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A Conversation About Race, Fear and Connection

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Paul Gross

In the wake of recent events, many speak about the need for conversations about race. In our country, the implications of race are a moral issue, a humanitarian issue, a justice issue and, yes, a medical issue. (One need only examine how racial categorization affects rates of death.) But what would this conversation about race look like?

Today, Pulse’s editor provides one offering. In August, we’ll invite all Pulse readers to join in with their stories, when Race will be the theme of More Voices.

I grew up in Stuyvesant Town, a middle-class housing development just north of Fourteenth Street on the east side of Manhattan. Built after World War II, Stuyvesant Town was a leafy and desirable place to live. There was a long waiting list to get in, and priority was given to World War II veterans, like my father.

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Icy Cold

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“Your hands are cold.”

I heard these words throughout my third year of medical school, the year during which we first touched patients on a routine basis.

My hands were cold. I was nervous; how could I not be? What a strange experience for me–asking strangers to disrobe, then touching their bare skin.

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Terms and Conditions

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If you are writing about a patient, his or her identity must be protected. Either you should obtain
written consent to publish the piece or you must disguise a patient’s identity so that his or her
friend or family member would not recognize the individual. In this case, the name must be
changed. Other helpful changes might be: sex; physical characteristics (e.g., age, hair or eye
color, body habitus); presenting illness; occupation; family constellation (number or age of
children). Please let our editors know what you’ve changed. If you have questions please use
the Contact Us form to query our editors.

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Now We Are Five

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Paul Gross

“I’m glad that you’re the one calling me with this.”

John’s comment takes me aback. It’s an unexpected, almost tender, confession from a twenty-year-old young man whom I’ve called with some good news and some not-so-good news.

“The good news is that your HIV test is negative,” I tell him. “You do not have AIDS. But the not-so-good news is that you tested positive for chlamydia, another sexually transmitted infection.”

I want to give him a moment to let this sink in, but he jumps in anxiously: “Can you treat it?”

“Yes, we can treat it. It’s easy to treat. It’s curable.”

“And I’ll be okay?”

“Yes, you’ll be fine. Once we treat it, the infection will be gone.”

I hear the sigh of relief.

We discuss where he might have picked up this infection–not entirely clear–and to whom he might have passed it along, also unclear.

That’s when he offers up his comment: “I’m glad that you’re the one calling me with this.” Not quite a compliment, not quite an intimacy, and yet a little of both.

I’ve cared for John episodically since his teens. During this week’s visit, he discussed his recent, unsuccessful, attempt to support

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The Story of Pulse

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One Monday morning, a number of years ago, the administrators at the family health center where I used to work instituted a new and time-consuming procedure for registering patients. They did this in an attempt to satisfy the rules and requirements imposed by the many different insurance plans our center accepted.

There was just one problem: the administrators forgot to tell anyone what they’d done–not even the center’s medical director, who happened to be on vacation at the time.

As the clerical staff stumbled over a brand-new, complex set of protocols that day, a line of patients, mostly poor, snaked around the lobby, out the front door onto the sidewalk. Tempers grew short. A fight nearly broke out. We providers sat in the back twiddling our thumbs, waiting for patients to trickle into the exam rooms.

Finally, after an hour-and-a-half, enough patients had been registered so that the line could finally fit inside the lobby. The exam rooms were all filled, and the doctors and nurses were desperately trying to make up for lost time.

At that moment, the health center fire alarm went off–signaling one of our periodic fire drills.

Needless to say, it couldn’t have happened at a

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What is Pulse?

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Every Friday, Pulse–voices from the heart of medicine publishes and distributes a first-person story or poem, together with a visual image or haiku, about health care.

Launched in 2008, Pulse was created by members of the Department of Family and Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine in collaboration with colleagues and friends around the country.

At a time when the pioneering work of Rita Charon has established the value of narrative medicine–an approach that places a premium on personal perspectives within a healthcare encounter–Pulse makes narrative medicine available to all and accessible to anyone.

Pulse tells the story of health care through the personal experiences of those who live it–patients, health professionals, students and caregivers. While medical care is often rightly criticized for being cold and oblivious, Pulse highlights the humanity and vulnerability of all its actors. In doing so it promotes the humanistic practice of medicine and encourages advocacy for compassionate health care for all.

Since its launch, Pulse has drawn the attention of the national media and policymakers. Widely used by medical educators to promote humanism and professionalism, Pulse enjoys a broad readership drawn to its diverse voices, compelling writing and authenticity.

Pulse welcomes

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Medicine Land Celebrates a Birthday

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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

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Things That Matter

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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

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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

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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

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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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