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

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Pam Adelstein

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Ode to the Bravest People I Know

2 Comments / Guts /

It takes guts to show up for your medical appointment and meet a new provider about whom you know nothing. Perhaps this one will stay longer than the last three primary care providers you have been assigned. Perhaps this provider will use your correct name and pronouns and will not deadname or misgender you. Perhaps this PCP will not dwell on the fact that you are trans when gender identity is irrelevant to your chief complaint. Perhaps you will not be asked the dates of your last menstrual period when you were born without a uterus. Or, perhaps support staff will think twice before asking about menses, as the word “menstrual” triggers dysphoric feelings, and you have had breakthrough bleeding when you’ve been unable to obtain a testosterone prescription.

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Universal Longing

Leave a Comment / Longing /

My work as a physician often centers around helping mitigate trauma held by my patients. Recently I realized that my work also revolves around helping my patients manage their longing.

People long so deeply, and for so much. They go through countless medical procedures for a chance to become parents. They trial numerous medications and lifestyle changes to lose weight, feel less pain, or sleep through the night. They yearn for relief from the panic and depression that prevents them from leaving the house, working, and making friends. They pray that their cancer will stay in remission amid traumatic memories that resurface with each test and scan. They long to affirm their gender identity – to look in the mirror and see themselves as they feel inside and be fully embraced by their loved ones and society.

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Questions That Need to Be Asked

5 Comments / House Calls and Home Care /

In medical school, the importance of monitoring vital signs, labs, and disease markers was drilled into our brains. When these numbers were sub-par, we were told to advise folks to “eat less processed food,” “get more exercise,” “take your meds as prescribed,” etc. It becomes easy to fall into the trap of treating the humans sitting across from us in the exam room as the total of their labs and vitals. But for many patients, other factors are just as important. Some cannot easily eat well or bathe themselves, so they ask their PCP to find home health care to assist them with food shopping, meal preparation, laundry, and basic housework.

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Wisdom from Her Younger Self

Leave a Comment / Chronic Pain /

Grimacing, my middle-aged patient described a somatic pain radiating out from a deep-seated void. This decades-old ache manifested itself as intractable muscle tension or tenacious migraines or debilitating heartburn and was always accompanied by emotional anguish.

At the void’s root lay existential angst, exacerbated by dark skies, loneliness, major decisions, and life’s transitions. Her genogram revealed deeply entrenched generational trauma. Her lab workup was normal. She sought out various modalities—medication, acupuncture, psychotherapy, psychic readings, herbal remedies. Her flares were fewer, but they struck randomly, disrupting her life for days.

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A True Exam Room

3 Comments / The Exam Room /

I recently accepted an opportunity to work in a new clinical setting. I now spend one day a week at a harm reduction site that serves people who are currently using or have used drugs within the past 12 months.

To my surprise, I’d passed by the nondescript brick building housing the site countless times. Clients come in to a room known as the “exchange”—a large space where they can make a cup of coffee or a bowl of oatmeal, grab some snacks, trade used needles or pipes for clean ones, or pick up a hygiene kit or a new T-shirt. Social workers make the rounds to assist folks with these tasks; as the clinician, I meander and chat with the clients, introducing myself as a doctor and offering to help them with any medical questions.

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Unraveling

1 Comment / Awaiting a Diagnosis /

A certain patient and I had always enjoyed an easy rapport at his annual exams and occasional acute care appointments.

Then one morning he presented with an itchy skin rash. The skin findings were minimal; he had tried over-the-counter creams to no avail. I prescribed a more potent topical medication, and he left satisfied. Two weeks later he called again, this time asking for an urgent visit. The rash had spread and the itch was keeping him up at night. He sent photos via the portal, but their blurriness made them difficult to decipher.

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Menopausal Moments

2 Comments / Loss /

The personal question patients used to ask me was “Are you pregnant?” Recently, a patient inquired, after sharing that his wife had started menopausal hormonal therapy, “Do you also take this?”

I have indeed started what I call my Menopause Trifecta: an estrogen patch, a progesterone pill, and a testosterone gel. Estrogen made me miserable during puberty; helped me become a mother of two children; and drove cyclical cravings, cramps, and crying. But my ovaries no longer produce estrogen. My “childbearing potential” is gone. Unused menstrual supplies gather dust in a cabinet.

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Spiraling

4 Comments / Hospitalized /

As a primary care physician, I like my patients’ charts to be updated, without redundant or irrelevant information. So, before initial appointments with patients I “inherited” when I joined my current practice, I take some time to “clean up their chart.”

When patients have complex medical histories and medication lists, cleanup is challenging. But worth it. This process helps me build a two-dimensional picture of the patient, their disease trajectory, relationship with specialists, and longitudinal overall health. When I meet the patient, I can then focus on listening and observing and understanding them three-dimensionally.

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Boys or girls?

7 Comments / Diversity /

Like many parents, I love to talk about my children. A conversation with someone to whom I’m newly introduced often begins with “Do you have children?” (Yes.) “How many?” (Two.) Then the natural and understandable follow-up question is usually “Boys or girls?”

Usually, I revel in the possibilities inherent in meeting someone new. However, at such moments, I pause and protest silently. Ugh! This is a question one should never ask someone you’re just meeting.

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Decades

2 Comments / Grit /

I’ve been aboard a “choo-choo train” for decades. I traveled to college, to medical school, to family medicine residency, to become an attending physician, then a medical administrator. Each new locale exposed me to a novel culture, with new languages, rules, and personalities—forcing me to learn different ways of thinking and relating to my environment.

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Listen Carefully to the Youth

2 Comments / Trans /

With tears in my eyes, I burst out of the classroom, seeking refuge from my teacher’s and classmates’ endless verbal battering of me. We were mired in a debate about whether the canon of religious music should be omitted from public school choral groups’ repertoires to “appease” students who felt uncomfortable with such music. The discussion was framed with a particular implication—that because of a squeaky and unreasonable minority, the majority of students were deprived of critical singing opportunities.

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