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First, Do No Harm

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 » Continue Reading.

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Finding a Way Home

Stigmata

Small Talk

The End of Nice

Leave a Comment / Stories / Rosalind Kaplan

“Mouse bite, one year ago” read the Chief Complaint entry on the chart I picked up from the “nonurgent” pile.

I was a second-year medical resident, on an eight-week stint in the Temple University Hospital emergency room. It was 3:50 am, the beginning of the end of the night shift. All hell could still break loose before my shift ended, but for now we were in a lull, and the less serious cases got our attention.

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Goodbye From the ICU

Leave a Comment / Stories / Andrew R Carey

Andrew R Carey

I do not know this man. I have never met him. All I know about him are the words typed in his medical chart–and that, before the day is out, he will die.

I have never heard him speak. I probably couldn’t pick him out in a crowd. Today he looks like a water bed: yellow, warm and squishy.

I wonder if he ever pondered what his last days might be like. Surely he hadn’t thought that at age forty-five he’d succumb to the final stages of hepatitis C, a disease he probably never knew he had. He’s been in this Boston ICU for forty days, idling under the cautious vigil of interns like me, doctors fresh out of medical school.

I have met the man’s mother, a small Puerto Rican lady who has the stereotypical osteoporotic dowager’s hump and always wears a decorative shawl over her head; we’ve spoken a number of times.

On this bitter December day, it’s been my profound duty to inform her that, despite our best efforts and elaborate technology, her son is still getting worse,

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Awakening

Leave a Comment / Stories / Benjamin Ostro

Benjamin Ostro with Boris D Veysman

Back when I was a premedical student, I didn’t devote much time to community service. I cared about helping others, and yet, feeling as driven as I did to excel in my academic and extracurricular commitments, I had little time for volunteering.

It’s been my sense that most physicians don’t do much community service. If you ask a doctor why this is so, he or she might shrug and say something like “My work benefits the community” or “I’m already overworked.”

Upon entering medical school, I absorbed this attitude more or less unconsciously. I viewed volunteer work as “rewarding,” but devoid of any deeper personal value. It was as if, before even joining the medical profession, I’d acquired some of its bad habits.

Then, as a third-year medical student, I was assigned to volunteer at Damon House, where drug addicts pick up the pieces of their broken lives.

Heading into the experience, I anticipated that Damon House would not be for me. I don’t enjoy heart-wrenching stories–and besides, what did I have to offer? Why would anyone there

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Mom Journeys to the Other Side

Leave a Comment / Stories / William Bryan

William Bryan

Mom was not fully conscious when she crossed over, but I’m quite certain she was aware of both sides of the veil as she departed the realm of the living. This is a brief story of her dying.

After my dad died, more than twenty years ago, my mom moved from our family home to live with my brother, Jim, and his wife, Barb.

In retrospect, it was an act of supreme foresight, ensuring that she’d be able to stay in a family setting even if she became unable to care for herself at some point. She enjoyed many quality years with her four grandchildren and traveled with her family to Greece, Maui and Croatia, among other exotic places.

Mom’s travels came to an end in late 2009 when illness struck–a progressive blood disorder, congestive heart failure, a bleeding ulcer, shingles and a mini-stroke. Barb, a PhD chemist turned in-house care provider, made it possible through her unselfish service for Mom to remain at home for all but the last week of her life.

Over the course of 2010, Mom was in and out of the hospital many times, her blood disorder growing worse.

Then, on Monday evening

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Hospital Corners

1 Comment / Stories / Eileen Valinoti

Eileen Valinoti

“And now, as we finish up, we’ll need to put our blankets away. I want you to fold them like this,” announced my yoga teacher–a bit sternly, I thought. With swift, deft hands, she began to demonstrate. Something in the tone of her voice and the sharp jut of her chin brought me back to Miss Coyle…

Miss Mary Coyle RN was the nursing arts instructor in my first year of training, more than fifty years ago. She taught our group of thirty–twenty-seven eager eighteen-year-old women and three young nuns–the basic nursing skills: how to give a bed bath; administer an injection; prepare hot and cold compresses, etc.

