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Toothache

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Majid Khan

I always look forward to meeting new patients–and I confess that I have a particular fondness for young patients. They are, you see, at the point in their lives where everything is possible. It’s possible to have fun when other people might feel upset, possible to enjoy oneself on Friday night after a hard week of work (or study) rather than complaining about being too tired. I love sharing in their dreams, their joys, their fun and their excitement. 

My first patient this morning is 30-year-old Kieran. We’ve never met; I wonder what she’s been up to, and if she’s planning any adventures. I’m looking forward to chatting, to exploring the “biopsychosocial” aspect of her medical complaint, as I keep urging my own students to do.

If only I didn’t have this damn toothache.

It’s my right lower wisdom tooth, I think. It’s been throbbing on and off for the past few weeks. I’ve been chewing on my left side in the hope that the ache will just go away, but it hasn’t; it catches me unawares whenever I absent-mindedly chew on the right.

Kieran, smiling and energetic even at this early hour, tells me her medical troubles–mainly » Continue Reading.

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Deja-vu

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It looked like the skin of an orange–peau d’orange, in medspeak. My fellow interns and I had heard about it in medical school; some had even seen it before. As our attending physician undraped Mrs. Durante’s breast one sunny morning during our first month as interns, we knew that what we were seeing was bad.

Mrs. Durante wore a hospital gown and a brightly colored head scarf. She looked like a child lying in the bed: small, delicate, demure. Her face was pretty, her voice soft and deep. By contrast, the mass rounding out the side of her right breast bulged aggressively. It was firm to the touch, reddish against her olive skin. When asked, she said it hurt.

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Affected

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Jessica Tekla Les

During my third year of medical school I was performing a routine breast exam, more for practice than anything else. I was trying the concentric-circles-around-the-nipple technique, one of several I’d been taught. About halfway through the right breast I found a lima-bean-sized lump, not far from the breastbone. I took liberties with this particular exam. I poked the lump, tried to move the lump, squished down on the lump. 

I took such liberties because it was my own breast. 

At the time, I responded clinically. I thought to myself, I am twenty-seven years old, with no family history and no risk factors. Nothing to worry about. I knew the likely diagnosis, a fibroadenoma or localized fibrocystic change, both common in my age group. I double-checked a textbook to be sure, then dismissed the lump from my mind.

A month later, shortly after my twenty-eighth birthday, my primary care doctor stumbled upon the lump during an annual physical–even though I hadn’t mentioned it to her. She agreed that the lump was tender and freely mobile, the opposite of what a cancer should feel like, but she ordered an ultrasound, just to be safe.

I thought, Really?

Then fear crept in. 

Five

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Falling in Love With My Doctor

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Judith Lieberman

The other doctors I consulted called him brilliant. His past patients praised his compassion. He actually responded to e-mails. And, lastly, he was known as the best-looking doctor at the cancer center. What more could I ask?

On the other hand, what choice did I have? After twelve years, I was facing a recurrence of a relatively rare oral cancer, located inconveniently at the base of my tongue. The treatment options were not great. The radical surgery recommended by one prominent cancer center could have left me unable to swallow, talk or eat normally.

My incredible husband stayed up many nights researching surgery, radiation, chemotherapy and all the combinations. On the bright side, my teenagers cleaned their rooms without being asked! 

The last straw came when, while talking on my cell phone to yet another cancer center and making the turn into a parking lot, I crashed my car. Just one more broken item needing to be fixed.

* * * * *

I prepare for eight weeks of combined chemotherapy and radiation, which my new doctor candidly describes as “setting off a bomb in your mouth.” Sitting in the exam room, I know that my husband

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Broken

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Jordan Grumet

I was a third-year medical student in the first week of my obstetrics rotation. The obstetrics program was known to be high-pressure, its residents among the best. Mostly women, they were a hard-core group–smart, efficient, motivated–and they scared the heck out of us medical students.

I remember the day clearly: Not only was I on call, but I was assigned to the chief resident’s team. I felt petrified. 

We’d started morning rounds as usual, running down the list of patients in labor. Five minutes in, my chief got a “911” page from the ER, located in the next building. This seldom happened, so instead of calling back, we ran downstairs and over to the trauma bay.

We walked into pure chaos. The patient was 27, in her last weeks of pregnancy and actively exsanguinating–bleeding to death. She and her husband had been fighting; apparently he’d picked up a kitchen knife and stabbed her in the neck.

As the ER physician and the trauma surgeon worked rapidly on the woman’s neck, my chief readied herself to deliver the baby. She turned to me.

“Quick, get me a sterile gown and a scalpel.” 

Helping her to gown and glove, I

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Dr. B Gets an F

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Gregory Shumer

Flashback to a year ago: I’m a first-year medical student–a fledgling, a novice–trying to integrate countless facts into a coherent understanding of how the human body works. Professors slam me with two months’ worth of information inside of two weeks’ time. They tell us that this is a necessary process, one that all doctors must go through: we must first learn the science of medicine before we can master the art of healing.

My life revolves around tests, labs, deadlines, long hours in the library and very close relationships with the baristas at Starbucks.

In the midst of this chaos, I developed a crippling ankle condition that transformed me into a concerned patient for the first time in my life. The pain started as a dull ache that I experienced only during exercise. Then it gradually worsened, to the point where I could barely walk to school the day after I’d played a basketball game. A golf-ball-sized bulge stuck out from my right ankle, and my two months of medical education suggested no remedies.

