As a practicing child and adolescent psychiatrist, I’ve been trained to treat depression and evaluate suicidal risk. Yet when it comes to working with an adolescent who expresses a wish not to exist, trying to clarify what’s actually meant feels daunting.
I’m reminded of this one Monday morning as thirteen-year-old Paula sits across from me in the interview room.
Driving from the Atlanta airport, I arrived at the hospital ICU where my mother had been admitted the day before for trouble breathing. This was the hospital where my siblings and I were born and where our father died. This was the hospital featured in The New York Times following the coronavirus outbreak in March 2020. The hospital still sees record numbers of COVID admissions, and I expected the staff to show signs of exhaustion and numbness to personal tragedy.
My brother was at our mother’s bedside, as he had been from the beginning. The critical-care attending physician was also present.
“Does the hospital have a palliative-care unit?” I asked.
Living and Letting Go in the ICU Read More »
It was midmorning at the hospital where I was a clinical medical-surgical instructor. I was standing at the medications cart with Sally, one of my third-year nursing students. One of the floor nurses approached.
“You have Anna in Room 44, don’t you?” she asked Sally.
Sally nodded.
“You better go in there,” continued the nurse. “She doesn’t look too good.”
Time fractured when my first husband died.
There was a before, which no longer existed, and an after, which was unimaginable.
In between, the thinnest–unfathomably thin–line, was the today. The today meant putting one foot in front of the other. One today led to the next today. And finally the year was over.
Collecting dust on the rustic wooden shelves above a sturdy workbench in my basement are models of history-making ships, spaceships and military fighter planes. There’s an enormous replica of the Space Shuttle Atlantis, complete with iconic NASA logo and a massive orange fuel tank nestled next to its launch tower. Not far off is a black-and-brown plastic replica of the forty-four-gun frigate USS Constitution, its hull held together by two gigantic bolts.
At most medical schools, the first two years are spent in lectures, labs and classroom learning. The third year is when students begin rotating on various clinical teams in the hospital and clinics, finally seeing patients as part of a large educational medical team. As I moved through pediatrics, ob/gyn, surgery and other core rotations during my third year, I took notes at the times when I felt out of place or discouraged.
Letter to Myself as a Third-Year Medical Student Read More »
For the past three years, I worked as a rural primary-care doctor. Two months ago, I resigned to pursue further training in hospice and palliative care. My patients were the inspiration that illuminated every step of my way towards this new path.
Marly came to me for a workup of her persistently elevated liver enzymes. Together, we navigated her new diagnosis—liver cancer—and a series of failed treatments. Eventually, Marly’s thoughts turned to facing her mortality.
“Let me die,” you say.
You’ve listed the reasons, presented the arguments: You’re a burden, a mere speck in a world of billions, one that will not be missed. A life that never asked to be born. Why prolong this pain?
“Please, let me die,” you say again, this time with a sob that allows no more words.
I hear you, I do.
We all remember our patients who die, though the first patient death really stands out from the rest. This was certainly true for me.
I was just starting the second year of my internal-medicine residency. This wasn’t the first time I’d seen someone die, but it was the first time I’d seen someone who’d been alive and well, and talking to me that morning, be dead by the afternoon–a shocking dichotomy that haunts me to this day.
You’re in the hospital again, propped in bed with pillows keeping you from listing to one side or the other, and I’m sitting on a pink pleather chair I’ve pulled up next to the bed.
We watch Dr. Phil until 4:00. I always find this show melodramatic, but you seem riveted. You want to know about these people, their lives, their lies, what they’ll do with the information unveiled to them.
When Dr. Phil signs off, I switch on the Classic Country music station, and we talk.
“I usually talk through the procedure as I go,” I say, pulling on a pair of blue nitrile gloves. “So you aren’t surprised by anything, so you know when to expect a sensation.”
The patient is lying on the table, eyes fixed upwards. One of the ceiling panels is illuminated with the green leafy branches of a tree—an image meant to calm and soothe, though I doubt it’s doing much for this woman.
“Or I don’t have to talk,” I tell her, arranging the instruments on my sterile tray as silently as possible. “We can be quiet or chat about other things.”
An Exception to the Rule Read More »
In 2013, as a hospitalist, I attended the annual conference of the Society of Hospital Medicine. This meant traveling from my home base in Ohio to Washington, DC, the site of that year’s conference.
The second day was winding down. Colleagues, new friends and countless strangers were scurrying to their rooms to freshen up and get ready for a night out on the town, where they’d continue to mingle, share research and professional achievements and scout out career opportunities.
I had other plans, however.
The World’s Second-Best Baklava Read More »
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