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

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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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August 2016

Al Amira Abaya

“There are some unusual spots on my feet that I want to have examined,” says the fifty-something woman with a friendly smile.

She is wearing an al amira, a two-piece veil consisting of a close-fitting cap and an accompanying tube-like scarf. The rest of her body is covered by her loose-fitting abaya, despite Philadelphia’s sweltering July heat. I have learned that these garments are traditionally worn by Muslim women as an expression of modesty when they’re in the presence of males not in their immediate family.

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Fistula Patient on Four

When I joined the surgical team, she was already a fixture, having languished there on the fourth floor for over two months. Attractive, in her early thirties, she wore little but skimpy lingerie–garb that seemed at odds with her belly, criss-crossed as it was with surgical scars and small holes that weeped gastric juices and intestinal fluids. On the team’s daily rounds, the surgeons would don gloves, avoid eye contact with her, hem and haw their way through a cursory exam, then quickly move on.

Only a medical student, and feeling awkward in her presence, I would trail behind, tapping out a note before hurrying off to catch up with the team.

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How to Change a Diaper

Two daughters bring their severely demented mother into the clinic. The mother is no longer able to speak, but over the last few days she has groaned more during diaper changes. Her nursing home is worried she might have a bladder or vaginal infection. To check her urine, we undress her and catheterize her. To check her vagina, we take a swab using a speculum. We spin the urine and look for sediment under the microscope. Nothing.  We look at the vaginal smear under the microscope, using both a saline prep and potassium hydroxide. Nothing. We treat her for bacterial vaginosis, because it’s a condition that’s easy to miss.

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Nothing Left Unexposed

“Use the room over there,” she said, pointing towards the closed door to my right and handing me a clear, plastic cup with blue-twist top. “When you’re done, open the slot behind you, place the sample and close the slot door.”

It’s opening day at my cancer hospital. First peek into my innards is a urine sample, checking for protein. Too much excreted protein may signal kidney disease, a death knell to my upcoming cancer treatment. Which would in turn mean a death knell for me. The urine sample will be followed by a needlestick into one of my veins to fill an endless line of blood tubes. Some will be used to check routine blood labs. The rest will be mailed to some lab somewhere for monitoring my immune response during treatment.

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Supermarket Encounter

I was in a large supermarket in the late afternoon. At the busy cheese counter, I took a number and stood waiting in the large crowd. When my number was called, I pushed through the customers to the counter and gave my order. After I’d finished, I took a half-step backward and collided with someone.

As I turned around to apologize, I found myself facing a young woman who towered over me. I am white; she was African-American and wore the uniform of a meter maid. I said that I was sorry, that I hadn’t seen her.

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Never Say Die

Christine Todd

In November of my intern year, I had trouble finding the sun. It was dark when I woke up for work, and it was dark when work was done and I headed back home. I’d picked up the service on the cancer ward from an intern named Bob, and Bob had left me six handwritten pages on the subject of Jim Franklin.

And this was the deal: Jim Franklin, thirty-seven years old, had been living on the cancer ward for the last three months. He had a two-foot-high stack of records, and the pity and admiration of nearly every nurse, tech and doctor in the hospital. He’d been diagnosed with Hodgkin’s lymphoma four years earlier, treated with chemotherapy and thought to be cured. A year ago his cancer had recurred, and he’d been failing therapy in what could only be called a spectacular manner ever since.

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Riding the Rails

William Toms

Our train starts to move slowly down well-traveled tracks. Sunny out,
clouds in the distance. We pick up speed.

We offer obligatory greetings,
courtesy How you feelings?
We both know why she’s here
we defer that talk
as if deferring for a few minutes will make it easier.

The trackside turns to trash, human detritus, rusting hulks without utility.

I edge closer, negotiating perfunctory reviews–
her history, her physical, her labs, her imaging–
she owns them, they’re hers alone.
Then it’s time to enter the forbidden room of abnormals:
machine-made “shadows,” the blood’s “too highs.”
Her cloak of woven fear lies quietly on her shoulders.

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