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May I Have Your Attention, Please?

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Adam Phillip Stern

Some sentences should never be interrupted. 

“We have the results of your HIV test,” the attending physician had begun. But fate interrupted with a seemingly endless loudspeaker announcement:

“May I have your attention, please? Would the following patients please report to the nurse’s station for morning medications….”

Nothing about Benjamin’s story was ordinary. He had been voluntarily admitted to an inpatient psychiatry unit after reporting many symptoms of depression–extreme somnolence, fatigue, thirty-pound weight loss with poor appetite, diffuse pain, decreased energy and joylessness for about three months.

Benjamin was charming, smart and eager to follow medical advice. As a relatively inexperienced medical student, I found interviewing him a refreshing change of pace from my difficult interactions with the poorly groomed individuals who paced the halls repeating nonsensical phrases and questions over and over again. Benjamin always peppered our talks with comments about current events and informed questions about his care. He could often be seen reading the newspaper or interacting with other patients or staff in a way that made me wonder whether he really belonged there.

Benjamin’s life story was as engaging as his demeanor. He had worked » Continue Reading.

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Pulse Readers’ Hopes and Wishes for the New Year

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Pulse Readers

Editor’s Note: Ten days ago, we invited Pulse readers to share with us their hopes and wishes for the new year. Here are some of their responses.


For my young patients who are living with HIV, I hope for relief from the stigma that shadows their lives, their health and their futures, and for acceptance and respect from family, friends, schools and society. For youth growing up surrounded by violence and poverty and by systems of education, health and human services that often fail them, I wish for empowering systems, safe spaces and nurturing adults who will help them to dream and to realize their potential.

Cathy Samples
(Director, Boston HAPPENS Program
at Children’s Hospital Boston)
Boston, MA

——————–

After watching my daughters experience three miscarriages, my wish (and prayer) for the new year is a healthy grandchild. My oldest daughter is now six weeks pregnant, and her first ultrasound is next week. We’re praying this little one arrives in August, healthy and whole. What greater gift and wish is there than new life?

Elizabeth Szewczyk
Enfield, CT

——————–

I wish that today’s medical students

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Pulse Takes the Day Off–and Reflects Upon a Historic Christmas

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Paul Gross

Dear Pulse Readers,

We’d planned to take the day off, it being Christmas and all–and then a historic Christmas Eve Senate vote gave us second thoughts.

When the Obama administration arrived in Washington this past January it occurred to me that Pulse might have arrived on the scene too late. Once health reform came into being, “the heart of medicine” wouldn’t ache quite so much. Maybe Pulse would become superfluous–like an offer of two aspirin after the headache’s gone away.

I needn’t have worried.

The healthcare reform bill that passed the Senate on Christmas Eve may be, as some say, a first step of historic proportions–a holiday gift for our nation, including some 31 million uninsured it promises to deliver access to. And yet one wonders, as others have pointed out, whether the real gift recipients won’t be the same crowd who’ve made our health system so complicated, expensive and ineffective in the first place.

Is the current legislation a historic promise of health care for all? Or a guarantee of prosperity to those who’ve mucked things up so badly?

Or both?

One thing seems clear: the most meaningful health reform

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An Intern’s Guilt

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Anna Kaltsas

“She’s been here for two months already. She’s very complicated; you’re going to be spending a lot of time with her and her family,” my fellow intern said as she began signing out her patients to me. 

It was my first rotation in the medical intensive care unit, and I was terrified. I was in my first few months as a “real” practicing physician–a title that I still felt uncomfortable with. If a nurse called out “Doctor!” I wouldn’t respond, thinking that she couldn’t possibly be referring to me.

My fear mushroomed as my co-intern rattled off the patient’s problem list–bone-marrow transplant, shock liver, congestive heart failure, anemia, coagulopathy, sepsis, acute renal failure, ICU neuropathy, encephalopathy, ventilator-dependent…I knew what these meant, I just felt overwhelmed to see them all in a single patient.

Her name was Laura. Her story was impossibly tragic. A newly married, successful young professional, she’d visited her general practitioner two months back, complaining of weight loss and a headache, only to have blood tests reveal devastating news: leukemia.

