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

Piece of Work

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Jennifer Frank

“You’re a real piece of work!” he spat at me. He was a patient named Martin; I was the supervising physician, trying to role-model for a second-year resident how to conduct a difficult conversation with patients like this. 

So far, not so good.

At first glance, Martin seemed an ordinary-looking older man, with close-cut gray hair and plain-framed eyeglasses. But I was struck by his scowl–he was expecting an argument, perhaps because during his interview with the resident he’d already encountered some pushback. 

He’d brought a long list of laboratory tests that his biofeedback “doctor” had instructed him to get, saying that his fatigue and other symptoms were caused by “adrenal dysfunction.”

I scanned the list–thyroid, blood count, chemistries, vitamins, adrenal function. “Testing for vitamins,” I thought. “Are they kidding?” Normally, we test for only a small handful of vitamins; would our lab even know how to test for the others? 

Outwardly, I tried to look neutral. “If I order a lot of tests, it’s statistically very likely that one will come back abnormal,” I said. “That may not indicate a real problem; it could only mean that you’ll end up having more tests.”

“I want all of » Continue Reading.

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Counting Cards

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Alexandra Godfrey

Once again, I see a still heart. As I stare at the fetal monitor, I search for signs of life. The screen flickers; my son’s heart does not.

The last time I saw him, he looked happy–content in his life-bubble. As he turned somersaults, he waved at me. I had thought he was saying hello, but I realize now that he was waving goodbye.

Soon I must deliver his still form into the world. My labor will be difficult–his cries exchanged for my tears; his body, small and membranous, fitting into my one hand.

This is not what I had envisioned. I had dreamt of my son’s vitality, not his mortality. I contemplate the suffering–is there no way to tally up the trauma?

For the third time, I am faced with the loss of a child, and experience is not making it any easier. 

When my first child was born, he too had a still heart. As he was rushed away, I was asked to give him a name. I called him Ben.

Life almost evaded him. Ben was born with a complex congenital heart defect that affects one baby in ten thousand. Without emergency cardiac surgery, the

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Each Day, Same Story

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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, she recorded some of her experiences as a brand-new doctor.

I have been his primary doctor for the entire three weeks he has been on the hospital floor. Sometimes he drives me crazy. Once or twice I’ve asked my senior resident to take over for a bit so I can hide out, catch my breath and try to get some of my other work done. Yet despite his daily demands and my hours of exasperation, I have never felt this connected to a patient before.

Over these weeks, I have watched his health slowly but steadily deteriorate. He first came to the hospital because his home oxygen wasn’t helping as much as usual when he got short of breath while walking. A week later he needed his oxygen whenever he felt anxious. Now he’s short of breath all the time. Without a face mask constantly pumping pure oxygen, his skin turns ashy purple and he slowly becomes agitated, then delirious. 

When I got to work this Sunday morning, the night team told me that overnight he had refused

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Breaking Bad News

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Bad news is like a lump of red-hot coal that lands in your palm–and that you can’t let go of, no matter how badly you’d like to.

I was tossed the burning coal over twenty years ago, when I was thirty years old and fit as a fiddle. Or so I thought. I also happened to be a first-year medical student, having my head filled with facts large and small about the human body.

Then something started to go wrong.

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Coming Full Circle

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Stacy Nigliazzo

Only thirty minutes into my evening ER nursing shift, and I was already behind. My first patient was a pregnant teenager with heavy vaginal bleeding. “About three months, I guess,” she flatly replied when asked about her last period. As we placed her legs in the stirrups for the pelvic exam, torrents of blood and water rolled into the kick bucket on the floor.

Dr. Parkman had barely opened the speculum when we saw it. I knew she couldn’t see the doctor’s face, but she could see mine. Shielding her from my expression, stunned and speechless, I cowered as best I could behind her left knee.

There it was. Tiny, pink and perfect. Her baby’s hand, so small that it would easily fit inside the shell of a walnut–outstretched as if reaching for us, for its very life.

The doctor and I both instantly knew there was no chance of survival. It just wasn’t time yet. He removed the speculum, and we watched as the tiny fingers slowly disappeared back inside.

Fifteen minutes later I exited the labor and delivery floor with an empty stretcher, having left my patient in a stark delivery room, pushing. The screeching fetal

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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

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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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