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Ms. Taylor

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Remya Tharackal Ravindran

Ms. Taylor was one of three newly hospitalized patients I saw that morning. She was a previously healthy woman in her forties, single and childless, who worked in the fashion industry. As I scanned her admission notes, three things stood out: shortness of breath, elevated calcium level and kidney failure. I read on, thinking of possible causes, then something caught my eye. Her breast exam had revealed multiple breast masses, and her chest x-ray showed fluid-filled lungs.

Everything fell into place: cancer, first in the breast and then spreading to the lungs. I was spared a diagnostic challenge, but I now had to face something more difficult–talking with Ms. Taylor about her diagnosis. Did she even know what it was? It didn’t seem so.

For me, breaking bad news is an elusive art. As I walked to Ms. Taylor’s room, I tried to recollect some of the strategies I’d been taught, like finding out what the patient thinks is going on and asking how much he or she wants to know. Still, I didn’t know how Ms. Taylor would react. I felt nervous. 

Ms. Taylor was sitting upright in bed, wearing an oxygen tube. She was a » Continue Reading.

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Pearls Before Swine

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Kate Lewis

I’m a third-year medical student, and I’m starting the second day of my new rotation–a month that I’ll spend with a family physician, Dr. Bauer, in his small, efficient home-based office.

Yesterday, my first day, a young woman named Sara came in for “strep throat.” She had dark Latina eyes, broad cheekbones and a delicate tattoo of the Chinese character for “dream” on her left wrist. She was 17 and seeking out a primary-care doctor for the first time in her life; I applauded her for taking responsibility for her own health care. Her tonsils were big and purple, covered in pus, but the rapid strep test was negative. She also reported a vaginal discharge. Dr. Bauer wanted to do a pelvic exam to check for a sexually transmitted disease (STD). He started her on antibiotics, ordered some blood tests and told her to return today to discuss her lab results and have the pelvic exam. 

Now Sara returns with her mother, wanting to know why the exam was scheduled. Impressed by Sara’s thoughtfulness, I tell her that we recommend the test, but assure her that the choice is hers. She looks me in the eye, confidently reports

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Adverse Effects

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Kenny Lin

Flashback to summer of 2008. I’m looking forward to August 5–the day that I’ll no longer be a faceless bureaucrat. The day that the US Preventive Services Task Force (USPSTF) will issue its new recommendations on screening for prostate cancer–recommendations I’ve labored on as a federal employee for the past year and a half.

For much of 2007 I combed the medical literature for every study I could find on the benefits and harms of prostate cancer screening. In November of that year I presented my findings to the USPSTF, a widely respected, independent panel of primary care experts They discussed and debated what the evidence showed and then voted unanimously to draft new recommendations. I didn’t get to vote, but it has been my job in 2008 to shepherd the draft statement and literature review through an intensive vetting process and to finalize both. 

As August 5 approaches, my colleagues in public relations warn me that the last time the USPSTF said anything about prostate cancer screening, the phones started ringing off the hook. I’m not so secretly hoping that the same will happen this time.

And I’m not disappointed! After we release the statement, my normally

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Making Headlines

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Reeta Mani

“Did he die of swine flu?” demanded a scrawny man wearing a blue shirt and green surgical mask. He was one of a throng of news reporters packing the lobby of a private hospital in the heart of Bangalore, my city.

It was early August 2009, and India had just recorded its first casualty from the novel H1N1 influenza virus. This latest variant of influenza–a chimera of swine, avian and human flu genes–was raising grave concerns among the medical community worldwide. To try to contain a pandemic, countries were ordering stockpiles of antiviral drugs and initiating vaccine production on a wartime footing. 

In Bangalore, as elsewhere, you could pick up any newspaper or watch any news channel and see headlines screaming “Swine Flu!” Men, women and children wore masks of all sizes, shapes and hues. Paranoia was at its peak: An innocuous sneeze could make people run helter-skelter for cover.