Her first inpatient chemotherapy treatments had been followed by a bone-marrow transplant, then by complications from chemotherapy. A barrage of serious infections had

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Mom

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Diane Guernsey

By this time next week, my mother may be dead.

In a sense, she’s been dying for a long time. This leg of her journey is the last in a decades-long trek with Parkinson’s disease.

She lies there, her head small and delicate on the pillow. Her hair is a wispy white thatch; her throat muscles are rigid, as if she’s just lifted a huge barbell. But her breaths come slowly, with long pauses in between, as if she’s nearly too tired to go on. Her brown eyes stare up sightlessly, lids half-open.

This nursing facility is part of a stepped-care retirement center where my parents moved more than ten years ago, anticipating the day when my mom would need more help than Dad could give her. They lived in an apartment there for years, while Parkinson’s slowly chilled my mom’s brisk, jaunty gestures and muffled her lively, Texas-inflected conversation into an inaudible murmur. (We all knew that this was inevitable, even though she received the most up-to-date drug regimen.) When a stroke unexpectedly felled my dad seven years ago, my mom, then 80, chose to move into the facility’s nursing wing.

About a

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Maman

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Paul Gross

At a recent religious service I attended with Maman, my 87-year-old mother, I watched her fumbling attempts to find hymn number 123, “Spirit of Life,” in the hymnal. I held my book up, opened to the appropriate page, so that we both could sing from it.

She glanced up momentarily, tightened her lips, hunched forward and resumed turning pages, finally arriving at the song when the congregation was singing the second verse, which she needed help finding–what with her poor vision and the swirl of notes and words on the page.

As this ritual repeated itself, hymn after hymn, it occurred to me how much cozier it would be if my mother and I could share from the same hymnal.

It also struck to me how unlike Maman that would be. Her need to do things independently–and the improbability of Maman reciting from someone else’s page–capture in a nutshell the difficulties we’ve experienced with her aging process.

Maman was born in Belgium in 1922. She lived through the Nazi occupation before coming to the U.S. Of her five siblings, only one sister remains.

My father died seven years ago after a lengthy battle

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Help Me

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Jennifer Reckrey

Editor’s Note: Jennifer Reckrey kept a weekly journal of her experiences during her intern year.


Week 13

I had a few free minutes at the end of my clinic session this past Thursday morning, so I took over a walk-in patient from an overbooked colleague.

The patient was a large, muscular Salvadoran man in his early forties who had long-standing hypertension. He said that for the past three months, he’d been feeling tired and didn’t have the energy to take his daily medications. Just a few months back, he’d finished a five-year prison sentence for armed robbery. Now he was living temporarily with his twenty-year-old daughter and her boyfriend, but he told me that he couldn’t seem to get his feet back on the ground. Though he made a little money here and there as a freelance mechanic, he couldn’t get steady work: no one wanted to employ a felon, and the job-placement program couldn’t help him because of his mental illness.

“What mental illness?” I asked.

Looking more at the wall than at me, he described voices that he’d heard ever since he was a boy. Though

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The Resilient Heart

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Paula Lyons

He was applying for a job on a refuse truck working for the City. This is a very good job for someone whose hiring prospects are otherwise limited. Excellent benefits, all state and federal holidays off, health insurance for oneself and one’s family, physical exercise in the fresh air. (All right, this was Camden, New Jersey, so exercise in some kind of air.) And one more plus: If the team is efficient and hardworking and get through their rounds by 11:30 am or noon, they can take the rest of the day off, yet get paid as if they’d worked the whole 5 am-to-1 pm shift.

I was the doctor doing his pre-placement physical exam–designed to determine if the potential employee has medical conditions or takes medicines (or recreational drugs) that might interfere with the employee “performing essential job functions in a safe, regular, and reliable fashion.”

He was twenty-five, slender but muscular, and very excited about the prospect of this job. He was polite and engaging. He surely was capable of lifting cans into the “load-packer” and running beside, or hanging onto the side of, the trash truck as it went on its rounds cleaning

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One More Child Left Behind

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Brian T. Maurer

Making the diagnosis might be straightforward, but sometimes getting adequate medical care poses a more formidable challenge.

