fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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Stories

Brain Cutting

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Emma Samelson-Jones

The page came to my resident, who grinned and looked over at me, his hovering medical student. “You should go to this.”

I looked down at the pager.

“Brain Cutting. 2:30 PM. Room B157.” 

Text pagers are the indifferent bearers of all news. Emergencies–“Smith, BP 60/30, Room L721”–appear in the same font as messages seemingly borrowed from a teenager’s cell phone: “OMG, the harpist in the hospital lobby is playing ‘My heart will go on’ from Titanic. WTF?”

I dutifully took the elevator down to the hospital basement and opened the door to the morgue. The medical examiner and a group of neurology residents and students were gathered around a steel table, its sides sloping gently down to a central drain.

As more people arrived, the residents repeated the patient’s history. Adrenoleukodystrophy–a rare genetic defect, marked by progressive brain damage. Same disease as in that movie Lorenzo’s Oil. A freak traffic accident involving a train had been followed by worsening weakness. Unsteady gait. Seizures. Personality changes. Death.

Most of the residents had cared for this patient over the previous year. We flipped through a pathology book with autopsy photos of another adrenoleukodystrophy case, then reviewed the brain MRIs that » Continue Reading.

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Heart to Heart

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Janani Krishnaswami

I first met you in pre-op. It was my first week as a third-year medical student; my white coat was still white, the hidden interior pockets empty and the ten gel pens neatly tucked in my front pocket still leak-free. Stationed on a surgery rotation, I had officially spent twelve hours in the operating room–a frantic, exhausting blur of standing on tiptoe, gripping surgical retractors and struggling to avoid contaminating the sterile operating field where the surgeons neatly clipped and cut. You were the next case. From your chart I knew the barest facts: your name was Marie; you were forty-five years old, diagnosed with invasive breast cancer and scheduled for surgical removal of both cancer-ridden breasts

As I made my way to meet you, my supervising resident tapped me on the shoulder. “Just to let you know,” he said, “you probably won’t get much of a history. She only speaks French.”

Somewhere among my overworked brain cells lurked a few years’ worth of grade-school French, so I shook your hand and launched into what I hoped was a confident introduction. “Bonjour, Marie! Je suis étudiant en medicine.” Your eyes lit up, perhaps in recognition of a familiar

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Hard Facts and Fiction

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Brian T. Maurer

At Daniel’s first visit, it had been like pulling teeth to get this fourteen-year-old slip of a boy to talk. Despite my thirty years experience as a physician assistant, I hadn’t made much headway. I’d pose a question, and his mother would jump in to answer it. He’d slouched on the exam table, staring at the floor. Occasionally he’d lift his eyes to meet mine, then quickly look away.

Daniel’s mother had said she was concerned about him. He didn’t sleep at night; he couldn’t get up for school. He’d missed so much that he was in danger of failing his grade, and the year wasn’t even half over.

Daniel’s mother was not much taller than her petite, quiet son. She was dark, slender and attractive, with a blunt, sometimes brusque, manner.

“If you want to know what I think, I think he’s depressed–just like his father,” she’d said.

I had to agree: Daniel showed many signs of clinical depression.

“We separated last year, and I’ve filed for divorce,” his mother had said. “His dad’s a drinker, and he won’t get help. It seems like he’s powerless to do anything about it.”

I couldn’t help but wonder

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Miscarriage

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Jessica Bloom-Foster

From the moment I walk into the room, she breaks my heart. She has just been sent to obstetrical triage from the ER, where an ultrasound has revealed a twenty-two-week pregnancy and a cervix dilated to four centimeters–halfway to delivery stage. She is moaning from her labor pains and moving restlessly on the narrow cot.

I am a second-year family medicine resident in a Midwestern hospital, and well past halfway through a busy call night. She is a thin, dusky-skinned woman, and she looks at me with wide, dark eyes full of sadness and pain. Her hair is pulled back with a nylon rag, and most of her front teeth are missing. Her face seems long and gaunt.

