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

Paul Gross

Medicine Land Celebrates a Birthday

Paul Gross

The first real patient of my medical career was a 60-year-old man in the surgical intensive care unit. I met him on the first day of the third year of medical school, when students join teams of doctors doing inpatient medicine.

The surgical team met at 7:00 am–a ludicrously early hour, I thought. There were nearly ten of us–four students, a couple of interns and senior residents and a chief resident.

As the team gathered around the patient’s bed, we students hung back, looking at the form before us. A pale, fleshy foot poked out from under his hospital gown. The room smelled funny.

The patient was comatose. Had he been awake and alert, he might not have been heartened by our team’s assessment, which was swift and automatic. In a telegraphic blur a resident recounted this poor man’s dismal hospital course, which included postoperative complications, and rattled off lab results. An intern picked up a clipboard from the edge of the bed and recited vital signs. A senior resident palpated the man’s abdomen.

The chief resident looked in our direction. “Listen to the lungs!” he barked. Startled, we jumped and began fumbling with our stethoscopes.

With his » Continue Reading.

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Things That Matter

Paul Gross

For me, the best part of being a doctor, and the biggest privilege, is getting to talk with people about things that matter.

“You look sad today,” I say to a patient I’m seeing for the first time–a thirty-eight-year-old woman with a headache. In response, her lower lip starts to tremble, and she wipes an eye.

As I reach for the box of tissues and hand it to her, I know that whatever has caused her tears will be more important than her presenting symptom.

A forty-five-year-old man comes in wanting help sustaining erections. When I ask for a few details, it turns out he’s having sex every single day of the week, and he’s finding it a challenge to maintain an erection for twenty to thirty minutes. When he misses a day, he has sex twice the next day “to catch up.” He has relations with his wife and also with a girlfriend who lives out of town, where he often travels on business.

Should I laugh? Let my eyes pop out of my head? Wag a finger?

Because I cherish the talking and like to think that I’m skilled at it, it’s all the more comical

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Pulse Takes the Day Off–and Reflects Upon a Historic Christmas

Paul Gross

Dear Pulse Readers,

We’d planned to take the day off, it being Christmas and all–and then a historic Christmas Eve Senate vote gave us second thoughts.

When the Obama administration arrived in Washington this past January it occurred to me that Pulse might have arrived on the scene too late. Once health reform came into being, “the heart of medicine” wouldn’t ache quite so much. Maybe Pulse would become superfluous–like an offer of two aspirin after the headache’s gone away.

I needn’t have worried.

The healthcare reform bill that passed the Senate on Christmas Eve may be, as some say, a first step of historic proportions–a holiday gift for our nation, including some 31 million uninsured it promises to deliver access to. And yet one wonders, as others have pointed out, whether the real gift recipients won’t be the same crowd who’ve made our health system so complicated, expensive and ineffective in the first place.

Is the current legislation a historic promise of health care for all? Or a guarantee of prosperity to those who’ve mucked things up so badly?

Or both?

One thing seems clear: the most meaningful health reform

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Maman

Paul Gross

At a recent religious service I attended with Maman, my 87-year-old mother, I watched her fumbling attempts to find hymn number 123, “Spirit of Life,” in the hymnal. I held my book up, opened to the appropriate page, so that we both could sing from it.

She glanced up momentarily, tightened her lips, hunched forward and resumed turning pages, finally arriving at the song when the congregation was singing the second verse, which she needed help finding–what with her poor vision and the swirl of notes and words on the page.

As this ritual repeated itself, hymn after hymn, it occurred to me how much cozier it would be if my mother and I could share from the same hymnal.

It also struck to me how unlike Maman that would be. Her need to do things independently–and the improbability of Maman reciting from someone else’s page–capture in a nutshell the difficulties we’ve experienced with her aging process.

Maman was born in Belgium in 1922. She lived through the Nazi occupation before coming to the U.S. Of her five siblings, only one sister remains.

My father died seven years ago after a lengthy battle

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Late Again

Paul Gross

One thing I love deeply about being a family doctor is that I get to take care of people–body and soul. A patient comes into my exam room with a litany of physical symptoms (“My shoulder…my knee…my stomach…so tired…this nausea…”) and then, in response to a questioning look, suddenly bursts into tears.

It’s all mine to deal with. The shoulder. The stomach. The tears. I get to gather the pieces and see if we can’t put this broken person back together again.

What a privilege.

And yet the joy of primary care is also its curse. With each patient, I have to keep track of everything–the trivial and life-threatening, the physical and mental, the acute, the chronic and the preventive. And try as I might, I simply don’t have enough time.

On paper, my office schedule looks simple: I see one patient every fifteen minutes beginning at 8:30 a.m. If I stick to my timetable, I can wrap up my twelfth patient by 11:30, finish up any leftover paperwork and enjoy an hour’s lunch before starting again at 1:00.

Ha.

The reality is that I’m never done by 11:30. In fact, my colleagues

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Breaking Bad News

Bad news is like a lump of red-hot coal that lands in your palm–and that you can’t let go of, no matter how badly you’d like to.

I was tossed the burning coal over twenty years ago, when I was thirty years old and fit as a fiddle. Or so I thought. I also happened to be a first-year medical student, having my head filled with facts large and small about the human body.

Then something started to go wrong.

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Halloween Horrors

Paul Gross

One October evening last year, I went to our local pharmacy to pick up a prescription for my daughter. I made sure to bring Cara’s insurance card because my employer had switched us to a new health plan.

I wasn’t sorry about the change. Our prior plan had been operated by incompetents–although they might only have been crooks, I couldn’t be sure–who also managed our flexible spending accounts. These accounts, you may recall, collect pre-tax income from your pay and then return it to you to pay for out-of-pocket medical expenses.

With that plan, nothing ever worked as advertised. I would submit a dental bill for reimbursement and the company would review it for three months before sending me a denial notice, stating that my health plan had no dental coverage.

“I know that I have no dental coverage,” I’d tell the representative on the phone. “That’s why I put a big X in the box labeled Flexible Spending Account.”

“You sure did!” she’d say cheerfully. “I don’t know why they did that. You’ll have to submit it again. This time, put my name on it….”

Or I’d submit a claim for a medical expense that was covered,

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A Brush With the Beast

It all begins one Sunday morning when Mrs. Morris, a 75-year-old retiree with a heart condition, trips on her way out of church. She falls flat on the sidewalk, can’t get up, and ends up in our Bronx emergency room. A CT scan shows a pelvic fracture, and she’s admitted to our inpatient team.

When I join the family medicine residents to see Mrs. Morris the following day, she can’t get out of bed. She’s got short, unruly white hair and a gee-whiz expression that charms us. “What a pain!” she says. Given how close she lives to the brink–terrible circulation has cost her one heart attack and several toe amputations–I’m impressed with her good cheer.

Things looks promising. Follow-up studies confirm that the fracture won’t require surgery, and in the afternoon a physical therapist pilots her through a few wobbly steps.

The next morning we come to Mrs. Morris’s room and find her peering at a novel. “I think it would be great fun to be a secret agent, don’t you?” she says to me.

We make arrangements to transfer her to a rehabilitation facility, where therapy will get her walking again.

All goes smoothly until a hospital

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