It was at this point–worried, looking for answers and desperate to get back to normal–that I decided to see someone.

Dr. B, the orthopedist

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Angels and Phantoms

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Joanna Dognin

“Mama,” a little voice pipes from the back seat. “Why is that boy in a chair?”

The sun is beaming into the car as we sit at a stoplight, waiting to exit a store parking lot. My two-year-old daughter has spotted a young man, barely twenty, who smiles weakly as he rolls by in an electric wheelchair, collecting money for muscular dystrophy.

“He’s in a chair because he needs help moving around,” I say.

“Why?”

“Because his legs need help.”

“Why? Because they don’t work?”

“Well…”

“Why are they broken?” she asks. “Is he broken? Why is he here? Where is his mama? Mama, where is the boy’s mama?”

* * * * *

“Dr. Lobozzo, you got any kids?” Gabriel asked, calling me by my maiden name rather than the married name I’d only recently begun using.

“No,” he continued with a sly smile. “Don’t tell me. I already know. You have two sons.”

I was newly married (without children), living in one of New York City’s boroughs and working in the Manhattan HIV primary care center I’d joined after getting my psychology license. The center integrated mental health and social services into

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James and Bob

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Paul Rousseau

I think his name was James, but I can’t remember for sure. What I do remember is the day’s heat, the metal cart and a rust-colored dog. 

Like many homeless people, James carried his belongings in a grocery cart–a sort of mobile home for the homeless, but without the protection of a roof, the support of four walls or the security of a front door.

I’d just walked out of the local Safeway store into its parking lot. He ambled over from a park across the street. His eyes were narrow, his face tanned and his clothes dirty brown from weeks of sleeping in the streets.

Being a dog lover, I found my eyes drawn to the dog–a mixed breed with matted hair, worn eyes and gray hairs on his snout. He looked underweight; I guessed he weighed no more than thirty or forty pounds. He stood obediently by James’ side, tethered by a rope leash. 

“What’s his name?” I asked.

“He’s Bob–best dog there is. In fact, best friend a man could have,” said James in a deep smoker’s voice. He smiled and rubbed Bob’s back. 

Then he asked, “Can you give me some money so I

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The Cruelest Month

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Ray Bingham

One day in April, I took the assignment none of the other nurses wanted: Baby Michael. A hopeless case. 

Born almost four months premature, weighing barely a pound, he was now all of six days old. His entire body wasn’t much longer than my open hand. As he lay motionless on a warming bed with the ventilator breathing for him, the night nurse gave me report: serious intestinal infection, bowel surgery, septic shock, multiple antibiotics, infusions to support his failing heart, transfusions to replace the serous drainage seeping from the surgical incision on his darkened, swollen belly. 

“Take good care of him,” she finished. “He’s been through so much already.” 

As experienced nurses, we both knew that a premature infant rarely survives so many medical complications.

Tiny and sick as he was, his parents Frank and Tonya loved him. Midmorning, they came to visit. They were a young African-American couple–he, tall and wiry; she, shorter, with thick, wavy dark hair. They both looked so weary. 

With the attending physician, Dr. Moore, I joined them at Michael’s bedside. Trying to be compassionate but honest, we described the progress of Michael’s infection and his grave prognosis.

Still, when Tonya held

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Trauma in the ER

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Michael Gutierrez

It was 5 pm on a cold November day. I was a third-year medical student heading into my first night on surgery call.

Changing into my scrubs, I wondered what it would be like. I knew that we had to carry a “trauma pager” and, when paged, get to the ER as fast as possible. There my job would be to listen as the ER physician called out his exam findings and enter them on a history-and-physical form.

I felt a mix of things. I was excited about the learning possibilities, but I also knew that whoever gets wheeled through the ER doors is someone’s daughter, son, mother or father. I decided not to think too hard–I’d just take what came my way and organize my thoughts later.

The night started off slowly. I checked on a patient our team had operated on earlier and added a couple of people to the next day’s surgery list. If the evening stayed this mellow, I might have time to study in the call room and get some sleep before rounds the next morning. 

Around midnight, my pager went off: “29 y/o female; head on motor vehicle collision; laceration of head;

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The Winner

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Majid Khan

I pull up on the side of the road on this rainy British summer’s day. The rain doesn’t make it easy to get my doctor’s bag out of the trunk, which I do in a hurry so I can make my way to the house where I’ve been asked to visit a 37-year-old man named Kenneth.

This really isn’t ideal. Now my bag is wet, my papers are wet, my trousers are wet and my mood is wet. I didn’t want to do this visit anyway, but I’m still in my last year of training before becoming a full-fledged GP, and I’ve been given the task by one of the senior GPs in the practice.

“Cough/temperature” says the note the receptionist has scribbled. But while reviewing this patient’s records at the surgery I’d also spotted the words “demyelination” and “bed-bound”–words that had triggered my resistance to coming at all.

I knew this visit would upset me. Kenneth has an autoimmune disease like multiple sclerosis that is slowly destroying the sheaths covering his nerves. Kenneth is only nine years older than me.

The brown wooden door opens, and a plump, smiling lady wearing an apron welcomes me in, tells

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Stuck

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I have never told this story to anyone.

It all started one night about ten years ago, three months into my internship. I was on call, having just admitted a man with a possible meningitis.

He now lay curled up in fetal position on the bed in front of me, looking thin and ill. Preparing to administer a lumbar puncture (a diagnostic test that involves removing fluid from the spinal canal), I gently pushed his head further down towards his legs.

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