Carl V. Tyler
I knew from last night’s house call that my patient Bessie’s time was near. All day long I’d felt the familiar churning inside, the sickly sweet combination of anticipated dread and anticipated relief. So when the phone rang while I was exercising at home, I wasn’t surprised. I quickly dropped the barbell weights to answer the call before it went to voice mail.Â
It was Bessie’s daughter, Susan.
The Pronouncement Read More »
Madeline R. Sterling
My time as a medical student is quickly coming to an end. Later this month, along with hundreds of my fellow seniors across the country, I will receive a medical degree.
This past winter, with nearly four years of arduous study, countless examinations and numerous clinical rotations under my belt, I couldn’t help but think, Yes, I’m ready to be a doctor.
And then I became a patient.
Peg Ackerman
Blanched by anemia, Mary rested quietly in the hospital bed. Her pallor made her barely visible amid the bleached bed linens–she seemed a mere shock of white hair against the pillowcase.Â
Age ninety-three, she’d visited the hospital a half-dozen times in as many months, shuttling between nursing home and hospital as many elders unwittingly do in their last year of life. She may have preferred to stay put, but no one knew for sure: as a person with dementia, she was presumably unable to speak for herself.Â
I was a palliative-care nurse practitioner in the hospital. Until about two decades ago, whenever someone neared the end of life the details of care were discussed with his or her doctor; nowadays, that intimate discussion often takes place in-hospital, with a total stranger. For Mary, I was that stranger.Â
Hospitalized for severe anemia, she had been scheduled for a colonoscopy. But when she refused to drink the four-liter liquid prep, her doctor flipped her to me to evaluate her “goals of care.”
Goals of care–that’s our euphemism for how a person wants to die. We ask questions like, “Do you want your heart resuscitated if it stops?” or “Do you want
Return of the Hero Read More »
Josephine Ensign
As a community health nurse, I work with homeless and street-involved teenagers. In almost thirty years of doing this work on both coasts, and in Thailand and Venezuela, I’ve gotten to know thousands of young people living on the margins of society.
I love working with them; they challenge me to see the world–and myself–in a broader way, one that opens up vistas of hope for positive change and a better future.
And I always find myself touched by their hopefulness and vulnerability. Their level of optimism varies depending on many factors: their socioeconomic background and level of education, their intelligence and social skills, their involvement with foster care, and factors such as the general level of chaos they experienced growing up, and whether or not they suffered childhood abuse. But no matter how bad their lives have been, these young people always seem to hold on to a sense of possibility.
Sometimes I talk to a homeless teen for ten minutes and feel convinced that he or she can make it out. But sometimes I’m wrong.
Take Will, for instance.Â
I met him in Seattle at a homeless-youth clinic where Will came for health care. He was
Ellen Diamond
For the past fifteen years, I have had an incurable form of leukemia.
Such diseases used to be called terminal illnesses, but we don’t hear that term as much anymore. With all the new drugs and treatments available, doctors have become more reluctant to refer to diseases they can’t cure yet as “terminal.”
In the years just after my diagnosis, when friends and family would ask what could be done for it, I used to say that nothing could be done, adding: “It’s terminal.”
I was trying to be honest, to say, “Come now, we must face this.” People’s reactions of shock and sadness, though, made me wish I’d put it some other way. But what other way?
My father, who’d died of the same form of leukemia at age forty-three, had never known what he had. It was a secret my mother kept from him and from my sister and me–and as with many such family secrets, each of us paid a high price. So I wanted to be all about honesty.
I continued to use those words, yet they never felt quite right. I began to sense that there was a
What to Say When You’re Terminal Read More »
Paul Gross
“I’m glad that you’re the one calling me with this.”
John’s comment takes me aback. It’s an unexpected, almost tender, confession from a twenty-year-old young man whom I’ve called with some good news and some not-so-good news.
“The good news is that your HIV test is negative,” I tell him. “You do not have AIDS. But the not-so-good news is that you tested positive for chlamydia, another sexually transmitted infection.”
I want to give him a moment to let this sink in, but he jumps in anxiously: “Can you treat it?”
“Yes, we can treat it. It’s easy to treat. It’s curable.”
“And I’ll be okay?”
“Yes, you’ll be fine. Once we treat it, the infection will be gone.”
I hear the sigh of relief.
We discuss where he might have picked up this infection–not entirely clear–and to whom he might have passed it along, also unclear.
That’s when he offers up his comment: “I’m glad that you’re the one calling me with this.” Not quite a compliment, not quite an intimacy, and yet a little of both.
I’ve cared for John episodically since his teens. During this week’s visit, he discussed his recent, unsuccessful, attempt to support
Sophia Lee Ryan
I’d prepared as much as I could: I had a huge coffee, a water and every kind of snack imaginable stuffed into my bag. In my head I carried as much information about dilation and curettage as I’d been able to absorb during a study session at Starbucks the night before.
