2024

I was in the process of leaving my first practice after residency, after three years at a rural community health center in western New York.

Saying goodbye to patients is emotional and takes extra time. Most patients expressed gratitude. Some brought small tangible gifts.

It’s time for our last psychiatric patient of the day in rural Florida. It’s 4:00 p.m., and by now the cows have been fed and the crops have been harvested.

Suddenly, there was a heavy tapping at the door and a swift shuffling of feet. A loud voice erupted, “Doc, I gotta talk to you!”

I learned it takes a sense of humor to survive a hospital stay. Lined up on gurneys, flat on our backs, the three of us wait to be put through our paces on some testing machine or other. Riffing off each other, I say aloud that I feel as if I’m in a used car lot. A second person says they want our parts. The third says, “Parts, I ain’t got no parts.”

Forty-four years ago, my husband changed jobs and I followed him—moving from a major university on the East Coast to the Coronary Care Unit (CCU) at a small community hospital in the Midwest.

Patients admitted with chest pain spent at least three days with us to see if their cardiac enzymes rose, indicating a heart muscle injury. Oxygen, morphine, antiarrhythmic medications, and defibrillators were our best friends. The nurse-to-patient ratio was about 1:3, and as we monitored our patients’ every heartbeat, we had time to also listen to their concerns and talk with their families.

Years ago, I had a bedridden patient—Mr. T—with extremely advanced Parkinson’s disease.

He was Caucasian, and the nurses warned me that he harbored extreme nationalist tendencies. Most of the caregivers in his nursing home were female and either immigrants from Africa or Black Americans. He was utterly cruel in his treatment of them. When they’d help transfer him from his bed to a wheelchair, for example, he tried to kick or punch them and issued a stream of profanities. His use of the B-word and the N-word was commonplace.

A few days ago, I welcomed our new first year medical students to the medical profession with a story. It went something like this:

I was in clinic yesterday, so I’m going to tell you a little story about clinic. I see patients in our school’s mobile health center. A few weeks ago, I and the third-year student rotating with me were waiting for the last patient of the day. It was already about 3:00 p.m., so we assumed our 2:00 p.m. new patient wasn’t going to show up, which isn’t uncommon in our free clinic. But around 3:15, she arrived. Showing up super late isn’t uncommon either. We quickly learned she is a recent immigrant from Haiti and was feeling bereft because she left her two kids behind when she got the opportunity to come to Miami.

My eating habits are embarrassing. I open and close the refrigerator from the time I get up until I retire for the night. Apples. M&Ms. Strawberries and blueberries. M&Ms. Bananas and grapes. M&Ms. Carrots and celery. M&Ms. Cereal with skim milk. M&Ms.

Dear readers,

In old movies, a greying, bearded physician arrives in the middle of the night to tend to a desperately ill family member. If the film has a happy ending, the doctor emerges from the sick room a few scenes later to solemnly pronounce, “The fever has broken.”

In my years as a physician, I would sometimes see those sudden turns for the better: A woman admitted to the hospital with a raging kidney infection responded to a few doses of antibiotic; a man with congestive heart failure whose shortness of breath went away after an intravenous infusion of a diuretic; a child who was happily eating breakfast two days after surgery for acute appendicitis.

It’s wonderful to see symptoms resolve with a medical intervention. But in my experience, many turns for the better are more nuanced.