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

Withering Away on the Outside


You are an angel, undeserving of such tortuous demise.

I bit my tongue to hold back these words I was thinking but couldn’t say to our young, male patient with amyotrophic lateral sclerosis (ALS). The attending physician had just exclaimed, “Foot drop is often one of the first signs of ALS. Do you notice here the distal muscle atrophy, including the intrinsic muscles of the hand, namely the dorsal interosseus muscles and thenar eminence?”

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Halfway Home

I met Terry the day after he sat in the back of a pick-up, joyriding on a busy interstate. A big rig whooshed by, sucked Terry out of the truck bed and slammed him into the side of the semi-trailer before he fell back into the truck. One scalp laceration and a few facial scrapes presented evidence of the accident. The damage occurred inside Terry’s head.
 
It shames me to admit I practiced the defense mechanism of black humor. During shift change, we joked and wondered if Terry had MFB, or mush for brains. Countless days and doses of diuretics, rehydration, and more diuretics without a twitch, grimace or cough from Terry decimated my hope for his recovery. I bathed him with coarse wash cloths and repented by lavishing his skin with lotion. I talked about sports, music, even Tiger Beat magazine. I prayed for him to a god in which I didn’t quite believe.
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Two Years and a Shadow

Just a shadow over two years ago, my parents’ lives shattered when old age carried deep illness into their home and broke everything into shards. Those shards will be with us forever. They will, I fear, be visited upon seven upon seven generations of sons and daughters and nurses and doctors and therapists and priests and aides and friends, seven generations to come.

The miracle is that we are still here, two years plus a shadow on from that nightmare time.

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Alloimmune

“I only have bad options for you.”

I had visited this place, this stifling humid ultrasound room, a thousand times in my fears. But now it was real, and I had a choice to make. All the grinning, stupid hope I had embraced, the idea that this was a walk of faith I could use to teach others, rose up as a dark maroon flush in my chest. Hubris. The ancient Greek kind.

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How Did He Just Wake Up?

I hung up the phone in shock. I never felt so helpless.

My brother was lying in a deep coma in a Bronx hospital, and none of his nine siblings were in America. My parents were dead, and the closest relative was my mom’s brother who lived in Canada. He had already booked a flight to New York for the same night.

Sitting in a village in Saudi Arabia, where I worked as a community health nurse, I cried and prayed.

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The Sign

Give, give, give–what is the point of having experience, knowledge, or talent if I don’t give it away? Of having stories if I don’t tell them to others?… It is in giving that I connect with others, with the world, and with the divine.

–Isabel Allende

My office at the hospital is not unusual. Amid the clutter there are several special mementos and notes received from patients and families over the years. Each one holds a story, brought back to life when I touch it again.

A few years ago, the sister of a long-term patient stopped by with a framed picture. We talked about her brother and his long battle with his cancer.

He had spent his career working for the city repairing street lights and signs. While in the prime of his life, he had developed a tongue cancer. After an initially successful surgical removal followed by radiation therapy, he developed a recurrence. Over the following months, the cancer had grown and spread. Eventually, there were no more options. He found peace and prepared for the end of his life.

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Blessed Events

Although I do not believe in medical miracles, I rejoice in the reality that I have experienced two—when I became pregnant with (and ultimately gave birth to) first my son and then my daughter.

From the age of thirteen-and-a-half, when I began menstruating, until age eighteen, I endured a great deal of pain whenever I got my period. My parents took me to the gynecologist, but he did nothing but assure me that “this too shall pass” with time.

Unfortunately, he was wrong. 

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Timeline

It’s 8:00 pm. You check your work inbox and prepare for the following day: reply to emails, fill prescriptions, prep your notes.

You wake at 5:00 am. You exercise, eat, rush your daughter to school. You arrive to work at 7:30 and review the schedule with your team. You see a man with shortness of breath and a new arrhythmia, a walk-in patient with a severe headache, a teenager there for a sports physical who admits she’s binging and purging. You’re already running behind.

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Sertraline for Diabetes

 
She was here for her diabetes.  Her blood pressure was high, she said, because she expected me to scold her.  She hadn’t brought her log, but her sugars were in the 200s overall.  Not good.  She hadn’t been exercising, but she had been taking all her medications.

Again we talked about options: cut out carbohydrates, increase exercise, add medicines.  She admitted a predilection for bread, and I talked about mood eating: how stress can drive us to eat.  She smiled back at me, shaking her head.  I mentioned our counselors and the option of coming just to talk.  She shook her head again, but her smile broke and her eyes closed.

Her one son, whom she brought here as a six-year old, had been deported back to a country he doesn’t know, where he has no one, where life is dangerous.

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Interpreter of Cries

 
It happens daily. I enter a room and come face to face with someone who’s afraid of me. But we make friends, we may even laugh and share a high five or two. Then I leave. And from the room next door, I can hear the horrendous cry. The aftermath. 

I’m a pediatrician, and the aftermath is when my capable medical assistant or nurse goes in after me to give a vaccine or check a hemoglobin level or administer a shot of antibiotics because the oral antibiotic isn’t working.

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Inner Turmoil

 
As a third-year medical student, I know I have a beautiful purpose in life. I care deeply about my patients. But the one person I am having difficulty treating is myself.

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Friendships Across Barriers

 
At my university I am involved with a program (OMA, or Opening Minds Through Art) that has exposed me to men and woman who have inspired and empowered me. Many have become my friends. The catch is, these people happen to be four times my age and have been diagnosed with different stages of dementia.
 
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