fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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Stories

Breadwinner

Breadwinner

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The first thing I notice are the dark circles under Mr. Jones’s eyes.

It’s 4:30 pm on a Wednesday during my third year of medical school. I’m in the fifth week of my family-medicine rotation, and we’re deep into our daily routine: triage, history, physical examination, differential diagnosis, present the case to the attending physician, repeat.

Mr. Jones is a new patient. His face and belly are round, his arms and legs lanky. His unkempt facial hair and calloused hands reflect a life of physical labor that has worn him down. According to his chart, he’s just started an office job. Slumped apathetically in a chair in the corner, he seems apprehensive and hesitant to talk to me. Understandably so: I’m a stranger with the word “student” attached to my name.
“I can’t remember how long it’s been since I’ve seen a primary-care doctor,” he begins.

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Birth of a Midwife

Birth of a Midwife

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As a nurse, I was brand new to labor and delivery–and I was on my third night shift in a row. Walking back from a quick break, I was called over by the charge nurse.
“You have the next admit from triage,” she told me. “She’s a live one–and so is her family. They’re carnies.”
“What’s that?” I asked, bewildered.
“You know, the people who do the circus and carnival circuit–gypsies,” she said, innocently using a term that is now considered derogatory, but was then often applied to the nomadic ethnic group known as Roma. “She’s going natural.”

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A Flower in Winter

A Flower in Winter

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It’s winter of 1993. A cold, snowy day. Windy. A blizzard. The phone rings.

I’m not on call for my patients today–except for one. Daisy has been in my care since the early 1970s, and given the risk that she may suffer a serious downturn, I’ve instructed her nursing home to call me whenever necessary.

This is that call. Daisy, my dear lady, the old artist, is dying.
Throughout her nine decades of life, her passion for poetry and painting, and her ability to engage the people around her, have been her constant companions on what has been a fraught journey. Her heart, however, has grown weary and is finally giving out.

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Being There

Being There

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Question: What is the most read book in a psychiatric ward?

Answer: Based on my observations, it’s the Christian Bible. During my psychiatry rotation in the third year of medical school, I saw so many patients researching, reading and preaching the word of God. Clearly, in those pages they found something they needed: vengeance against those who’d wronged them, a secret prophecy, confirmation of their sanity. Or maybe they saw the central message: “You’re loved. We (God, humans, nature, whatever) care for you and will take care of you. We understand you.”
Seeing these patients cling to the Bible felt moving and deeply sad–painful, really. A younger, more innocent me might have seen some grace and faith. But, honestly, all I saw was emptiness–in the sense that patients in deep despair, who’ve been told, “Your mind is broken,” “Your body is broken” or “You’re going to die soon,” lack something in their lives: real human connection.

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The Big Chill

The Big Chill

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Tonight was yet another night on call in our emergency department–a chilly winter night on which I did a cruel deed: I discharged a homeless man back out into the cold.
This is a routine event in the life of psychiatry residents like myself. Normally, no one would bat an eye. It shouldn’t have mattered to me, either–except that the previous night I’d had to walk home from the hospital parking garage in decidedly adverse weather.
The streets were covered with slush and ice, which, along with the heavy rain and bitter winds, made my usually effortless fifteen-minute walk a nightmare. As wind gusts kept upturning my umbrella, I struggled to manage it while also trying to keep my feet from slipping on the ice.

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Casseroles and Conversations

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2017 was a heartbreaking year for our family.
To start things off, my wife’s parents–both of them!–were diagnosed with terminal illnesses. We spent the next few months immersed in the painful, complex process of transitioning them to home hospice care and beginning to face and grieve the prospect of their deaths.
In the midst of this, Hurricane Harvey began heading towards Houston, our hometown. My wife, Marsha, drove to her parents’ ranch, south of the city, intending to bring them back to our home, on higher ground. But the heavy rains arrived a day earlier than expected, trapping Marsha and her parents for three terrifying days and nights in their flooded house.

