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The Silent Treatment

1 Comment / Stories / Frances Smalkowski

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 » Continue Reading.

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Fifty Minutes

Leave a Comment / Stories / Elizabeth Tyson-Smith

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

1 Comment / Stories / Robin Schoenthaler

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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Soon

1 Comment / Stories / Stacy Nigliazzo

“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.

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Sick and Tired

Leave a Comment / Stories / Paul Rousseau

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.

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.

But without the transfusions, Nancy would likely die within a few days.

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

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Healing Words

1 Comment / Stories / Gretchen Winter

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.

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.

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

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Heroic Measures

Stepping Back From the Edge

Leave a Comment / Stories / Bill Ventres

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.

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

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Natural Selection

1 Comment / Stories / Jeremy Shatan

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.

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

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Cracking the Code

Leave a Comment / Stories / Zohar Lederman

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.

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.

“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.

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.

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

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Pained

Leave a Comment / Stories / Remya Tharackal Ravindran

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.

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Crafting My Own Safety Net

1 Comment / Stories / Nicola Holmes

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.)

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.

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

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