Month: August 2020

Into the Night

What makes the desert beautiful . . . is that somewhere it hides a well.” — Antoine de Saint Exupéry

That summer night in the desert a few weeks before my seventh birthday is etched in my memory forever. We met our smuggler around sunset, when he came to our motel room to pick up my mom and all six of her kids, each of us with some degree of ailment—a broken arm, a bacterial eye infection, a cough. We followed the smuggler into the Tijuana-San Diego desert through a hole in a metal fence. By nightfall, we were hiding from helicopter lights above looking for people like us.

The enormity of what was happening was palpable: my mom was risking our lives for “the American Dream.” This was a single night in our long story of resilience in the face of uncertainty. Life adversities can build character but can also tear it down. Growing up in minority communities that met trauma with resiliency also meant I witnessed the deadly impact of living with a lifetime of cumulative stressors. 

A Run with Death

I wrote “Katie” on my legs every morning the summer before my first year of medical school. Katie was a childhood friend of my friend Sammy. Sammy and I were doing a charity run across America with the Ulman Cancer Fund; every morning, my team would gather to dedicate our day’s run to a cancer survivor, fighter, or victim. Before embarking on the miles ahead, we would read their stories aloud.

Decision

B546 wants to die
eight years after they saved her.
Cervical-cord injuries are cruel.
For Maria it was a gunshot,
but it could have been a car wreck, a fall,
or a drunken misstep off a roof.
The reasons seemed to matter; now they don’t.
Thirty-two, alone, paralyzed, on a vent,
she mouths “no” to the antibiotics, the heart meds.
“I want to die,” she shouts in a whisper.

Troubleshooter

As a third-year medical student midway through a family-medicine rotation, I’m supervised by a family physician in several free clinics in our large city.

On Fridays, we run a clinic for torture victims who’ve left their home countries to seek asylum in the US. I’ve been following a new patient, Julian, an African refugee.

Julian is a small, thin man in his early thirties. His large eyes, shy smile and soft voice belie the determination and resilience evident in his story.

Diagnosing Heart Attacks

In the 1990s, I took care of patients presenting with chest pain to the ER, and our mantra was “time is muscle.” We raced against the clock to deliver oxygen and medicines to patients and, hopefully, prevented permanent heart damage.

But not all heart attack sufferers complained of crushing pain the way they do on TV. The ER physician couldn’t risk giving heart attack medications for non-cardiac conditions like gastric reflux or gallbladder attacks. Oddly enough, some people in our care died from heart attacks whose only symptom was a twinge of discomfort. While others, screeching in pain, didn’t have cardiac problems at all.

People versus p-Values

The only thing that seems certain these days is uncertainty itself. I am in the process of preparing educational materials for the general public to address some of the misinformation related to the COVID-19 pandemic. How does one address all the misinformation out there, especially when people’s lives are concerned?

Something That Is Certain

“All of us are overworked, tired, and frustrated, but today it’s only us who can help. This is our call. So be brave and work without complaining.” The chief of our COVID ICU was briefing new staff assigned to the COVID ward before they started their shifts on Monday. I was there as the pediatric COVID consultant on call for the coming week. We were seeing only a small number of infected kids, but the thought of entering the COVID ward wearing full PPE kit was still unsettling. With so many health-care personnel getting infected, admitted, or quarantined every day, nobody knew who would be next.

Differential Diagnoses

When their ambulance is dispatched to a 9-1-1 call, paramedics attempt to cherry-pick a diagnosis based on the age and the one-sentence description they get of the patient’s complaint. We occasionally nail it, most times not, with humor, sarcasm, gloom or fatal cheer. There are often curveballs; it’s hard to streamline individual patients and their array of needs with our quick-and-dirty prehospital tools.

The Worst Good News

When my oncologist reassured me “Your exam is normal,” I wasn’t convinced I was okay. Neither was he. Unwilling to wait and see whether my worrisome symptoms improved with time, he handed me a requisition for a scan.

All I could do was hope for good news, a response as reflexive as squinting in blinding light. It never occurred to me to question whether “good news” was the best thing to hope for.

Phototherapy

On a damp, overcast Friday morning, I was wandering around the downtown area of a nearby city with my camera. I found an interesting scene and photographed it, carefully adjusting my camera’s settings and the composition until I felt I’d conveyed what I’d felt when I saw it.

Lowering my camera from my eyes, I realized that, for the first time in months, my mind felt clear and my heart felt open. This realization struck me so hard that I sank onto a park bench. Tears of relief and sadness leaked from my eyes.

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