Month: January 2020

Last Day

Last Day

It’s my job to empty a plastic bag
filled with meds both past and present
and read out loud the labels of those we stopped,
and explain why, and while we’re on why
why he needs oxygen at night, and the rescue inhaler.
Between pills it’s my job to ask in a generic way
about life outside the clinic? He takes out his phone
because his story needs a prop.
His ex called yesterday, Only one ex, one’s enough,

Dead, Slightly Dead and More Dead

When the walls of his failed heart collapse, he suffers a damaging heart attack. He lacks any blood flow, so the EMTs declare him dead. Shocked, he fluctuates between slightly dead and more dead. The ambulance volunteers bring him to Northern Westchester’s cath lab.

Unafraid, he sees The Light. He meets Moses carrying tablets down Mt. Sinai, greeting newcomers going up. Relatives weigh his mitzvahs: pro bono work with clients, sick friends, nursing home visits. The judge calls his wife to the witness stand. She says, “He should live.” They await the verdict.

 

“You Need to Stop Drinking”

Early in my family medicine residency, I admitted a woman to the hospital for complications of alcoholism. She was young. She didn’t look like a chronic alcoholic. She continued to work. Even her fingernails were polished. Yet she had alcoholic pancreatitis. She was in severe abdominal pain and was vomiting uncontrollably. As the level of alcohol in her body dropped, she started to shake, indicating withdrawal. We admitted her for intravenous hydration and detoxification from alcohol.
I felt drawn to her; she was someone who, like me, had made wrong choices. I wanted to do my best for her.  Her physical symptoms improved quickly; she would only be in the hospital for a few days. Her real problem was the alcoholism itself. She acknowledged that. She was ready to change her life.
Desperate Measures

Desperate Measures

In my very first job as a doctor, working in a London hospital in the 1980s, I always took a ridiculously detailed past medical history for every patient I saw. I started to notice how many elderly women had had septicemia, a life-threatening infection in which enormous amounts of bacteria enter the bloodstream.

The neighborhood surrounding the hospital had once been the worst slum in London, and it didn’t take me long to guess that these infections were probably caused by illegal self-induced abortions during the hungry years of the Depression.

When I asked–slowly, carefully, subtly–I was told some intensely personal and secret stories.
Breadwinner

Breadwinner

The first thing I notice are the dark circles under Mr. Jones’s eyes.

It’s 4:30 pm on a Wednesday during my third year of medical school. I’m in the fifth week of my family-medicine rotation, and we’re deep into our daily routine: triage, history, physical examination, differential diagnosis, present the case to the attending physician, repeat.

Mr. Jones is a new patient. His face and belly are round, his arms and legs lanky. His unkempt facial hair and calloused hands reflect a life of physical labor that has worn him down. According to his chart, he’s just started an office job. Slumped apathetically in a chair in the corner, he seems apprehensive and hesitant to talk to me. Understandably so: I’m a stranger with the word “student” attached to my name.
“I can’t remember how long it’s been since I’ve seen a primary-care doctor,” he begins.

The Third Wheel

I am trying to move the language from forever to this moment, in the aiport departure lounge. To loosen up on declaring “You’re always” and “You’re never” and instead say “Right now you are …”

I might think I know what’s coming, but I have no idea exactly what it will look like and when it might happen. For now, the “what ifs” are not dormant, but also not dominant. Regardless, an illness becomes an uninvited third person in a two-person marriage. 

Protea caffra

Beverly called the ambulance because she couldn’t walk anymore. Her feet were edematous after ten days of radiation treatment for metastatic lung cancer, and her heart was slowly overfilling with fluid, backlogging into her body. She was stoically resigned to her pain and newfound infirmity, but she kept a wry sense of humor, cracking jokes about being waited upon and the “magic carpet ride” sling we lifted her onto.

During transport to the hospital, Beverly told me she grew protea: pale red, pink and cream-colored flowers native to South Africa. Her family sells them at local farmer’s markets in bouquets. When I inquired further, Beverly perked up and gave me the rundown:

Training During the Plague

Training During the Plague

If you had told me thirty years ago,
when I took call on endless sleepless nights
on incandescent AIDS wards full of fear
on which I tried to do the healing work
of drawing blood and packing leaking wounds
and viewing films of microbes gone berserk
in lungs and brains of patients wasted frail
to postpone certain death from HIV,
if you had told me then that I would see
a family with an AIDS tale just as bad—
today, two parents with disease but well,
their uncontaminated child, alive–
my doubt would equal that of Didymus
who disbelieved the Resurrection tale.
Like he who needed proof with sight and touch,
I’d need this scene to change my mind as much.

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