“Wake up, Eli,” I whisper, tapping his collarbone. “I need to re-check your blood pressure.”
“Aw, come on, doll,” he snickers. “A man can’t snore if he’s dead. Ain’t that good enough?”
“No, sir,” I reply. “I need numbers.”
It’s two a.m. I’m seven hours into a sixteen-hour shift in the emergency department of a busy city hospital, running five rooms in the “sick but stable” section with Dr. Watts.
Paul Rousseau
“You told me you’re tired–tired of all the transfusions, and tired of being sick. Do you want to stop all the transfusions, Nancy?” I asked the woman lying in the hospital bed.
She was silent. Her husband of nineteen years, sitting nearby, was silent as well.
“What are you thinking, Nancy, can you tell me?” I asked.
Nancy, forty-eight, was suffering from chronic muscle inflammation, severe lung disease, pneumonia and–most severely–from terminal myelodysplastic syndrome (MDS), a blood and bone-marrow disease for which she had to receive transfusions of platelets and red blood cells every other day.Â
Fed up with the transfusions, she’d asked to speak with the hospital’s palliative-care doctor–me–for help in rummaging through her various treatment options. In fact, these were limited to two: to continue the transfusions, or to stop.Â
But without the transfusions, Nancy would likely die within a few days.Â
I was finding it extremely difficult to counsel her. For one thing, she looked so alert and vibrant–not nearly as sick as she really was. The only overt evidence of disease was the bruising on her arms and
Gretchen Winter
As a physician-in-training, I find joy in helping to ease pain and occasionally cure illness. But I often find my greatest sense of purpose in helping patients to heal emotionally, whether by allaying a patient’s fears, addressing a lingering concern or lending a listening ear.
Having majored in communications in college, I’d assumed that the patient-physician relationship would be the easy part of medicine. I’ve learned, though, that getting it right isn’t always easy.
An encounter with a patient named Mary Collins brought this lesson home to me.Â
As a third-year medical student, just finishing the third week of my family medicine clerkship at a community health center, I was starting to feel competent at performing the basic history and exam.Â
It was a Friday afternoon, and Ms. Collins was my last patient of the day. She was a timid-looking woman of forty-three, clad in loose jeans and a T-shirt.
Steadily, I worked through the requisite questions: “Do you have any chest pain?…Do you get blurry vision with your headaches?”
When Ms. Collins said that she had a buzzing noise in her ear, my mind began ticking off the possible diagnoses: presbycusis (age-related hearing loss); Meniere’s disease (an
Gil Beall
“Doctor! Doctor! He’s stopped breathing!” the stout woman shouted, clutching at my white coat.Â
It was 1953, and I was a first-year resident responsible that night for the patients on the medical ward–including those in the four-bed room the woman pushed me into.Â
There I saw a melee taking place around a seventy-year-old man with chronic lung disease.Â
The man had been examined and admitted that evening by my colleague, who’d given me what little information he had before leaving for the night.Â
The man had been too absorbed in his breathing to talk much. We’d hooked him up to an oxygen tank and started an intravenous infusion of the bronchodilator aminophylline, which brought about modest improvement. We couldn’t think of anything else to do and agreed that his prognosis was poor.Â
Now I found him unresponsive and surrounded by frantic family members. Someone had knocked a vase off the nightstand, and the floor was littered with broken glass and roses.Â
Listening with my stethoscope, I thought I could hear heart sounds, but his chest wasn’t moving. And my informant was correct: He wasn’t breathing.Â
But, I thought, he is not dead. I had to try to revive him.
Nowadays,
Bill Ventres
I can walk.
It’s not pretty. It’s not easy. It’s not without assistance. But I can walk.
Six weeks ago, I wasn’t able to walk. A few days before that, I’d begun a visit to the city of Antigua, in Guatemala, and was enjoying its colonial ambiance with friends.
Then, after a brief bout of sore throat, I contracted Guillain-Barre Syndrome, an autoimmune disorder that afflicts the peripheral nervous system. My body’s defense system, its antibodies triggered by the offending virus, had decided to attack the nerves in my arms, legs and trunk.
Upon awaking at 7:30 am on November 2, 2011, I could barely get out of bed. On rubbery legs, I made my way to the bedroom door to call for help. Six hours later, I was 99.9 percent paralyzed from the neck down.Â
In twenty-five years of practice as a family physician, I had never seen a case of Guillain-Barre. And in all honesty, I couldn’t remember any statistics associated with the illness, such as the fact that it affects about two in 100,000 people. I only remembered that it came on quickly and could have devastating effects, which I was experiencing already.
The consulting
Stepping Back From the Edge Read More »
Jeremy Shatan
By the time my wife and I reached Hospital B’s exam room, early in the afternoon, we’d already put in a very long day.Â
Across the room, which was no bigger than a galley kitchen, stood three doctors. One–I’ll call him the Chief–was the bearded, bushy-maned head of the pediatric oncology program. His explosion of salt-and-pepper hair made a startling contrast to his posh British accent. With him were Dr. Transplant, a small, kind-faced woman who specialized in bone-marrow and stem-cell transplants, and Dr. Nice, a genial young pediatrician with a Midwestern accent.
