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

She Went Home: End of Life in the Era of COVID-19

The mother had delivered a healthy newborn. After a careful instrument count and exchanging pleasantries, I headed for the shower. It was getting late, and I had unfinished business.

On to the ICU, but not for my usual reasons. I heard sounds of beeping intensify just before I entered the room, and I felt an ache inside. My eyes focused on the vital signs on the screen. I sat down. “Good evening,” I said.

A smile spread across her face. Struggling, she said,  “Good evening, I love you.” I was relieved, at least for the moment. Until then, I did not know if I would ever talk to her again.

I remember the way she looked at me: as through a haze. I remember regretting not having spent more time with her. I remember reassuring her that it was all going to be okay.

When I asked my mother how her day had been, she said “Okay.” But the look on her face suggested otherwise.

I knew my time was running short. I wasn’t even supposed to be there as Coronavirus had swept the globe. I was only there through subterfuge, under the guise of a physician. In truth, I

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Chapters in a Life Story

My patient, Mary Kay, was a take-charge person. Even after a surgical error left her legs completely paralyzed, at age 48, she adjusted well to living in a nursing home and was dynamic, intelligent, and dedicated to her family and friends. Some of her friends even enjoyed a weekly martini with her.

After her tragic medical experience, but before I assumed her care, Mary Kay’s husband, unable to live without her, had taken his own life. Thereafter, with the best of intentions, her family withheld other unpleasant news from her, including hiding her granddaughter’s chronic fluctuating illness. Mary Kay secretly became despondent and overdosed on her medication.

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Transition

“Hi, Sue,” I said. “Here’s my letter of retirement.”

“You know I don’t want to hear this,” she replied.

“Yes, but the time has come, and I’ve been clear about my intentions for several months.”

“Do you think you could work a few extra months so you can help us find and train your replacement?”

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Time to Step Aside

When I was straight out of residency training, my first practice was on a small island off the coast of New England. I embraced the challenge of providing the full range of services that I had learned as a family physician, but that definitely proved to be an uphill climb on a number of levels, both personal and professional.

Although I soon felt very connected with the islanders in general and my patients, my wife and I missed our families back in New York and the familiar offerings of a  suburban community. So after three years, I decided to move to the mainland (or “America,” as the locals called it) to continue clinical practice there and the teaching that I had begun to do with a nearby medical school and residency program.

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Turning Red to Green

I frequently let endings dominate my life. My leaving home for graduate school ended my secure life under the care of my parents. My marriage ended my existence as a single woman who charted her own course, while my divorce ended my status as a married woman. Retiring ended my decades as a middle school teacher. The death of my parents ended my identity as a child and gave me a new persona as a sixty-seven-year-old orphan.

I have tried to teach myself, especially during these pandemic days of isolation and introspection, that with each ending comes a beginning. Life continues, even if the tomorrows take on different hues, scents and sounds than the todays and yesterdays. Just as the red light only temporarily stops my journey until the green light restarts it, so do I have the ability to create a beginning to a life that has ended.

Therein, however, lies the challenge. I have the ability to start over, to find a new way to garner meaning and purpose from my life, but do I have the mental stamina to do so? As a person with a proclivity towards depression, it is difficult for me to muster the

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An Editor’s Invitation: Endings and Beginnings

Dear Pulse readers,
A colleague who is leaving our practice for California asked me today if I would be willing to assume the care of one of his patients–someone who asked him specifically if I could become her new doctor.
I warily perused her chart and counted forty-one medical problems, from the trivial to the life-threatening, anxiety prominent among them. She seemed a busy bee of a patient, with eleven appointments scheduled for this coming month alone. She’s keeping a lot of doctors hopping, I thought. And soon enough, I’ll be one of them.
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Life Gives Us Choices (Sometimes)

I recently heard that a former coworker had passed away. The news took me by surprise, as I had not known that she was ill. I was told she had cancer and had made the choice to let it run its course without treatment. Earlier in my career, I probably would have questioned this decision. Why refuse treatment, when it’s available? Why not do everything possible to “beat” the cancer?

I do not know the details of her illness, or at what stage the cancer was diagnosed, but I realize that she made an informed choice and that it was her prerogative to do so.

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Floating

Although the hospital where I attended nursing school in the ’60s was large—about 500 beds—the hospital where I got my first job was twice its size. I was intimidated and knew only how to get from the front door to the nursery, where I worked, and from there to the cafeteria.

One evening in my first year there, the charge nurse said, “I got a call from the Staffing Office. They need you to work on Five Center tonight.”

“What’s Five Center?”

“Medical patients.”

“Oh, geez, I don’t know how to care for medical patients,” I responded.

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Hope or Despair, That Is the Question

According to the Bible, Eve bequeathed us freedom of choice once she opted to eat the apple from the forbidden tree. The consequences of her act were severe—exile from the idyllic garden. Robert Frost, one of my favorite poets, reinforces this connection between choices and consequences in his poem “The Road Not Taken.”

Since self-isolating in mid-March, I have thought a great deal about Eve, Frost, and the idea of choosing. While COVID-19 has stripped me of my normal life—teaching, ushering, socializing—it has forced me to make choices about the “new normal” that defines me.

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November More Voices: Choosing

Dear Pulse readers,

Our November More Voices theme is Choosing.

As I write this, two days before Election Day, our nation is about to do some choosing of its own. And like many choices we turn over in our minds, the final outcome will not be 100 percent on either side of the scale.

In health care, decisions need to be made all the time. As a physician, I choose whether or not to recommend a test or treatment. I choose which medication to propose to a patient.

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Waiting for the Future to Arrive

After my husband rolled out of bed and onto the floor–a loud thunk at 3:00 a.m.–time moved quickly. Paramedics. Hospital. Unfolding diagnosis: Looks like a stroke. Definitely a stroke. Massive stroke. Decision: No dooming him to a future without movement or speech, without the ability to appreciate sci-fi and Mozart and spring.

Then the waiting began. His brain took its sweet time to ease into the complete and irreversible loss of function necessary for organ donation. In truth it was only days, but each one felt endless. I sat alone. I sat with family and friends. I walked the hospital hallways, trying to create to-do lists through my gray cloud of trauma. Call lawyer. Pick up healthcare directive. Change life plans. I sat some more. Waiting became a way station, a stopping off point where I sat and watched for the arrival of a future I did not want.

Eventually, the spark that was him officially died. On that final day, I shooed away the visitors, closed the curtains in his ICU room and pulled out the CD player I brought from home. We listened to music from his exquisite collection. We talked. (Okay, I talked, but I like to think that,

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The Gift of Today

I’ve spent my whole life waiting. Waiting to join my sisters in boarding school. Then, once I was in boarding school, waiting for the Christmas and summer holidays when we could go home. And all through high school, waiting to go to university, which, in my opinion, would be much better.

When I got to university, I was in a six-year program, so graduation seemed very far off—so I studied and waited and studied and waited.

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