A few H1N1 cases had been confirmed in Bangalore, but fortunately none had been fatal. The local media, on the alert 24-7, were hounding any doctor associated with the diagnosis or treatment

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The University Hospital of Somewhere Else

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Paula Lyons

July 1. My first day as a family medicine intern, assigned to Labor and Delivery, and my first night on call, 6 pm sharp. Enviously, I watched the other interns smartly packing up to go home.

“See you in the morning–maybe!” they joked.

I glanced at the status board: eight patients in labor. And now I was “in charge,” at least in name, till 7 am report tomorrow.

Several chaotic hours later, I finished helping a Guatemalan mother of five to deliver her sixth son. My hands were trembling.

Toweling the plucky little newborn dry, I admitted the truth: Despite my University Hospital’s proud reputation as a maternity center, this woman would probably have done as well or better in her own warm, clean, cilantro-scented kitchen. At best, I was superfluous; at worst, a comical hindrance.

In shaky Spanish, I told her, “Su hijo es muy guapo y tiene salud!” (Your son is very handsome and healthy.)

“Lo se,” she replied, smiling. “Tranquila, doctorita. Todo estara bien.” (I know, little doctor. Be calm, all will be well.)

Washing my hands after the next

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Babel: The Voices of a Medical Trauma

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Editor’s Note: This week, on the eve of Pulse‘s second anniversary, we offer a remarkable piece. It is the true story of a hospitalization as told from three points of view: first, the recollections of the patient (who happens to be a physician); second, events as recorded in the medical charts by doctors and nurses; and third, the version put forth by the hospital.

FRIDAY

Patient:
It is fall 2005, and I am nine months pregnant. A healthy 33-year-old pediatrician, I am a longtime patient of Doctor A and Doctor B, who delivered my two young children at this hospital. My husband and I are eagerly anticipating the birth of our third child.
One evening after dinner, the contractions start coming every five minutes. My husband and I pack our bags and drive to the hospital. I am nearly 4 cm dilated. After observation, Doctor C calls Doctor A, makes a diagnosis of false labor and sends us home. 

Chart:
9:25 pm: 33 year old gravida 3, para 2, 38 5/7 week seen in office this AM almost 3 cm. Negative PMHx, c/o contractions q 5 min. Cervix

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Sweet Lies

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Marilyn Hillman

I can sense the question before it comes.

“How are you doing?” 

I want to answer, How do you think I’m doing, with my husband morphing into a ghost? I’m dying here. But thanks for asking.

Instead I clench my fists and deliver a cheerful response: “I’m good.” Which is, of course, a lie.

My husband is demented.

I cannot say these words out loud. Pushed to the wall, I’ll say that my husband has dementia, like it’s temporary–a virus curable by bed rest and chicken soup. Murray admits only to memory problems, while I split hairs over which verb I can stand to put next to his decline. We skitter around the truth like insects caught in a pool of light and scurrying for cover. The reality is, we’re on a steady downhill course, with Murray in frantic pursuit of words and ideas he can’t remember, while I chase after him, trying to mine precious nuggets of coherence buried in his muddy ramblings,

Murray imagines himself still capable of living a richly layered life, despite what his psychiatrist calls a severely impaired executive function system. What the hell is

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Family Business

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Joanne Wilkinson

My mother’s mother was more a force of nature than a person. Chablis in hand, stockings bagging a little over her solid, practical navy pumps, she delivered her opinions without the slightest sugar-coating. She used words like “simply” and “absolutely” a lot. “He is quite simply the worst mayor we’ve ever had.” “She had absolutely no business having four children.” My cousins and I all listened and quaked, hoping the wrath would not be turned on us. Even after my mother’s death, when you might imagine she would soften toward me a little, I still felt the need to stand up straighter whenever she looked at me. Behind her back, I called her “The Graminator.”

The Graminator had been retired for almost as long as I could remember and she had three major interests: wine, the stock ticker on CNN, and the politics of the Catholic Church, upon which she delivered opinions at every party.