I take a rapid history before examining her, noting that she looks far older than her thirty-seven years. She tells me freely that she uses heroin and crack, is in a methadone program and smokes half a pack a day. She has not seen a doctor during this pregnancy. Her pains started at least twenty-four hours ago. This is her eighth child. She has only been using heroin for a few years. I ask her why she started using drugs,

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See One, Do One, Teach One

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Lisa DeTora

Back when I was in graduate school and working as a medical writer, a physician told me that the key to learning medical knowledge was simple: see one, do one, teach one. It was a clever (and effective) way of convincing me that I was qualified to teach something–like how to write a report–that I’d only attempted once myself.

Now, on days when nothing goes right, I find myself thinking back to that expression–and to the years when I used to see and do more, before I tried to teach anyone anything.

Soon after college, I worked at a private outpatient facility supervising the care and treatment planning for eighteen developmentally disabled adults. I was, in my own fashion, hoping to make a difference.

My program taught skills that would, we thought, enable our students to enter the workplace. But after years of observing and tracking their progress, I came to understand that most would never hold a job–and that some disabilities outweigh even decades of hard work and incremental improvements.

Some of my class, after taking doses of Haldol or Thorazine on a hot afternoon, would glaze over during group activities. I’d keep an eye on them

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Wounded Messenger

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I pulled back the plunger, sucking lidocaine from the bottle into the syringe as I prepared to lance Jimmy’s abscess. A voice in my head kept repeating, like a mean-spirited parrot, that I’d never done this procedure before–not even under supervision, and certainly not by myself…

I’d met Jimmy two months earlier. He’d come into our clinic with a fever, shortness of breath, a horrible cough, and a crumpled paper photocopy of a chest x-ray taken at another clinic. They’d diagnosed pneumonia and given him a course of antibiotics.

But now a month later, still coughing and drenched in sweat every night, he’d come to see us. He was pale, perspiring, exhausted and in pain.

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Intern’s Journal–Surprises

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Jennifer Reckrey

Editor’s note: Jennifer Reckrey is a family medicine resident in New York City. Each week while she was an intern, Dr. Reckrey recorded some of her experiences as a brand-new doctor. Today’s stories are from weeks number nine and twenty-five.

Week Nine

I dreaded my rotation in the Intensive Care Unit. Though all the tools to keep a body alive are right there, their continuous bells and beeps jangle my nerves. I’m always afraid that in this place I will be called on to act decisively and invasively. And my mind will go blank. I will hesitate, and that hesitation will make an already awful situation worse. But even more than that, I dreaded this rotation because I think of the ICU as a dead end–a place you don’t leave alive, or if you do, it’s as a shadow of your former self.

So when I met my first ICU patient–a sixty-year-old woman with metastatic lung cancer, intubated for respiratory failure after a routine chest-tube placement–I imagined the worst. 

She was fully conscious and mentally sharp. For the first two days I cared for her, she was very stable. But she wasn’t improving–any time we turned down

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Chemo? No, Thanks

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Elaine Whitman

“If I were you,” said the radiologist, as I sat on the gurney discreetly wiping goo from my right breast, “I’d make an appointment with a breast surgeon as soon as possible.” His somber tone of voice, the white blotch radiating ugly spider tendrils on his ultrasound screen…neither of these made me nervous. If anything, I felt mild interest: “How very odd. He must think I have breast cancer. Or something.”

Ten days later, after a lumpectomy and sentinel lymph node biopsy, my husband and I sat in the breast surgeon’s office. “I’m so sorry,” he said. “You have Stage IIb breast cancer. There’s a 1.1 cm tumor in your right breast, and the cancer has spread to three of your lymph nodes.” 

I looked first at his solemn face, then around the room. Who was he talking to? I believe the psychological term is “dissociation”: a defense mechanism against painful emotions. Oddly, I didn’t feel particularly frightened–just very, very tired. Neal drove me home and I took a five-hour nap. 

When I woke up, I realized it was true. I had breast cancer. 

