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

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

Pamela Adelstein

The Expect

Statistically, to avoid missing a case of appendicitis, one must send to the ER some patients with symptoms of appendicitis whose appendices turn out to be normal. This lesson from medical school is imprinted indelibly on my mind.

In my residency program, if a resident sent a patient to the ER, the resident was required to go the ER to evaluate them, to further their learning. However, this created a conflict of interest—if you had to meet a patient in the ER, you missed out on sleep. Hence I thought hard about the disposition of each patient.

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Lipo

My patient inquires about one final issue during her appointment. After wavering for years, she’s decided to travel to Florida for liposuction. She has saved portions of her paycheck over the past year to pay her airfare, hotel, and surgical fee. The surgeon requires X-rays, an EKG, bloodwork, and preoperative clearance. And I am asked to provide them.

Often patients unhappy with their weight—and physical appearance—dream of a quick fix. With an internet recommendation of a surgeon and a few Zoom calls, the surgery is booked.

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A Routine Clinic Session

I open the door, belt out a “hello,” and peer at the patient seated in the exam room I’ve just entered. My gaze is drawn to a homemade button pinned to their jacket and then to their T-shirt. Both depict a photo of their loved one who was a victim of gun violence. The victim’s dates of birth and death are imprinted below the photo. A quick mental subtraction reveals a life ended far too soon.

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Popping the Question

Last week it happened again. It starts with a hesitant smile, a subtle pause, eyes looking me up and down, and a gaze that tentatively rests at my stomach. I sense what is about to occur, and I wait like the proverbial deer in the headlights. Then comes the timid question: “Are you expecting?”

I pause awkwardly and briefly contemplate my response. Because my patient is inquiring out of love and genuine curiosity, I tamp down my sarcasm and mumble, “It’s my pants style.” The patient lowers their eyes and murmurs something apologetic.

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Searching for Activism

My senior year in college, I took a course called Women and Radicalism. It was an exciting class. We studied radical movements on the left and right, with a focus on women’s participation. The course featured a weekend retreat with women activists. For two days, women took the stage to describe their causes and advocacy roles. I attended many sessions, in awe of these phenomenal women who were making a difference in the world. I noted that most of them had been thrust into their cause by a personal adverse event, such as gun violence or an environmental catastrophe.

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Tug of War

A tug of war lives within me, and my physical body and soul are struggling mightily. Gratitude pulls one end of the rope, and burnout yanks the other. I feel immensely grateful that I can meaningfully contribute to people’s care during the pandemic. I’ve triaged, tested, talked with and tended to countless patients since COVID-19 began. I am blessed with wonderful family, friends and community plus a job with deep purpose and meaning. Each workday I feel enriched by those around me.

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Asking Permission

When our children were young, my husband and I taught them about the need to ask permission before performing actions that could have consequences. As part of our strategy, we highlighted whenever a poorly thought out choice triggered a positive or negative outcome.

To my bemusement, even into their early adolescence, our kids would ask if they could have a snack or dessert or watch an extra show. I would bring great ceremony to my reply, in the hopes of perpetuating their impression that asking for permission was still necessary.

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