It was the end of an exhausting afternoon in our busy pediatric practice in Enfield, Connecticut. I had just finished seeing what I thought was the last patient of the day, only to find yet another chart resting in the wall rack, a silent signal that one more patient waited behind an adjacent closed door.

His name was Aaron. Six years old, he sat on the exam table cradling his left arm in his lap. The most striking thing about the arm was the large bluish bulge on the side of his elbow. His mother stood by his side; his grandmother sat in the corner chair.

“What happened?” I asked.

“Another kid pushed him off a table at school. He won’t move his arm.”

I took a step closer. “Let’s have a look.”

Gently, I palpated the borders of the blue bulge. Aaron winced in pain. I felt his wrist to check the circulation to his hand. “Squeeze my fingers,” I said. He tried and winced again.

“It’s likely broken,” I explained. “At

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Second-Guessed

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Andrea Gordon

It was a good night, but it’s been a brutal morning.

As a family doctor who does obstetrics, I generally enjoy my time with laboring patients. When I arrived on the maternity floor last night to start my call, things looked pleasantly uneventful. Several patients were in labor. Only one wasn’t progressing well: Ana, age twenty-two. 

I was told that Ana had come to the floor two days earlier, leaking puddles of clear fluid but not contracting. She still wasn’t contracting, even after two days on pitocin, the drug that causes or strengthens uterine contractions.

To add to this difficulty, there was Ana’s shift nurse, Barbara.

Barbara and I had a history. Another night, caring for a very annoying patient, I’d thought that Barbara had acted unprofessionally, and she’d accused me of shirking my responsibilities. We hadn’t parted on the best of terms.

As the night wore on, Ana’s uterus finally began to contract, but she didn’t tolerate the discomfort well. She was also fearful of taking any pain medication–a perfect catch-22.

Avoiding a replay of our last collaboration, Barbara and I managed to soothe Ana and her husband, and they changed

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Steep Sledding

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Jonathan Han

“Don’t worry,” my doctor said.

I barely heard what he was saying; lying there in the hospital bed, I was caught up in contemplating the diagnostic procedure I was scheduled to have the next morning.

“With these anesthetics,” he continued, “you won’t feel or remember a thing after it’s over.”

“Okay,” I answered weakly, signing the consent form with unaccustomed legibility. But could I really forget the emotional trauma of these past twelve hours?

I’m a physician, and blessedly accustomed to standing on the other side of the health-and-illness divide. But after four days of crampy abdominal pain, my self-diagnosed “gastroenteritis” had horribly morphed into a “rule out carcinoma” directive. Now I faced another twelve hours of waiting–reviewing the possibilities, expecting the worst–until my procedure could be performed. Could I stop silently reviewing my CAT scan findings (that suspicious abdominal mass) and numb my feelings of anguish and anticipatory grief?

“Do you want a sleeping pill for tonight?” asked my doctor.

“I don’t know,” I stammered.

“It may help you sleep,” he pressed.

“Okay,” I said, grasping at the chance to escape this nightmare. Inwardly, though, I craved

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Late Again

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Paul Gross

One thing I love deeply about being a family doctor is that I get to take care of people–body and soul. A patient comes into my exam room with a litany of physical symptoms (“My shoulder…my knee…my stomach…so tired…this nausea…”) and then, in response to a questioning look, suddenly bursts into tears.

It’s all mine to deal with. The shoulder. The stomach. The tears. I get to gather the pieces and see if we can’t put this broken person back together again.

What a privilege.

And yet the joy of primary care is also its curse. With each patient, I have to keep track of everything–the trivial and life-threatening, the physical and mental, the acute, the chronic and the preventive. And try as I might, I simply don’t have enough time.

On paper, my office schedule looks simple: I see one patient every fifteen minutes beginning at 8:30 a.m. If I stick to my timetable, I can wrap up my twelfth patient by 11:30, finish up any leftover paperwork and enjoy an hour’s lunch before starting again at 1:00.

Ha.

The reality is that I’m never done by 11:30. In fact, my colleagues

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