Month: June 2012

Presentation

William Toms

The patient is a 61 yo M with a Hx of NIDDM, ASCAD, HBP, COPD and CHF who presents with chest pain radiating to his jaw and both arms for thirty minutes, accompanied by diaphoresis, SOB and nausea. PE shows bibasilar rales, generally regular rhythm with frequent ectopy, an S3 gallop, 2+ JVD, liver edge 10 cm below RCM, 2+ edema. EKG shows Q’s V 1-4, STE V 3-6; CXR shows cardiomegaly and basilar congestion. Initial CPK and troponins are elevated…

and his wife is in the waiting roomterrified
and his children are on the wayworried
and his dog is at homeconfused
and his flowers are in their bedsgrowing

and, yes, he has a Living Will
and, yes, he would like a tissue
to wipe away his tears


About the poet:

Bill Toms was medical director at Dartmouth-Hitchcock Keene, a large group practice, for nine years, retiring in 2005. He now practices part-time, seeing homebound patients for his colleagues, and leads discussions regarding listening to patients at Dartmouth Medical School. “I have been fortunate to have been a family physician in …

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What About Bob?

Joseph Fennelly

The time: early one morning, thirty years ago.

The place: my local hospital.

At this point, I have been an internist for twenty years. I’ve just entered the cardiac care unit, where my patient Bob, a ninety-five-year-old man with advanced senility, has been brought because he’s having chest pain. 

As I step through the door, Bob codes. The young residents and staff swing into action, rushing the crash cart over to his bed.

Quickly, I jump between them and Bob. 

“Don’t resuscitate him!” I shout.

Looking stunned, they eye me as I stand there with folded arms, making myself into a human shield.

Bob lies motionless, not breathing, his monitor registering occasional spontaneous heartbeats.

Suddenly it hits me: I need to see the situation through these young residents’ eyes. After all, isn’t this a patient in the cardiac care unit? Aren’t his monitors signaling a heartbeat? And isn’t their duty to protect life? 

To help them understand why I’ve staged this aggressive assault on their training in high-tech medicine, I must help them to understand Bob. They need to know this gentle, …

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Cold Comfort

Mary T. Shannon

Leaning against the hospital bed’s cold metal rails, I gazed down at my husband lying flat on his back. Under the harsh fluorescent ceiling lights, his olive skin looked almost as pale as mine. 

We’d been in the outpatient unit since 6:00 am for what was supposedly a simple procedure–a right-heart catheterization to assess the blood pressure in John’s pulmonary arteries. Now it was 3:00 in the afternoon. 

Before we’d arrived that morning, John had seen the procedure as a chance to take a day off from the clinic where he practices internal medicine.

“I think I’ll go out this afternoon and hit a bucket of balls,” he’d said as we drove to the hospital. “My procedure shouldn’t take that long.”

“Are you sure you’ll be up to golfing afterward?” I’d asked.

“Right-heart catheterization is a simple outpatient procedure,” he’d answered, as if talking to one of his patients. “The pulmonary artery pressure will probably be somewhat elevated, just like the echo showed, and then the pulmonologist will decide if I need another medication, that’s all.”

After thirty years of marriage, …

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In Line at the Hospital Coffee Stand

Tabor Flickinger

At the coffee stand as always getting tea,
so always that the ladies see my weary face
and start the water steaming without words.

I hover there with others waiting think through labs to check 
imaging to glance at does he have pneumonia or pulmonary edema 
has social work found her a nursing home will his family want a feeding 
tube despite his end-stage dementia did I order cytology on that peritoneal 
fluid when will I next see the sun it’s so

“Oh, did you take care of him before? He’s dead.”

                                                                  unnatural in here fluorescent 
now where was I peritoneal fluid hey I wonder who is dead

“Yes, I heard. We all had him at some point. 
He was in the hospital every few weeks for his heart and renal 
failure. What happened?”

“He didn’t want to suffer anymore. Had us turn off his defibrillator. 
Stop dialysis. Arrhythmia. Likely hyperkalemia.”

I know the man they mean without names.
I took care of him before. He’s dead.

His heart pumped ten percent it couldn’t keep fluid out 
of his lungs and felt like drowning sometimes better after 
dialysis but he hated the fistula in the arm that got …

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Gentle Men

Alan Blum

Editor’s Note: This week, Pulse once again presents sketches by Alan Blum, a family physician who for years has been jotting down visual impressions and snippets of conversation as he cares for patients. These sketches go back as far as 35 years, representing patients who have died or with whom he lost touch because of geographic relocation. These drawings are from the recently published book Gentle Men (Firebrand Press).

About the author:

Alan Blum is a professor of family medicine and holds the Gerald Leon Wallace endowed chair in family medicine at the University of Alabama, Tuscaloosa, where he also directs the Center for the Study of Tobacco and Society. In 1977 he co-founded Doctors Ought to Care, an international physicians’ organization that pushed organized medicine to become more active in combating the smoking pandemic and the tobacco industry. As a result of these efforts, Dr. Blum received the Surgeon General’s Medallion from Dr. C. Everett Koop. Alan Blum’s sketches and stories have been published in Literature and Medicine, The Pharos, JAMA, Hippocrates, Emory Medicine and The Color Atlas of Family Medicine.

About the sketches:

“These sketches …

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