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My Black Bag

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Retirement means downsizing. “If a thing doesn’t give you joy, throw it away,” says the current mantra, as if it were that simple.
In my study closet, behind my obsolete Kodachrome lecture slides (about as necessary these days as a harpsichord), sits my little black bag. Does it give me joy? It’s much more complicated than that.
The bag holds all the medical instruments I carried through my training as a doctor–internship, residency and fellowship: sphygmomanometer (no longer functional), stethoscope, ophthalmoscope, otoscope, reflex hammer. There’s also a moldy leatherette case containing the dissecting kit that I used in classes from college biology through gross anatomy. The instruments are still shiny and sharp, which is more than I can say for myself.

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Finding the Words

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“So how was your trip?” ask well-meaning friends and coworkers when I return from a medical mission to Engeye Health Clinic, in rural Uganda. Even years after my first trip there, trying to find the perfect words to describe it is a challenge.
I have been involved with Engeye since its founding, more than a decade ago. As the administrative coordinator with Albany Medical College’s department of family and community medicine, I helped a second-year medical student, Stephanie Van Dyke, and a faculty member, Dr. Bob Paeglow, put together a medical-mission trip to the small Ugandan village of Ddegeya. The clinic was to be managed by a visionary accountant named John Kalule (born in Ddegeya) and staffed by visiting US physicians. My role was to recruit the medical teams and handle all of the trip’s logistics.

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X Factor

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I was a brand-new intern on the intensive-care unit, and Cassandra was the very first patient I saw there. A petite, slender woman, she was rolled in on a stretcher, accompanied by her tall, athletic husband, Jack.
Cassandra was in her twenties, like me–but mortally ill. That grabbed my attention from the start. But the biggest lesson she taught me came about because we got her prognosis all wrong.
She had lupus, an autoimmune disease that unleashes the raw power of the immune system against the patient’s organs and joints. Fortunately, my attending rheumatologist, Dr. Schmidt, was an expert in lupus and its intricacies. Although small in stature, he cast a large shadow in the field; physicians from near and far referred their most challenging cases for his consultation. He radiated confidence, and, like my teammates, I admired his clinical acumen.

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Prayers of Passage

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The day began in Mom’s room with a 10:00 am conference at Upper Valley Medical Center, west of Columbus, Ohio. In attendance were my ninety-three-year-old mother Joanne (now in her third week of hospitalization), her palliative-care nurse Richard, her Episcopal priest Mother Nancy and myself.

Mom was on high-flow oxygen therapy delivered through a nasal cannula. Despite this, her blood-oxygen levels were well below normal. Clearly, her lung function was declining. Her heart wasn’t pumping well, and her blood pressure was barely seventy over fifty.
Things can change quickly with our elders. Thirty days earlier, Mom was going to dinner with friends and taking excursions in her assisted-living facility’s van to pick up things she needed, including small bottles of wine to share with “the girls” at dinner.

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Keeping the Flame Alive

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This month, at medical schools across the country, first-year students will officially don the physician’s traditional white coat for the first time.

The white-coat ceremony is a powerful symbolic moment. It signifies that the students are moving beyond their identity as ordinary citizens and into their new identity as healers. The ceremony celebrates their idealism and their commitment to a life of caring for others. And, although they may not realize this, it constitutes a pledge to assume responsibility for their patients’ health and well-being–and the stresses that go with that commitment. As the students accept this responsibility, their lives will be forever changed.

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Shock Treatment

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I sat in the cold, sterile examination room, anxiously awaiting my new orthopedic doctor–the fourth in two months. I was losing hope of ever finding a doctor who would listen to me. The first three had suggested that my pain was all in my head
I want someone to take me seriously, I brooded. I don’t want to be brushed off as the stereotypical hysterical female. My pain is real, and I’m not crazy. I need someone to believe me.
Finally, there was a soft knock on the door.
“Good afternoon, I’m Dr. Lee.”
In front of me stood a man with an impeccably groomed goatee. He glanced at my elbows, which I have a habit of bending too far backwards while relaxing. Brow furrowed, he reached out to shake hands.

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