I thought of her almost like Scrooge, hoarding and counting her certainties while all the people she had alienated went out to eat together in a messy, shabby, second-rate fellowship of true happiness. I felt caught in the middle: I cared

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The Case of the Screaming Man

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Paula Lyons

As everyone knows, the human body has orifices. Occasionally, these become occluded, or occupied, by things that aren’t supposed to be there. Every doctor knows this, as does almost everyone else. Who hasn’t heard, as a child, the cautionary phrase “Don’t stick beans up your nose”?

Human nature being what it is, almost every clinician must deal with foreign objects–flora, fauna–that have been put into places where they don’t belong. Sometimes, though, “beans” can materialize without a patient’s permission.

Here is one such case–a personal favorite of mine–that I’ve mentally entitled “The Screaming Man.”

I was back in the furthermost part of the clinic, arguing with an insurance company representative about the need for a patient’s CT scan, when one of our receptionists ran up.

“Dr. Lyons! There’s a man screaming in the waiting room!”

“Is he bleeding?”

“No, he’s banging his head with his hands and screaming! I think he might be crazy!”

I ran to the front. There in our packed waiting room was in fact a seemingly crazy man, screaming, dancing around and batting at his left ear with both hands. The other patients were cringing

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Keeping Secrets

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Reeta Mani

Rohit walked into our HIV-testing center in South Mumbai one busy morning. I was struck by how stylish he looked in his jeans and casual linen shirt, very different than the usual patients who visit our sprawling public hospital campus. He paced back and forth in a corner, looking at his watch and whispering into a cell phone.

I guessed that he’d chosen this crowded setting because of the anonymity it afforded; here he stood little risk of running into an acquaintance who might start to wonder.

During Rohit’s pre-test counseling, he confided his fear of being HIV-positive. He told us about having unprotected sex with female commercial sex workers during overseas business trips–and about a routine insurance health checkup that had hinted at something wrong.

He was here to learn the truth.

The next day, when he came for his results, Rohit was astonishingly calm.

“Your blood sample has tested positive for HIV,” I said and, per our routine, handed him the lab report so he could see for himself.

Rohit held the piece of paper and sat, gazing deeply into nowhere. Just when I thought he might have

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Postmortem

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Sandy Brown

Coming out of my exam room on a Monday morning, I saw two overweight police officers standing in my waiting room. From past experience, I knew that they were there to tell me that one of my patients had died and to collect information for the coroner’s report. Even as I geared up to hear the impending bad news, the doctor in me couldn’t help wondering how they’d passed their department physicals.

“Do I need to call a lawyer?” I joked, trying to guess which of my patients it could be.

“Michael Freund died on Saturday,” said Dalia, my office manager.

It was a shot to my gut. Mike was seventy-three years old, but one of my healthiest patients for his age. He neither smoked nor drank, took no medicines except for the occasional Viagra and played tennis with a passion. He was fit and trim, and I couldn’t imagine what had done him in.

I hadn’t seen Mike in the months since he’d come in for his annual exam, which had raised no red flags. Then I remembered that he had called me the previous Thursday with some vague complaint that I

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Confessions of a 75-Year-Old Drug Addict

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Arlene Silverman

The physician, a slim, young man with a shaved head and intense, dark eyes, reaches out to shake hands. I fumble to extend one hand while the other clutches a questionnaire that I haven’t finished filling out. 

“That’s okay,” Dr. Gordon says. “You can finish later.”

He can tell that I’m nervous, but seems to understand. He knows that I’ve had to sign in at a window surrounded by other patients, many younger than my own children. Some of them look dazed; others have dozed off. Still others, alert, look as if they’d just come from their job at the bank.

Me? I walk with a cane. My clothes have been carefully chosen to look presentable. I’ve come through a door labeled “Chemical Dependency Clinic” in small, discreet letters. If you hadn’t been looking for the sign, you’d have missed it. The building has no street-level windows and is in a neighborhood that could kindly be called “transitional,” rundown at its core but reluctantly yielding to gentrification.

I am seventy-five years old, and I have come to Dr. Gordon because I’ve become addicted to drugs.

While he scrolls through my

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