Three days later, barely recovered from the lumpectomy, I had a second surgery to

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First Night Call

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Abby Caplin

During my first night on call as an intern, I felt scared. Not just scared–terrified. I was serving on the medical center’s pediatric oncology floor, and medical school hadn’t prepared me for children with cancer. What did I know about cutting-edge chemotherapy regimens? What if a child suddenly developed an overwhelming infection or a seizure triggered by a tumor? Someone would expect me to know what to do.

“It’s okay,” said Brad, the second-year resident. “The nurses do everything. You just treat the kids’ hypertension.”

“How?” I asked.

“Hydralazine,” he answered, glancing at his watch. He looked tired and ready to split. “Ten to twenty milligrams IV every four hours.” When I looked up from my hasty scribbling, he was gone. I was alone.

For reassurance, I touched the small but reliable pediatric handbook in my white coat pocket. My other pocket was stuffed with index cards, each labeled with a patient’s name, diagnosis and quantities of information written in my tiny print.

I looked down the hall towards the spill of light at the nursing station, the darkening corridors lined with rooms of sick children all trying to sleep–or at least not vomit from the chemotherapy.

I

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Snowscape

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Jeffrey R. Steinbauer

The snowstorm had started on Friday, before I’d gone on call for my group. At first I’d thought the weekend would remain quiet, that the small town where I practiced might just slumber under a fresh blanket of snow. But by early Saturday morning, things had gotten busy at the hospital. Several emergency-room visits, phone calls and admissions from the nursing home changed the stillness I’d felt amid the snowfall. In no time, there was the familiar stress of trying to bring order to a day that was rapidly becoming chaotic. 

Sometime that afternoon, I looked up from a chart to see the town sheriff standing at the nursing station. Although we were acquainted through weekly Rotary Club meetings, he now was barely recognizable–bundled in heavy winter clothing, his head covered by a parka hood. Flakes of snow lingered on his jacket and caked his boots. Beneath the hooded parka, his eyes were severe and his face ruddy; together they broadcast an unspoken weather report. He was not smiling.

“Doc, we need you to come with us,” he said.

This was an unusual request, coming at an inconvenient time. There was much to be done–phone calls to

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Ripped From the Headlights

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Maureen Picard Robins

“Get a notebook,” he said. 

Dr. Altman and I stood face to face on the pediatric surgical floor of Columbia-Presbyterian Babies & Children’s Hospital. It was the first week in December. A metal crib–it seemed more like a cage or prison–separated us. In this center space lay my yellow heart: my eight-week-old daughter, wounded by surgery, dulled by morphine, our whispers flying over her.

It had been nearly twenty-four hours since Dr. Altman opened the baby’s abdomen and held her tiny intestines in his hands, untwisting them like a fisherman untangling his line; nearly one day since he’d performed a Kasai procedure, fashioning a conduit so that bile could tremble down to her small intestine; one thousand four hundred and forty minutes since I’d been ripped from the headlights of the speeding car known as biliary atresia, a rare condition in which the duct from the liver to the small intestine is blocked or missing. 

“There’s a lot to learn,” Dr. Altman said. “Write down all your questions. There is no way you will remember all this.”

There was only one question I wanted to ask, and I didn’t dare.

Besides that, there were so many other

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A View From Nepal

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Caroline Jones

The farmer wanted to know why his three-year-old son couldn’t walk or talk. 

I sat opposite him in a dark, cold classroom converted into an examination room for a four-day medical clinic last spring in the village of Lapa, high in the Himalayas. 

Wind whistled through the stone walls; rain pounded on the tin roof. The room’s single ceiling bulb kept flickering and dying; I had to use a camping headlamp to see my notes. And communications were hampered, to say the least: We conversed via two translators–from English to Nepali, from Nepali to the local Tamang language, then back again. It sounded a bit like the telephone game, and had similarly uncertain results.

Still, one look was all I needed to make the diagnosis: Down syndrome. I found the telltale single hand crease, eye folds and wide gap between the first and second toes and asked about the boy’s medical history: he’d never seen a doctor; sometimes he had diarrhea, fever or a cough. 

I thought back to my journey here, the last leg of which had begun five days earlier. With two other doctors, I had left Nepal’s capital, Kathmandu, on a winding, bumpy, eight-hour Jeep

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