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fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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May 2013

How It Was When You Stopped Knowing Me

Susan Rooke

When I cannot help remembering, I recall
that the end of your memory arrived
in a Texas spring so wet it churned the rivers,
ripped white frame houses from the banks
and sent them rampaging on the currents
like Pamplona bulls turned loose into the streets.
There were bridges on those rising rivers, and
I cannot help remembering that I crossed them

driving south, looking down to see the sharp horns
of shingled eaves tossing, slinging muddy foam
in the floodwaters down below. I drove hours

just to get you, because you’d lost the knack
of getting anywhere yourself–a block away,
next door, downstairs–and so, when I cannot help
remembering how it was when you stopped
knowing me, I recall that I came for you to guide
you through the rushing streets of your newly
foreign, unfamiliar land, that metaphorical Pamplona,
not as just a native steering a tourist through
the crowd, but as if I’d been your child, as if you
» Continue Reading.

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Return of the Hero

Peg Ackerman

Blanched by anemia, Mary rested quietly in the hospital bed. Her pallor made her barely visible amid the bleached bed linens–she seemed a mere shock of white hair against the pillowcase. 

Age ninety-three, she’d visited the hospital a half-dozen times in as many months, shuttling between nursing home and hospital as many elders unwittingly do in their last year of life. She may have preferred to stay put, but no one knew for sure: as a person with dementia, she was presumably unable to speak for herself. 

I was a palliative-care nurse practitioner in the hospital. Until about two decades ago, whenever someone neared the end of life the details of care were discussed with his or her doctor; nowadays, that intimate discussion often takes place in-hospital, with a total stranger. For Mary, I was that stranger. 

Hospitalized for severe anemia, she had been scheduled for a colonoscopy. But when she refused to drink the four-liter liquid prep, her doctor flipped her to me to evaluate her “goals of care.”

Goals of care–that’s our euphemism for how a person wants to die. We ask questions like, “Do you want your heart resuscitated if it stops?” or “Do you want

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On the Road

Josephine Ensign

As a community health nurse, I work with homeless and street-involved teenagers. In almost thirty years of doing this work on both coasts, and in Thailand and Venezuela, I’ve gotten to know thousands of young people living on the margins of society.

I love working with them; they challenge me to see the world–and myself–in a broader way, one that opens up vistas of hope for positive change and a better future.

And I always find myself touched by their hopefulness and vulnerability. Their level of optimism varies depending on many factors: their socioeconomic background and level of education, their intelligence and social skills, their involvement with foster care, and factors such as the general level of chaos they experienced growing up, and whether or not they suffered childhood abuse. But no matter how bad their lives have been, these young people always seem to hold on to a sense of possibility.

Sometimes I talk to a homeless teen for ten minutes and feel convinced that he or she can make it out. But sometimes I’m wrong.

Take Will, for instance. 

I met him in Seattle at a homeless-youth clinic where Will came for health care. He was

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During Lunch at Medical Center Hour Today

a developmental biologist shows us a video of a fertilized egg 
dividing into two then four then eight cells–
a day’s worth of differentiation in a minute–
followed by a slide of a week old blastocycst drawn in cross section
with an outer cell mass or future placenta and an inner cell mass
that’s either someone already or destined to be someone
with the same constitutional rights as any non-incarcerated citizen, 
and while on the subject of genes as destiny the next clip
shows an unfertilized stem cell donated by a monkey at a lab
where the genetic basis of alcoholism is put to the test: 
the stem cell donor sits in the corner of a cage, big smile on her face
since she was randomized to drink as much beer as her genes wanted, 
and while that was supposed to be funny 
it wasn’t as funny as the story of the pope who decreed
that no human eggs could be stored in Italian laboratory freezers, 
prompting wily Italian scientists to freeze dry eggs 
for room air storage and quick and easy shipment to countries without popes,
but who needs eggs when stem cells on their own can be encouraged

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What to Say When You’re Terminal

Ellen Diamond

For the past fifteen years, I have had an incurable form of leukemia.

Such diseases used to be called terminal illnesses, but we don’t hear that term as much anymore. With all the new drugs and treatments available, doctors have become more reluctant to refer to diseases they can’t cure yet as “terminal.”

In the years just after my diagnosis, when friends and family would ask what could be done for it, I used to say that nothing could be done, adding: “It’s terminal.”

I was trying to be honest, to say, “Come now, we must face this.” People’s reactions of shock and sadness, though, made me wish I’d put it some other way. But what other way?

My father, who’d died of the same form of leukemia at age forty-three, had never known what he had. It was a secret my mother kept from him and from my sister and me–and as with many such family secrets, each of us paid a high price. So I wanted to be all about honesty.

I continued to use those words, yet they never felt quite right. I began to sense that there was a

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