Month: August 2019

First Time, Last Time

“Deeper compressions! Deeper! Make sure you get that recoil!”

I push harder and lift off higher. I’m starting to sweat. My stethoscope is banging around my neck. I should have taken it off, I think. My hair is flying around my face. I should have tied it up. I’m on tiptoe; my legs are cramping. I should have stood on a step stool.

“All right, she’s getting tired. Next!”

Embarrassing…I only lasted through one round of compressions. Other people (taller, more muscular people) are lasting longer. I really need to lift weights. Doing chest compressions is much more physically demanding than I’d thought.

The Patient Is Always Listening

“Excuse me? I’m lying right here, ya know. C’mon!” 

The voice came from behind the cloth curtain of the test bay, in a tone of defensive disbelief. It belonged to a patient who had Brugada Syndrome and an implanted defibrillator awaiting her stress test. 

I had been discussing Brugada, the potentially lethal and heritable “sleeping sickness” marked by unheralded syncope (loss of consciousness) and sudden death. My colleague and I were enthusiastically running through the electrocardiographic characteristics, diagnostic uncertainties, defibrillator firings and death rates when the conversation turned to the patient. 

“If she were to drop dead during exercise…” I had started to say.

I AM Taking My Medicine

It was 1962. I was in my third year of medical residency at Philadelphia General Hospital, the only charity hospital in the city.

I was in the outpatient clinic, seeing an African-American patient for the first time. I noted that he was on an anticoagulant, Dicoumaral (similar to Coumadin).

His prothrombin time (a test that indicates the level of blood thinning) was very low—in fact, outside of the therapeutic range. When the range is too low (meaning the blood is too thick) or too high (the blood is too thin), the patient is at risk for serious complications such as clotting or hemorraghing.

Without thinking, I said, “You must not be taking your medicine.”

Dear Nurse

I was an RN for more than forty years and am now retired. As a recent hospital patient, I documented my experiences. This resulted in a letter to nurses everywhere.
 
Dear Nurse,

Please be kind to me. I am frightened, alone and in pain. I am way out of my comfort zone and need every bit of encouragement you have to offer.

I arrived at the emergency room a short while ago, was transferred from the ambulance stretcher to a narrow bed and told that a doctor would see me soon. Curtains were pulled around my little cubicle–for privacy, I assume–but honestly, I do wish they had left a small gap to let me see people, activity, life!

I do have a call bell within reach, thank goodness. For that I’m grateful. I do not, however, have a friend or family member with me for moral support. I didn’t want to impose on anyone, but I’m beginning to understand why it’s recommended. Example: I could really use a tissue! It doesn’t seem important enough for the call bell, but a friend could dash out to get one immediately.

escape thumb 3

Release

“In 2009, after many years in hospice work, I was asked to help a friend in Oregon do the spiritual work around her choice to have medical aid in dying. (She asked me to do this not as part of her hospice care, but as a friend.) We did a weekend intensive, and within two weeks she took her leave. I did this series of collages about a month after her death to honor her life choices and my experience of her release from her broken-down body.”

The Lies We Tell Ourselves

Always occupied with the needs of others, medical students often put their needs and wants aside. Sometimes for an unhealthily long time.
Although the consequences of such self-inhibition are not readily apparent, they can have an insidious impact on academic and clinical performance. But the story I am about to tell is something far worse.

A Perceived Snub

I ambled with squirrels and rabbits on an urban trail overflowing with chaparral and mossy oak. Early morning bird chatter, drone of bugs in rays of sun, and the crackle of underbrush beneath my feet kept me company. My thoughts wandered brisk as the sound of river water on rock.

A man wearing a holey T-shirt and sweatpants approached me, accompanied by a large German Shepherd. The dog was off leash but seemed friendly. The man had a vacant stare, and as I passed him I gave a perfunctory smile and “Good morning.”

He didn’t even note my existence nor change his faraway gaze, and I immediately snickered at his lack of basic human decency. Shaking my head, I glanced back at him. He had stopped, looking up at the cloud-threshed sky, and suddenly emitted an unearthly wail.

Nurse Ratched, Nurse Lillian

The movie, One Flew Over the Cuckoo’s Nest, became popular the year I was working on my hospital’s med/surg psych ward as a nursing student. While this cult classic raised awareness about injustices in mental institutions, the public assumed all administrative nurses were cut from the same cloth as the film’s RN whose name rhymed with wretched. On more than one occasion, I had to restrain myself when someone said, “Bet you’re Nurse Ratched, ha, ha, ha. Only kidding.”

Encounters: “You know…sometimes I don’t remember that I have it.”

Should I talk about the bad stories or the good stories?

Okay, the bad part is hearing that something’s wrong with you. That burns me.

I don’t want doctors bothering me–just leave me alone. I don’t know why I’m afraid of doctors. Sometimes I just don’t like to hear them talk. I just found myself going more to the doctor after I was diagnosed. Before, I didn’t have to go to the doctor. I was healthy.

I don’t like hospitals. My father died in a hospital. My mother died in a hospital–she was brain dead when she passed away, in 2002. My sister died in a hospital. To see somebody’s tongue out their mouth, and hooked up to those machines–I’ve always told my daughters that I don’t want to die in a hospital, that I want to fall asleep in my house.

I love all five of my daughters in a different way. They know what I’ve got. They know who gave it to me.

They used to like him, but they don’t care for him too much now, after, you know, what he done. They felt that he took my life, and he could have told me. When it …

Encounters: “You know…sometimes I don’t remember that I have it.” Read More »

Pharmacy Visit

You are a big man, a little heavy, but nothing
that can’t be fixed by daily, brisk walks
or swept away by a
dose of cancer and a blast of treatment.
You have been called from your glass enclosure
to help me.

A productive, bronchial cough
is still with me–too long.
Chinese practitioners call this a lurking pathogen
tossing antibiotics into my weary kidneys to excrete
as a mindful French woman
with her midday steamed leeks.

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