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

Cold Comfort

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Mary T. Shannon

Leaning against the hospital bed’s cold metal rails, I gazed down at my husband lying flat on his back. Under the harsh fluorescent ceiling lights, his olive skin looked almost as pale as mine. 

We’d been in the outpatient unit since 6:00 am for what was supposedly a simple procedure–a right-heart catheterization to assess the blood pressure in John’s pulmonary arteries. Now it was 3:00 in the afternoon. 

Before we’d arrived that morning, John had seen the procedure as a chance to take a day off from the clinic where he practices internal medicine.

“I think I’ll go out this afternoon and hit a bucket of balls,” he’d said as we drove to the hospital. “My procedure shouldn’t take that long.”

“Are you sure you’ll be up to golfing afterward?” I’d asked.

“Right-heart catheterization is a simple outpatient procedure,” he’d answered, as if talking to one of his patients. “The pulmonary artery pressure will probably be somewhat elevated, just like the echo showed, and then the pulmonologist will decide if I need another medication, that’s all.”

After thirty years of marriage, » Continue Reading.

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Gentle Men

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Alan Blum

Editor’s Note: This week, Pulse once again presents sketches by Alan Blum, a family physician who for years has been jotting down visual impressions and snippets of conversation as he cares for patients. These sketches go back as far as 35 years, representing patients who have died or with whom he lost touch because of geographic relocation. These drawings are from the recently published book Gentle Men (Firebrand Press).

About the author:

Alan Blum is a professor of family medicine and holds the Gerald Leon Wallace endowed chair in family medicine at the University of Alabama, Tuscaloosa, where he also directs the Center for the Study of Tobacco and Society. In 1977 he co-founded Doctors Ought to Care, an international physicians’ organization that pushed organized medicine to become more active in combating the smoking pandemic and the tobacco industry. As a result of these efforts, Dr. Blum received the Surgeon General’s Medallion from Dr. C. Everett Koop. Alan Blum’s sketches and stories have been published in Literature and Medicine, The Pharos, JAMA, Hippocrates, Emory Medicine and The Color Atlas of Family Medicine.

About the sketches:

“These sketches

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A Greater Truth

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Nancy Elder

Should someone have to lie to get care? For millions of uninsured Americans, finding a way to receive health care is a challenge. In my practice, I’ve been seeing more and more of the following:

“Where have you been living lately?” I ask my third patient of the morning, a heavy-set, forty-nine-year-old man with dark, weathered skin and rough hands.

“I’ve been staying with my friend,” comes the casual reply

“How long have you been staying there?” I continue.

“You know, for a while.” His tone is a bit guarded.

“How long is ‘a while’?” I am wary now.

“You know, a bit of time.” I can see that I’m making him uncomfortable.

“A month, six months?” I persist. “A year, two years?” 

He capitulates. “Maybe a year or two.”

I sigh inwardly. Instead of starting my conversation with “What seems to be the matter today,” I am vetting his housing status. For eight years now, my clinical practice has been exclusively with the homeless of Cincinnati, and despite our program’s generous definition of “homeless,” this man does not qualify for our

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Mother And Son

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Adnan Hussain

I judge. Even though I’m not supposed to, even though I try my best to stop myself, I still judge. Fundamentally, I guess, I’m a creature of habit, caught up in an endless current of seemingly instinctive behaviors. As a first-year medical resident, I sometimes feel acutely aware of this in my dealings with patients.

I stand at the bedside of Sharon Weathers, an unassuming woman in her mid-thirties for whom I’ve been caring over the past few days. She was admitted with excruciating abdominal pain that has proven resistant to our attempts at pain management. Each morning, I visit her to ask, “How did you sleep? On a scale of one to ten, how would you rate your pain?” And each morning, I feel a pang of suspicion–near-certainty, actually–that her pain is mostly a calculated attempt to get us to give her ever-higher doses of morphine. 

