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This month... Making Assumptions

Kendra Peterson

July first Fellow,
a pager blares announcing
my initiating consult, a 29-year-old
(just my age)
malignant melanoma
and a first-time seizure
while receiving an infusion
of experimental treatment.

When I arrive
she's already gotten
two milligrams of ativan
dilantin load is hanging
and I examine
a somnolent young woman
now coming 'round,
could be my friend, my sister, me,


no fever or stiff neck
no lateralized weakness
reflexes are brisk throughout
and toes go up with plantar stimulation.
I recommend the usual labs, brain MRI
and scurry off to find
my famous mentor,
the one whose genius moved me
three thousand miles across,
a differential diagnosis forming
as I ascend the stairs.

After history and exam conveyed
I list for him the possible causes
for a seizure in this patient:
          -the experimental drug itself
          -electrolyte imbalance
          -immune suppression with CNS infection
          -maybe she's a drinker or drug user
          -could be a subdural
          -a sinus thrombosis on birth-control pills,
and almost as an afterthought,
I suppose she could have

          -brain metastases.

As my words cascade
and pool between
I notice a kind question
forming in his eyes
as if he seeks to understand,
or perhaps I am familiar.
Gently he says, "You realize
she has brain mets,
don't you?"
Well maybe,
but....
and with a hint of desperation
my list begins to flow again.
He holds my gaze, an eyebrow cocked.
Then soundlessly he walks away.

After visiting Radiology,
finishing my write-up with leaden
heart in the harsh yellow
of the nurses' station,
a light hand finds my shoulder
and I turn to face the knowing
eyes, a moment that covalently
establishes our bond of understanding.
"You really didn't want her to
have brain metastases, did you?
Neither did I," somberly, "Neither did I."
Then soundlessly he walks away.


About the poet:

Kendra Peterson is a neurologist who lives in Palo Alto, California. She is a member of Pegasus Physicians at Stanford University, a group of physicians who write creatively.

About the poem:

"This poem is derived from an experience that occurred many years ago on the first day of my neuro-oncology fellowship, but that has had a lasting impact. It reflects the challenge that healthcare providers often face, feeling empathy and compassion while simultaneously applying our knowledge, intellect and judgment. The mentor described in the poem has mastered this challenge, modeling it both in his approach to the patient and in his interaction with the fellow."

Poetry editors:

Johanna Shapiro and Judy Schaefer

Comments   

# deborah 2015-10-20 10:53
Your mentor understood the "soul" of man that reaches out to learn beyond mere intellect. Great knowledge is at once a a blessing & a curse to those who are called to healthcare. My wish would be more doctors to teach from the heart - empathy & compassion, and from the mind - not just knowledge - but true wisdom. Too often doctors compete to see who can be the loudest & most obnoxious as they talk down to others who are just wanting to learn. Too many bang their fist on the desk & have fits assigning blame when a patient does not do well. I wonder if it is their own frailness they are hiding from? I salute your mentor, go and be like him.
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# Maria Romanas 2015-10-12 13:01
As a pathologist, I have to make the diagnosis of cancer many times over the course of my workday. If I were to personally know the patients, my work would be unbearable.
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# martin kohn 2015-10-12 09:37
very moving poem, one I'm saving for our "empathy" session next year. best, mk
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# Susan Dimopoulos 2015-10-10 20:16
Thank you for so beautifully capturing the humanity involved in health care - which unfortunately mostly gets overlooked/igno red or denied, for various reasons.
I have recently participated in a consumer consultation process to advise a professional Physicians college on what 'patient centered care' looks and feels like, and what they might do to achieve it...after reading this poem I believe we need to call it 'person centered care' - for there to be real improvement in health care there must be recognition & respect for the needs of both the patient and the physician.
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# Patti Davis 2015-10-10 07:55
Sometimes encountering others hurts us. Thank you for saying so beautifully. And thank you for continuing to be vulnerable to those encounters.
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# Norma Smith 2015-10-09 22:59
Thank you so much for this beautiful piece of work. For all of the work that's expressed in it. Your work of learning; your mentor's work of accepting, *and*being able to teach integrity of all dimensions. and thank you for learning how to accompany your patients with honesty and care. It's all in this poem. Yes, the poem is about the impulse toward denial, but I think it's more/also about acceptance, with a side of sadness.
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# Dorothy Blake 2015-10-09 22:46
I wept for all three of you and for the human condition.

Thank you for the poem. I think to Latin derivation of poem is "to make". You made a wonderful one.

Dorothy Blake
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# Margaret Fleming 2015-10-09 22:26
You helped me to picture him, hear him.
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