2021

My heart rate increases, and I feel color coming into my neck and cheeks. I’m not a clinician: I say this phrase inside my head as I take a deep breath, trying to slow my heart, which feels like it might beat out of my chest. 

Then I say—this time out loud, to the person sitting across the exam table from me—“I’m not a clinician,” before continuing with, “… but on your physical exam I noticed something out of the ordinary, and I’d like to have one of our physicians take a look at you.” I wait and smile my warmest, most empathetic smile.

“If we are in an end-of-life situation, can I be with him?” I asked Lisa, the veterinary technician. She’d brought Alex, my springer spaniel, to my car after his oncology re-check.

COVID protocols had upended vet appointments. I’d park in a numbered space and text the receptionist. A tech wearing PPE fetched Alex. I’d wait in my car for the oncologist’s call, praying for continued remission.

“He looks good; I don’t find anything of concern,” I’d hear, and breathe relief. But as the months since chemo went by, the possibility of recurrence grew. The prospect of not being present to say goodbye, for Alex to feel safe and loved to the end, haunted me.

“Yes, we do allow clients to come inside then,” Lisa answered.

Prior to COVID, the waiting room overflowed with somber pet parents cradling grey-muzzled dogs; dogs with shaved abdomens, amputated limbs, or coats moth-eaten from chemo. So much innocence and vulnerability, love and fear. I’d feel guilty witnessing these sad tableaus, when Alex’s report read, “No evidence of disease.”

During his year-long treatment, I’d come to know the oncology staff. I wondered how they coped, day after day, treating pets with life-limiting illnesses, knowing that each case

One of the most interesting aspects of being an ophthalmologist is the daily need to interpret what patients say they see.

Is it a flash or a floater? A gray spot or a fuzzy, broken line? Perhaps a shining area in the upper corner of your vision? Or maybe two images side by side? And what does “blurred vision” mean to any given person? 

Walking to the clinic, I pass a school where children gather in their crisp school uniforms. I admire their superhero lunchboxes, beaded purses, and colorful barrettes; I notice how tightly the younger children hold their older siblings’ hands. Next I pass an abandoned church, with stained-glass windows that shine on a sunny day, with wildflowers and weeds covering its front yard, with its earth-colored stone walls.

Arriving at the clinic, I admire my patients’ homes, standing out boldly among the drug houses. They are painted bright colors, and many have yards full of flowers and vegetables. One of my patients, in her bathrobe and slippers, is sweeping her front steps as her obese cat sits on the stoop, observing the scene and obviously not impressed. Even though she lives across the street from this clinic, she prefers to see me at the downtown office, so she can stop by McDonald’s on her way. Where else can she get such a large meal for so little money? I suppress my worries: Is her blood sugar in the 400s? Is her blood pressure still elevated? Did she see her cardiologist? Instead, I chat with her about her cat and her ailing back

“Estoy cansada,” my client says as she drops onto my couch, settling herself inside the dip that holds her body every week.

I close the door to my therapy office and sit across from her. “I’m sorry you are tired, Anita. Tell me about your week,” I say. Then I sit quietly until she is able to focus.

She tells me that she sleeps all day, that her body hurts everywhere, and that her adult son never visits her despite the sacrifices she made to keep him fed and clothed growing up.

“You are a good mother,” I say. I know this because she also tells me stories about him—how happy, polite, and generous he is with others and how much they laugh together when he calls her on the phone on Sunday afternoons. I sit in silence, waiting until she looks up at me, her lip quivering.

With a crisp gesture, sharp as the crack of a whip, the nurse sends the curtain rings skittering along the track, separating the bed on one side of the room from the other. The doctor does it more sedately, pulling the curtain along as if walking an aging dog, chatting to calm an anxious patient as she does. Either way, the object seems to be patient privacy.

Even when the curtains are drawn tightly enough to prevent a sliver of a glimpse of the person within, the task inevitably fails. There can be no real privacy when a few squares of linoleum and a few yards of fabric separate one bed from its neighbor. Without distance or density to muffle sounds, a discrete murmur directed to one patient easily reaches another.

As someone who has spent a few nights in a hospital bed, am I dismayed or outraged that patient privacy is a polite illusion? In theory, perhaps. In reality: Hell no.

The tedium of confinement sharpens the appetite for distraction, and hospital stories can be particularly tasty. I’ve heard police question a woman about how she landed one bed over from me. Turns out, a would-be boyfriend, spurned and angry,

I treat a lot of patients with multiple disabilities, like cerebral palsy and epilepsy, so things get complicated when they are admitted to the hospital. The parents have to deal with multiple rounding teams who come into the room at unpredictable times.

One such parent told me how she had solved the problem of dealing with surgeons who would not answer her questions. Her child’s surgeons often rounded at an ungodly hour in the early morning when no one was awake, spent a few minutes in the room and then moved on. By the time the mother was awake, the surgeons had left.

So, she figured out a strategy. Once the surgeons came into the room, she closed the door and stood in front of it. The surgeons could not leave until she let them out, and she would not let them out until they had answered all of her questions.

I have often recommended that strategy to other parents. By the way, it also works with rounding teams from other specialties.

David L. Coulter
Natick, Massachusetts

My patient walked into the exam room, expressionless, her shoulders hunched. Her last blood pressure reading had been high.  

I gently closed the door. “Good morning,” I said. “My name is Esther, and I am an RN. How are you today?”

“I am OK, I guess.” 

“You are here for a BP check. May I check it?” 

“Sure, why not.” 

When the ambulance doors shut, a fertile silence is wrought as patient and paramedic situate into the tight, mobile quarters. The patient, strapped backwards on the gurney like a carnival ride, stares upward at bright lights and cabinetry chock-full of colorful medication boxes. As the ambulance takes off toward the hospital, the paramedic begins an ataxic dance, hopping and twisting over blood pressure cords, pulse oximetry, heart monitor leads and IV tubing.

Patients may not be as forthcoming around large numbers of family, bystanders or medical personnel, but the atmosphere in the back of the ambulance is made for intimacy and truthful candor. I make sure they’re comfortable as can be, and then I continue the interview. Chief complaint, SAMPLE history, secondary issues, reassessing everything. Once it’s just the two of us on what can best be described as an awkward first date, we both open book and overshare.

Some joke or express their deepest pain and fears. Anxiety, stresses, regrets. The alcohol and pills they imbibed. The nagging injuries, traumas and diseases. I stay nonjudgmental.

COVID patients speak about the shame and small mistakes they made to contract it. One man on high-flow oxygen being transferred to the ICU

During my fifteen years as a health educator and project manager for a large HMO, I met frequently with the physicians, managers and medical staff in their offices. Sometimes these were formal meetings, and sometimes I just dropped by to run through an idea or check out a procedure. Perhaps we met to work on a new outreach program. Or perhaps I gave an in-service about the databases we used to track patients with chronic conditions. Even though the doors between the waiting areas and the offices and exam rooms were locked, many of the receptionists recognized me and buzzed me in when I waved to them.

I loved my job and the camaraderie.

Upon retirement, one of the most difficult adjustments was the loss of that sense of belonging, of being an integral part of the medical community. Nowadays, when I go to the clinic for a visit with my physician, I am just one of the hundreds of anonymous patients passing through each day, restricted to the patient side of the waiting room doors, no longer allowed access to the inner sanctum of offices and exam rooms unless accompanied by the medical assistant.

To combat this loss, I