence for women and girls worldwide.

While visiting important historical sites through FASPE, I was struck by the complexities of memorializing large-scale events of human suffering. Early in the fellowship, we visited the Grunewald train station, a major deportation site for the Jewish community of Berlin during World War II. Over time, several commemorations of the violence enacted at the Grunewald train station had been installed by diverse groups, simultaneously reinforcing and contrasting with one another to bring a piece of this history into the present and future.

In my work as a physician, this experience compelled me to consider the ethical challenges of addressing histories of collective harm and health-related trauma in underserved communities. In particular, this lesson from FASPE shaped my career interests in gender equity and preventive health. Inspired by “A Woman in Berlin,” an important post-World War II literary work by a German journalist, I wrote an essay arguing that past and present incidents of mass sexual violence should be proactively acknowledged as medical and public health crises with genocidal attributes.

At the conclusion of the fellowship, our cohort visited the Auschwitz-Birkenau Memorial and Museum in Oświęcim, Poland. Standing in the physical space where millions of people were exterminated was a powerful, humbling experience. This moment moved me to make my own contribution to the ongoing work of addressing medical and public health professionals’ complicity in mass crimes—including the genocides of World War II, in which Nazi physicians participated freely and voluntarily. I later wrote a commentary article calling attention to the unmet obligations of the medical and public health professions to address femicide, a severe and highly prevalent form of gender-based violence, as a global health problem.

Participating in FASPE reinforced my belief that as physicians and public health professionals, we must seek accountability for our profession’s role in perpetuating harm. I am grateful that FASPE offered me the intellectual framework, personal experiences, and practical skill set to begin my own professional ethics journey.

Anish Kumar, Class of 2025
Krishna Patel, Class of 2025
Esha Bansal, MD, MPH, Class of 2023

Anish Kumar is currently on a Scholarly Year project—a yearlong research training—at RubiconMD, a New York-based digital health company that aims to improve access to specialty care. Professional interests include how clinical medicine and artificial intelligence intersect and resulting ethical questions, and using digital technologies and policy solutions to improve access to health care for LGBTQ+ and limited-English-proficiency patients.

As part of the FASPE program, our group had the opportunity to visit the Charité–Universitätsmedizin Berlin, a university hospital and medical school in the center of Berlin. Here, we traced the steps of pioneers of medicine, where figures like Rudolf Virchow and Carl Wernicke elucidated concepts that have become integral to modern clinical practice. But it was in these same hallways where academics contributed to and benefited personally from the atrocities of the Nazi regime, gaining easy access to human subjects and cadavers for their research efforts.

Our cohort visited a facility in Brandenburg, Germany, that was part of the Aktion T-4 campaign, in which medical professionals selected patients with serious illness or disability for systemic execution. Many of these clinicians were swayed by arguments that caring for such patients was excessively resource-intensive and that these patients represented “life unworthy of life.”

I was horrified to learn that doctors had signed up their own patients to be killed—a realization made even more chilling by witnessing the remnants of a gas chamber prototype that was used, which eventually became the notorious killing machines used to execute mass murder in concentration camps. I saw that rank-and-file physicians had been compelled to corrupt their core ethical values and murder their own patients, all in the name of public health.

In discussing how to memorialize the remains of victims of the Holocaust and Germany’s colonial campaigns in West Africa, we confronted challenges around the use of human specimens in research without consent. Having previously worked with digital forms of clinical data and understanding its growing ubiquity in health care technologies, I was struck by similar implications that are increasingly posed by digital data. Inspired by my experiences at Charité, I am currently writing an opinion piece arguing that certain forms of medical data should be considered “digital specimens” and that their use in research should be regulated in similar manners to physical samples.

I realize that part of my duty as a physician is to stay vigilant and speak out against claims that blindly dismiss the importance of an individual patient in alleged deference to the greater good. I am grateful for the opportunity to participate in FASPE and to walk away with a new vocabulary, refined perspective, and a deeper confidence in my ability to recognize and engage with the inevitable ethical dilemmas that will face me as a physician.