I was a third-year medical student doing my obstetrics and gynecology clerkship, and I was about to spend a day at the local family-planning clinic. The clinic offers support to women on all aspects of contraception, from education and counseling to providing various methods of birth control or carrying out terminations. I knew that this was their OR day, so I’d researched some of the cases that I would see: early pregnancy failure, repeated fetal deaths, second-trimester abortions for congenital anomalies.
Behind Closed Doors Read More »
Jeremiah Horrigan
No one goes to a hospital to heal. They go because they must–as I did three years ago, when a one-hour colonoscopy turned into a four-day surgical sleepover.
My grandfather had warned me long ago against hospitals. “You don’t want to go there,” he said. “That’s where the sick people are.” Pop died at the age of ninety-four, at home.
His warning came strongly to mind as I walked into the place that I’ve come to call HospitalWorld. Silently, I replied: Hospitals are where the sick people are, all right. They’re also where the doctor people are. I have no choice.
I was fifty-nine years old, and, after years of foot-dragging, this would be my first colonoscopy.
Unsuspected Symphony Read More »
Paul Rousseau
“I want everything done. Please, Dr. Rousseau, do everything. We have two children–they can’t be without their father. Do you understand? Do what it takes to keep him alive!”
Angie, a petite woman with long blonde hair, fixes me with piercing blue eyes. Her husband, Joe, fifty-two, has scleroderma, an autoimmune disease. In its most devastating form, it hardens the skin and destroys the kidneys, heart and lungs.
Joe is dying of sepsis and multi-organ failure in my hospital’s intensive-care unit.
“Please, do whatever it takes to keep him alive,” Angie pleads.
Suddenly, I am thrust into the depths of grief. Not hers, mine. It happens just like that–no warning, no nothing, just a painful inner quivering and the trickle of tears.
“I want everything done,” Angie repeats. Then she stops and stares at me. Her eyes look down at the table, then up at me again.
“Are you okay?” she asks.
“Yes, I’m fine.”
“I didn’t mean to make you cry,” she says softly.
“You didn’t. It’s okay. But let’s talk about your husband.”
“What’s the matter?” she asks.
Suddenly it’s I
Cross-Examination Read More »
Steven Lewis
Minor chest pains that woke me early one morning–and which did not go away three, four, five, six hours later–landed me flat on my back at a local emergency room, a perversely comforting beep beep beep issuing from the monitor hanging precariously over my head.
Frankly, I didn’t really think that I was having a heart attack–as a former EMT, a devoted watcher of medical television, and a cultural cousin of Woody Allen, I’m ridiculously well versed in the symptoms of a myocardial infarction. However, after I’d endured a morning of chest pains at an age where all warranties have lapsed, it was prudent to go to the hospital. And since my wife was out of town–and my grown kids off with their kids–I drove myself over to the ER.
Once the wraparound curtain was pulled to protect my flimsy privacy and the EKG was recording electrical impulses in my thumping heart, I already felt a little better. And yet I had never felt more alone in my life. So alone that every time a nurse or med-tech appeared I tried squeezing megabytes of information into those swishing curtains of opportunity. I let each of them
Desperately Seeking Herb Weinman Read More »
Audrey Cortez
Years ago I worked as a registered nurse in a busy surgical pre-admission clinic, preparing patients who’d been scheduled for surgery for the upcoming operation and hospital experience.
My workdays were packed with back-to-back, hour-long appointments. Whatever surgery the patient was facing–oral, orthopedic or anything else–every interview followed the same format. I would greet the patient, who’d often bring along a family member, and quickly escort them both into my small office, seating them in the stiff, outdated plastic chairs facing my desk. On the way, trying to save time, I would explain that as part of the pre-admission process I’d need to do a health interview and a physical assessment, get an accurate list of the patient’s medications, labs, X-rays, EKG results, etc., and also tell the patient various details related to the pending surgery and hospital stay. In that same hour, I also had to chart all that I’d done and make a chart for the day of surgery.
I tried hard to keep the interviews running on time while also keeping the atmosphere warm and friendly. Overall, I felt successful at striking this balance, except when I encountered my biggest challenge:
Ashish Massey
“Aren’t those decorations looking nice?” asks a soft voice beside me.
Startled, I turn to find a young woman wearing a red-and-white sari. Her head and face are swathed in the folds of the sari, leaving only the large red bindi on her forehead clearly visible.
We’re sitting on a grassy tuft amid a large campus green. All about us stand buildings with signs in both Hindi and English. Atop the central building waves an Indian flag, around which workers are hanging colorful garlands, tassels and lights.
“It looks very nice. What is it for?” I reply in Hindi, feeling that my accent must betray my American upbringing.
I am a fourth-year medical student. Two days ago I arrived here in New Delhi, after a sixteen-hour flight from New York City. Today I will begin a six-month fellowship working in pediatric oncology centers. It’s a chance to gain clinical experience working in places where resources are scarce–and it’s also a way to learn more about my ancestry and, in the process, about myself. My parents emigrated from India thirty-seven years ago, and my last visit was at age eight, nearly twenty-five years
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