This morning, Sharon looks as if she just woke up, her tangled blonde hair falling haphazardly across her face. As she struggles to sit up, I’m struck by how incongruous the cheerful polka-dot hospital gown looks on her tough-looking physique. 

Sharon looks strong; she has the aura of a battle-hardened gladiator.

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Stepping Into Power, Shedding Your White Coat: Donald Berwick’s Graduation Address

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Donald Berwick

Editor’s Note: Donald Berwick, recent Administrator of the Centers for Medicare and Medicaid Services in the Obama Administration, and a founder of the Institute for Healthcare Improvement, gave this speech at his daughter’s graduation from Yale Medical School on May 24, 2010.

Dean Alpern, Faculty, Families, Friends and Honored Graduates…

I don’t have words enough to express my gratitude for the chance to speak with you on your special day. It would be a pleasure and honor at any graduation ceremony. But, I have to tell you, to be up here in this role in the presence of my own daughter on the day that she becomes a doctor is a joy I wouldn’t dare have dreamed up. I hope that each of you will someday have the chance to feel as much gratitude and pride and love as I feel right now, joining you, and, especially, joining Jessica. Thank you very much. I am so proud of you, Jessica.

Now, I have to tell you the truth about Jessica. Jessica was supposed to be a boy. At least that’s what the ultrasonographer said when we took a look at “him” in utero. “Never been wrong,” said the ultrasound

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Epiphany

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George Saj

It happened one wintry night in 1965. I was in my third year of medical school during a rotation on the pulmonary service.

My supervising intern had been busy all evening admitting a dozen people in various stages of respiratory distress; they were suffering from ailments ranging from flu to double pneumonia.

It was my job to collect each patient’s sputum and culture it on a Petri dish, which would take several days to grow out. I also prepared stained slides of each sample. We did this in hopes of being able to visually identify the offending bacteria, so that we could speedily administer the appropriate antibiotic.

This was painstaking work: the intern and I had to repeatedly re-check the patients who weren’t improving. Every few hours, we’d return to listen to their chests, assessing the progression of their pneumonia. Then we’d check our findings against X-ray pictures, adjust their antibiotics, collect and look at their sputum specimens again, and wait for them to get better.

Slowly, most did. But I found the testing and re-testing tedious and unsatisfactory, as its results were incremental, subjective, often subtle and hard to measure.

At

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Out of This World

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Katelyn Mohrbacher

When I met Jasper, I was a third-year medical student doing a nine-month rural clerkship, and he was an eighty-year-old man in a coma.

Family members surrounded Jasper–a tall, broad-shouldered man–as he lay in the hospital bed. His wife, Esther, a petite, lively woman also in her eighties, stood by his head, grasping the bed rail. At the foot of the bed stood their son, a middle-aged man with a baseball cap on his head, his hands fisted in his pockets. Flanking the bed were his sisters (both nurses), one with curly hair and a baggy sweatshirt, the other slim and well-groomed. A warm summer breeze wafted through the room, bringing the scent of fresh-cut grass.

Jasper had been admitted two days earlier. In the days before that, Esther said, he had “drifted,” becoming quiet and very sleepy, and eating little. On admission, he’d been severely dehydrated and short of breath.

His two daughters had always hovered in attendance. Now one anxiously quizzed my supervising physician about her father’s sodium level. This led to a discussion of his care.

“I want everything possible done for him,” Esther said. Her children agreed.

In the days that followed,

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Physician, Heal Thyself

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Randy Rockney

After a long day’s work as a pediatrician at an academic medical center in Providence, RI, nothing says “relief” like a visit to my therapist. I don’t see him often, but he has helped me through many life transitions. I think we both agree with the Buddhist precept that the only constant in life is change.

One evening after work, a couple of years ago, I arrived early in the neighborhood of my therapist’s office. I was hungry, but there wasn’t time for a meal, so I stopped at a pharmacy to peruse the snack aisle. The smallest and cheapest option available, a bag of roasted pumpkin seeds, seemed perfect.

