Month: July 2016

Rough Start

 
Approaching the hospital bassinet, I glimpse his hair first–long, carrot-colored fuzz sticking out in all directions from his pink, bowling-ball scalp. A chubby, scrunched face comes into view next, cherry-red lips forming a Cheerio and one eyelid wavering just enough to reveal a soft blue puddle beneath it.

Gingerly, I slide my hands under his sausage-like arms, my fingers cradling the doughy curves of his tiny neck, caressing the orange-yellow cornsilk on his occiput. Slowly, I lift him from the sterile white mattress he’s called home for the month since his exit from the womb, since his insurmountable hurdles began.

Emergency Intubation

During my first year of anesthesia training I was called to open an emergency airway for a patient struggling to breathe in the Medical ICU. When I arrived amid a flurry of activity and billowing yellow isolation gowns, the monitor was crying DING DING DING to alert us that the patient’s oxygen saturation was hovering in the mid-80s–dangerously low. The patient’s small face was obscured by the oxygen mask, his frail body covered by a hospital gown.

The patient was too confused to follow any instructions, and the loud noises of the ICU machines didn’t make things any easier. I tried to communicate: “I’m from anesthesia and I’m going to put in a tube to help you with your breathing.” A nod. I positioned myself at the head of the bed and quickly checked to make sure we had everything we needed: suction, laryngoscope, styletted endotracheal tube and a clear view of the monitors. Check.

“We’ll take good care of you, Sir,” I said as my senior resident started pushing the drugs that would render the patient unconscious and immobile.

One Afternoon at Teatime

Marilyn Hammick

Arthur stops close to where we sit waiting
for the person you call the activities lady
to serve us drinks and biscuits.
He moves his wheelchair with slippered feet,
so we become another group.
You introduce me, This is my sister,
I nod to Arthur and watch his mouth form words
that seem reluctant to reach me, hang
in the air unsteady, diminished.

He continues to speak, I continue to nod,
I think he’s asking about my name,
you seem to understand, or do you guess?
I’m trying to work out if there’s a knack
I’ve yet to grasp, a way to hear
the hush and lisp of his voice, because
all the time you’ve been here, where
you don’t want to be, after all these months
Arthur is the first person you’ve introduced me to.

Letting Go.Houck

Letting Go

Gia Marie Houck

About the artist: 

“I am a hospice social worker in Austin, Texas. I also very much enjoy photography as a hobby, and photo editing to make more artful images.”

About the artwork:

“This image symbolizes the peace of acceptance and letting go in loss–whether it be just for a moment or for a longer time. To me, it also speaks to the courage to let go when treatment is not working and is making one too sick to have any quality of life. I associate with this image a quote by Hermann Hesse: ‘Some of us think holding on makes us strong; but sometimes it is letting go.’ The photograph that became this image was taken in the Italian Cemetery in Colma, California.”

Visuals editor:

Justin Sanders

It Doesn’t Work That Way

My second month of residency. My first solo thoracentesis–a procedure to remove fluid around the lung. The supervising physician I’d just met watches over my shoulder as I carefully count and percuss the rib, fasten the drape in place, gown, glove, and cleaned off the skin.
Infiltrate with lidocaine…good. Thread the catheter into the trochar…good. Attach the stopcock…good. Make sure it’s open in the right direction. Puncture the skin, pull back on the syringe, fill the syringe with fluid. A sigh of relief–it’s in the right place. Turn the stopcock, remove the syringe…. The supervising physician makes an inarticulate noise. I look at the stopcock and freeze. It’s turned the wrong way. I have just introduced air into the area around the lung–a major mistake.

Mortuus (Dead)

It was a grim night. A man had stumbled, drunk, into the street and been hit by a car. The car drove off, but bystanders called 911. The man was strapped to a bright yellow gurney and brought to the emergency department in an immaculately clean ambulance. He himself, however, was disheveled, soiled and violently combative. He fought. He yelled. He spat. He smelled. He was disgusting. 

Everyone deserves good care, thought I. My evaluation found him to be merely drunk. I considered imaging studies, but they would have required general anesthesia, which didn’t seem advisable given the man’s condition. Instead, I admitted him for observation. I got to sleep about midnight.

Blindsided

Alice Y. Kim

When Teresa showed up forty-five minutes late for her appointment, I sighed. I knew this would disrupt our clinic’s afternoon schedule.

That was nothing unusual, though. The clinic treats large numbers of patients who are undocumented, homeless and uninsured, and many must walk or take public transportation to get here. After seven weeks on rotation here as a third-year medical student, I knew that appointment times were flexible.

As I read Teresa’s notes and recent lab results, the nurse came in.

“Teresa’s blood pressure is 210/122,” she told Dr. Fuentes, the attending physician.

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