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Vanishing Act

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Sudeep Dhoj Thapa

It was a summer night during my first year of medical school. Small bugs danced about the school buildings’ lights and filled the air with their penetrating hum. 

In the television room, located across a small grassy lawn from the dormitories, I sat watching old movies with my classmate and friend Rajesh. 

Rajesh was tall and chunky. He wore his thick, jet-black hair combed back, which made his broad face and smile appear even more so. I’d known him since our first days at medical school.

“Everyone in my hometown knows me,” Rajesh had told me. “I’m the first one in my area to go to medical school.” Clearly he enjoyed being the pride of his small town. Eyes alight, he’d talked about everything he wanted to do for his townspeople once he was a doctor. 

Living in a dormitory makes strangers into siblings, and we’d become great friends. During those first euphoric months of medical school, Rajesh, his roommate Bob and I had made a habit of getting together late at night with other classmates to watch old movies on TV.

Those nighttime gatherings had grown less frequent, » Continue Reading.

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Seeing Patients: The Sketchiest Details

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Alan Blum


Editor’s Note: This week Pulse is once again pleased to present sketches by Alan Blum, a family physician who’s been capturing his patients on paper, with grace and affection, for decades. These quick portraits are taken from a collection entitled Seeing Patients: The Sketchiest Details.

You say you think you got a medicine
to stop my seizures?
I don’t know why,
it’s the only exercise I get.

Well, it’s a long story with me.
Spent all my money on my wife
when she died.
Two years cancer.
Wasn’t able to do anything.
Wasn’t able to save her.
Spent all my money.
All the money I had saved
I spent on her.

You better just go ahead and do it now,’cause I am mentally prepared for y’all to kill me today.

Well, let me tell you a little story.
I had a little pain in my chest here.
I don’t know whether it was gas pain or not.
So the doctor took one of those electro things
with all the wires and he said,
“Well, it look good, but I need more tests.”

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Joe the Handyman

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Angela Yang

“Forty-two-year old male, chronic pain syndrome,” the chart reads. 

I’m a third-year medical student doing an elective at a physical medicine and rehabilitation clinic, and this is my first time seeing Joe. 

Sitting expectantly in the exam-room chair, he’s a gaunt man with a long face and dark tattoos down his arms. Wire-rimmed glasses, stringy ponytail, faded jeans and leather jacket complete the look. 

“Nice to meet you,” I say. “I’m Angela, a medical student. I’m doing a couple of weeks here with Dr. Ross, the chief physician.”

“Thank you, doc. I’m Joe.” He smiles, dark eyes twinkling, and I glimpse yellow-stained teeth. 

Probably from smoking, I think. 

Joe starts talking, jiggling his leg nervously.

“My car was towed yesterday. And these past two weeks have been tough. I got kicked out of my apartment, had no money for the bus, so I had to walk here today, five miles, for my pain meds.” 

He’s here for refills, I think wryly. Can I believe his story? Someone who’s walked five miles in this hot weather should look worse–especially if he’s in pain. Or am I passing judgment because of his greasy

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The Pronouncement

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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. 

It was Bessie’s daughter, Susan.

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Illness 101

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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.

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Return of the Hero

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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. 

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. 

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. 

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

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On the Road

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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.

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What to Say When You’re Terminal

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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

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Now We Are Five

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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

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Behind Closed Doors

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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.

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Unsuspected Symphony

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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.

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Cross-Examination

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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

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