Twice a week, my classmates and I filed into her classroom, which was set up to resemble a sickroom. Its features included basins, bandage trays, a large bath thermometer and a hospital bed, on which reclined a lifelike mannequin whom we called “Mrs. Chase.”

One morning Miss Coyle announced that we were to learn how to make the hospital bed.

Some of us yawned and shifted in our seats.

Miss Coyle frowned. “A badly made bed is uncomfortable to lie in, and a wrinkled bottom sheet can lead to pressure

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Are You a Doctor?

Leave a Comment / Stories / Margaret Kim Peterson

Margaret Kim Peterson

“Are you a doctor?”

I am sitting by my husband’s hospital bed in the surgical admission ward, where he is being prepped for surgery to close a severe pressure ulcer on his left ischium, the knob on the pelvis where your weight rests when you sit.

Dwight was eighteen when an illness damaged his spinal cord, rendering him a paraplegic. He is 49 now, and developing the kinds of problems that go along with being a middle-aged cripple (his self-descriptor of choice).

One such problem is pressure ulcers. We thought we’d learned how to manage these, but met our match in this one, which has refused to heal no matter what we’ve done. Finally Dwight has agreed to surgery, and to the months of post-operative hospitalization that will follow.

So here we are in surgical admissions, talking with the anesthesiologist.

“You’re anemic, so you’ll need to be transfused before surgery,” she tells Dwight. “The surgeon has ordered two units of packed red blood cells.”

“What?” Dwight asks, through a fog of preoperative anxiety.

“Packed red blood cells,” I say. “As opposed

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Conundrum

Leave a Comment / Stories / Matthew Hirschtritt

Matthew Hirschtritt

Walking from an exam room to the nurse’s station in the small outpatient clinic where I worked as a second-year medical student, I paused by a window to gaze out at the winter sunset. After a moment, I looked down to scan the notebook where I kept my schedule and notes for my last patient of the day.

4:15, Ms. Smith, 26, lump on groin–the bare bones of a story waiting to be filled in.

Feeling tired and looking forward to dinner, I sighed dramatically, dropped into a chair in front of a computer console and called up Ms. Smith’s electronic health record.

Like most medical records, it was divided into tabs that reflected the parts of a medical history–“Past Surgical History,” “Medications,” “Allergies,” etc.

I clicked on the tab labeled “Problem List.” Up popped a staggering collection of diagnoses, from diabetes, hypertension and high cholesterol to kidney failure and dialysis.

Yikes! I thought. This isn’t going to be easy.

In the eighteen months since I’d started medical school, I’d seen quite a few patients with multiple chronic conditions. For the most part when

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Mementos and Memories

Leave a Comment / Stories / Paul Rousseau

Paul Rousseau

Delores sits tilted to the right in a worn wheelchair, a curtain separating her from a sleeping roommate.

She is wearing a blue blouse stained with something orange, perhaps Jell-O, and white pants and white socks. A worn gold wedding band adorns the fourth finger of her left hand. Her hair is a shiny gray, perfectly coiffed, and her face is etched with deep wrinkles, a testament to eighty-nine years of life.

A tiny bedside shelf displays two faded black-and-white photos from the 1930s or ’40s: one is of Delores in her twenties, a demure smile on her face; the other shows Delores with a young man in a bow tie–her husband.

A greeting card sits nearby, almost falling off the shelf; its front shows a tree with beautiful, gold-glittered leaves, an old-fashioned style rarely seen today.

Since the card is propped open, I read the scribbled note: “Love you Mom. Miss you so much. See you next week. Anna.”

I walk over to Delores.

“Hi Delores, it’s Dr. Rousseau.”

She looks at me blankly, as if I’m of no more consequence

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