Krishna Patel is currently on a Scholarly Year project, and started a 501(c)(3) nonprofit called Health and Education Alliance, supported by Mount Sinai’s Diversity Innovation Hub Fellowship. The nonprofit builds partnerships between health care organizations and school districts to maximize access to health care and education opportunities through holistic community centers.

Before arriving in Berlin and Krakow for the two-week fellowship, I found myself grappling with a lot of excitement but also some element of concern. Having lacked any prior ethics background and knowing I would be in a cohort of folks with much more knowledge than me in this domain, I couldn’t help but worry about how I might be judged. However, I am so thankful to say that all of the other 41 fellows, who challenged me to break down and realize my own biases and weaknesses, were among the kindest, most insightful group of people I have had the pleasure of meeting.

In particular, it turns out that spending entire days in close proximity with everyone at historical sites, where some of the greatest horrors in history have been memorialized, is one of the best ways to bring people together, albeit in a way that I could not have comprehended prior to this experience.

I found myself able to make myself vulnerable in sharing my thoughts and being transparent when discussing the fellowship’s fundamental themes, namely: what is inside us that makes us prone to becoming perpetrators or complicit in flawed systems, despite our most noble intentions?

As a future physician who is currently in the midst of a Scholarly Year, where much of my work focuses on improving health care and education inequity for underserved neighborhoods and families with special needs, I have been unable to stop myself from ruminating on this question since the conclusion of the fellowship. It is no secret that both health care and education, especially in the United States, are flawed systems—to say the least—yet how can this be reconciled with the vast majority of individual agents, including teachers, nurses, doctors, and aides who devote themselves to a career of helping others during times of high need and vulnerability?

Truthfully, I still do not have the best answer to this question. However, without FASPE, I would never have been able to come away with the ethical framework to engage in self-introspection and evaluate my own biases and shortcomings as much as possible. Moreover, I do not believe I would have the courage or even the words to articulate some of my frustrations, which have encouraged communication with people I speak to for my Scholarly Year work in my hometown, Pittsburgh.

I could not be more grateful for my FASPE experience and I’m optimistic it will stay with me throughout the remainder of my professional career. It reinforces the notions that as physicians who have the great privilege of having roles and rights in patients’ lives not otherwise granted to most other professions, there is always more that we can advocate for as a collective profession to minimize harm and hold ourselves accountable.

Esha Bansal, MD, MPH, is currently a resident physician in internal medicine at Hospital of the University of Pennsylvania. Professional interests include reducing preventable morbidity and mortality through population health research and public policy, particularly in cardiovascular disease, and advancing gender equity by designing equitable, sustainable health interventions that reduce sexual and gender-based violence for women and girls worldwide.

While visiting important historical sites through FASPE, I was struck by the complexities of memorializing large-scale events of human suffering. Early in the fellowship, we visited the Grunewald train station, a major deportation site for the Jewish community of Berlin during World War II. Over time, several commemorations of the violence enacted at the Grunewald train station had been installed by diverse groups, simultaneously reinforcing and contrasting with one another to bring a piece of this history into the present and future.

In my work as a physician, this experience compelled me to consider the ethical challenges of addressing histories of collective harm and health-related trauma in underserved communities. In particular, this lesson from FASPE shaped my career interests in gender equity and preventive health. Inspired by “A Woman in Berlin,” an important post-World War II literary work by a German journalist, I wrote an essay arguing that past and present incidents of mass sexual violence should be proactively acknowledged as medical and public health crises with genocidal attributes.

At the conclusion of the fellowship, our cohort visited the Auschwitz-Birkenau Memorial and Museum in Oświęcim, Poland. Standing in the physical space where millions of people were exterminated was a powerful, humbling experience. This moment moved me to make my own contribution to the ongoing work of addressing medical and public health professionals’ complicity in mass crimes—including the genocides of World War II, in which Nazi physicians participated freely and voluntarily. I later wrote a commentary article calling attention to the unmet obligations of the medical and public health professions to address femicide, a severe and highly prevalent form of gender-based violence, as a global health problem.

Participating in FASPE reinforced my belief that as physicians and public health professionals, we must seek accountability for our profession’s role in perpetuating harm. I am grateful that FASPE offered me the intellectual framework, personal experiences, and practical skill set to begin my own professional ethics journey.