We were there with our fourteen-month-old son, Jacob. A week earlier, he’d had brain surgery at one of the city’s internationally recognized medical institutions. It had revealed a malignant brain tumor.
As my wife and I talked with the doctors, we struggled to wrap our heads around all the new terminology and medical professionals we’d encountered upon entering the world of childhood cancer. Meanwhile, as his grandmother watched, Jacob explored the books and toys in the hospital’s well-stocked, sunlit playroom. He was happy to be out and about after
Natural Selection Read More »
Zohar Lederman
I am a medical student in Pavia, Italy, doing my fifth year out of six. It is summertime, and, as I’ve done every summer for years, I’ve returned to my small hometown in the south of Israel. There, among other things, I volunteer as an emergency medical technician (EMT) with Magen David Adom, the Israeli Red Cross.Â
It’s 7:30 on a Friday morning. I’m at the Red Cross office, talking with the paramedic and a doctor, when a young volunteer runs in.Â
“There’s a car pulling up outside–they’re bringing an unconscious patient!” he says.
The paramedic goes to get the advanced life support equipment, and the doctor and I quickly go out to the car.Â
The patient, a pale, eighty-year-old women, sits in the front seat. Her family says that she complained of chest pain, so they drove her here. She lost consciousness on the way.Â
We whisk her out of the car and begin chest compressions right there on the pavement. The equipment arrives almost instantly, and we have plenty of staff and volunteers around to help perform CPR. Even though
Cracking the Code Read More »
Remya Tharackal Ravindran
The light from my pen torch strikes the steel-blue eyes of the patient lying before me. Her pupils stand wide open and still.
My pager’s shrilling pierces the quiet. Fumbling with the buttons, I read the message: “Call 7546 STAT.”
It’s my first rotation on the floor as a new internal medicine resident. I dial the number, various possible disasters bubbling through my head.
“The patient in 723, Mr. Martini, is complaining of severe abdominal pain,” says a nurse’s voice. “The day-shift resident ordered one milligram of morphine, but he refused it. I want you to come and evaluate him right away.”
“Can you give me two minutes?” I ask. “I’m in the middle of doing a death pronouncement. Is he otherwise stable?”
“His vitals are fine. But don’t take long. He’s driving me crazy.”
Moments later, hurrying to Mr. Martini’s room, I grab his chart from the rack. Mr. Martini, fifty-six, was admitted earlier today for abdominal pain. Presumed diagnosis, inflammation of the pancreas. He’s suffered from alcohol-induced pancreatic inflammation before. He’s also had surgeries on his back and knees.
Nicola Holmes
As I guide my car through the evening traffic, I feel tears on my cheeks.
I am a doctor who plans ahead: I write out plans for my patients. This has led to my nickname, “Plan Doctor.”
Each of my consultations is carefully crafted in separate steps. The conclusion is laid out in my own neat copperplate handwriting on a plain white page. (My father taught me to write copperplate. For hours every evening I would copy stencils of words he’d written out. At the time I felt persecuted; now each day, as my writing flows, I marvel at his wisdom.)Â
Each plan leaves the room with the patient, melded with his or her hopes. It is real–you can hold it in your hand. Some patients tell me they put their plans on the fridge; once an elderly lady brought in a crumpled one dating from nine years earlier.Â
I always share plans A and B with my patients and hold plans C and D in reserve. The plans are clear, unambiguous. I put in time scales: “review in 5 days if still has
Crafting My Own Safety Net Read More »
Alison Block
It’s one of my earliest memories: I’m wrestling with my brother, and I’m losing, because I’m five and he’s seven, and he’s bigger and stronger than I am. So I bite him, hard.
Instantly I know I’ve crossed some sort of line, and I employ my most primitive defense mechanism, shouting out, “He bit me! Jon bit me!” I feel shame, because I am old enough to know it is wrong to hurt people–and to lie.
Some years later, I am accepted to medical school. I go to the first ceremony of my medical career–the one where I get my short white coat–and I take a modernized version of the Hippocratic Oath. I will try to do the best I can for my patients, and I will recognize the awesome responsibility that it is to care for other human beings. I notice one thing is lacking, though–the often-quoted phrase “First, do no harm.” The sentiment is there, but the words are not. I don’t make too much of it.
I spend two years sitting in class learning about various -ologies, and then I take an eight-hour test, the national board exam, to prove that I’ve learned something. I
First, Do No Harm Read More »
Erin Imler
Finding a Way Home Read More »
I started my third year of medical school as a surgery clerk.
With this eight-week clerkship came a flood of conflicting advice from older, wiser peers: “Ask a lot of questions, but speak only when spoken to.” “Offer to help, but stay out of the way.” “Be friendly and likeable, but not too friendly–or too likeable.” For the medical student, such is the mystique of the OR.
Three weeks into my general surgery rotation, I was helping my senior resident to see patients in the clinic and evaluate them for surgery. She grabbed the first chart off the day’s pile, knocked on the exam-room door and turned the handle, glancing at the chart before saying, “Hello, Mister–”
“Tran,” the patient finished.
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