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Common Thread

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Peter de Schweinitz

One sunny afternoon during my fourth year of medical school, I spent a day assisting a New Yorker turned rural Southern podiatrist. As we whittled dead skin, checked pulses and scheduled minor procedures, an arrogant question formed in my mind: Why did you choose the feet instead of something more impressive, like the heart? 

Maybe he read my mind. Later, seeing me off to my car, he said, “I know that you medical doctors could do my job. I’m here so that you can do more important things.”

At the time, I didn’t know whether to pity his lack of aspiration or admire his humility. But a year later, when I was a primary-care intern, something happened that changed my perspective.

A patient I’d not met before, Carrie, had come for a post-operative wound infection on her ankle. This was the type of visit that irritated me–cleaning up for the specialist. 

Sitting on a chair in the exam room was a slender, sophisticated-looking young woman with short-cropped hair, sleekly manicured nails and horn-rimmed glasses. Normally, I would have asked her to hop

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The Silent Treatment

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Frances Smalkowski

Last year, while enjoying a two-week tour of the cultural capitals of China, I was amazed by how at home I felt. Searching my memory for the reasons behind this unexpected state of mind, I suddenly remembered Mr. Loy.

We met more than forty years ago. I was in my third year as a nursing student, doing a semester-long rotation in a large psychiatric hospital. Each student was assigned a patient for the semester, and Mr. Loy was mine. 

We were expected to forge a therapeutic relationship with our patients. This was a tall order; most of our patients were diagnosed with some form of persistent schizophrenia, and few spoke in any coherent fashion, if they spoke at all. 

Mr. Loy was no exception. A short man in his late sixties with raggedly balding hair, he made frequent references to “the machine on my head.” His bald spots marked his attempts to remove the machine. The machine, he said, had commanded him to kill his son. Because he’d actually tried to do so, using a large knife, he’d been hospitalized as criminally insane. 

Before our first meeting, I read Mr. Loy’s medical history. Thanks to the psychiatric nursing

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Fifty Minutes

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Elizabeth Tyson-Smith

“I know it will kill me,” my patient Jan says calmly. 

We sit in my office looking out on the river below, which glints in the fall sunshine. It is a warm day for November. Jan has just learned that her breast cancer has spread to more internal organs. 

Her doctors have told her that she will not recover.

I–who have had breast cancer twice–cringe inside. Jan’s blue eyes fix on mine, but she expresses no emotion at all. 

In 1990 a routine mammogram showed a bright white constellation in my breast. The biopsy was positive. I heard four words: “You have breast cancer.” I was forty-eight; I was certain it would kill me.

Jan is forty-five, married, with two young children. Although she’s been living with metastatic breast cancer for three years, her main focus in our sessions is not her cancer. When we discuss how hard it is to lose other members in her support group, she doesn’t mention herself in that context. She shows despair only when speaking about her children and how horrible it will be when they

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Closing up the Cabin

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Robin Schoenthaler

I met Burt the Monday before Labor Day. As I walked into the room, he stood up–a sturdy, fifty-three-year-old guy with a direct, sky-blue gaze. Although he was a little etched around the eyes, he mostly looked the picture of health.

Two years before, he’d had a cancer. It was treated and thought to be gone. But for several weeks now, he’d been having excruciating low-back pain; he rated it a ten out of ten. The day before, a new CT scan had revealed that his original tumor had spread to his liver and bones. A spiderweb of tumor damage in his spine was the cause of his pain. 

If I were a layperson or if this were my brother, I’d be hysterical. But I’m a radiation oncologist (a doctor who gives radiation to cancer patients), and this was my patient. I’d seen this kind of thing before, and I felt hopeful that radiation could help. 

During our visit, I spoke frankly but moved slowly, trying to both honor the situation and help the family cope with the nightmare Burt now faced:

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