Month: December 2020

I Carry Her Memory

Ms. K was one of the oldest patients I’d met. I wanted to sit and hear her stories, to say, “Tell me more,” the way we learned in medical school. But the equipment sustaining her left no room for a chair to sit in. And COVID had stolen her ability to speak in sentences; she puffed out words two or three at a time before inhaling again. Even so, each word was sharp and spirited and made me smile.

Her face was a rich and deeply wrinkled landscape. Ms. K’s gown hung loosely on her, exposing the silhouettes of her ribs and knobby shoulders. I was surprised when I pulled the layers of blankets back from her feet. In contrast to her thin arms, her legs were thick and smooth, due to the accumulation of fluid as a result of her weakly pumping heart. Her heart had been failing for years, yet she had beaten the odds and thrived.

Another Day on the Calendar

“And the year 2020 came to an end and they all lived happily ever after.” Wouldn’t it be nice if we could all leave this year behind and be certain of the “happily ever after” part?

I have often wondered at the hype that typically accompanies the end of a year and the beginning of another, especially since the year starts and ends at different times, depending on which calendar we choose to follow. The Jewish New Year and the Chinese New Year do not coincide with the 1st of January, and they do not even occur on the same day each year.

It eventually occurred to me that the meaning we attach to a day or anniversary is what gives it significance, not the day itself. On one occasion during my residency training, I specifically asked to be allowed to deliver a laboring patient’s baby because it was the anniversary of my mother’s passing. I felt that helping to bring a new life into the world on the day when I could have been focusing on death would have a special meaning. I remember looking at an obituary as a child and announcing to my mother that someone had …

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The Kiss

The year is 2015, and I’m on my thirteenth surgical mission, but my first to Venezuela. I am a plastic surgeon, traveling with a nonprofit that offers free plastic surgery for people with birth defects such as cleft lip. We’re making a two-week visit to the coastal city of Cumaná, 250 miles east of Caracas.

Halfway through our first day of surgery, I’m asked to come out to the waiting area to assess a young girl named Vanessa, whose mother has brought her as a walk-in patient.

Coming Out of Retirement

People cheered the first trucker transporting a huge load of COVID-19 vaccines as he left the Pfizer plant in Kalamazoo, Michigan. The news anchor exclaimed, “This just might be the beginning of the end.” That driver represented one individual in a long chain of workers besides doctors and nurses needed to end the COVID-19 pandemic.

A  few days before, an email from the state health commissioner had popped up in my in-box. Its subject line caught my attention: “Urgent: Volunteers Needed for Vaccination Campaign.” To me, there’s a light at the end of the tunnel now that a vaccine is a reality. I felt excited to help and answered the call without hesitation. As an RN who has given hundreds of tetanus injections to ER patients, I have medication administration skills to offer such an effort.

The Doorknob Moment

“Doc, can I say just one more thing?”

Every clinician knows this moment—the so-called doorknob moment, when your hand is reaching for the exam-room door, and your patient asks the question that’s been on their mind the whole visit. It’s the issue that’s been nagging them, usually an embarrassing or emotionally laden issue, sometimes both. Every clinician knows better than to walk out on a doorknob moment.

I sit back down. “What’s on your mind?”

She Went Home: End of Life in the Era of COVID-19

The mother had delivered a healthy newborn. After a careful instrument count and exchanging pleasantries, I headed for the shower. It was getting late, and I had unfinished business.

On to the ICU, but not for my usual reasons. I heard sounds of beeping intensify just before I entered the room, and I felt an ache inside. My eyes focused on the vital signs on the screen. I sat down. “Good evening,” I said.

A smile spread across her face. Struggling, she said,  “Good evening, I love you.” I was relieved, at least for the moment. Until then, I did not know if I would ever talk to her again.

I remember the way she looked at me: as through a haze. I remember regretting not having spent more time with her. I remember reassuring her that it was all going to be okay.

When I asked my mother how her day had been, she said “Okay.” But the look on her face suggested otherwise.

I knew my time was running short. I wasn’t even supposed to be there as Coronavirus had swept the globe. I was only there through subterfuge, under the guise of a physician. In truth, I …

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“Crisis Care” at the Border

In the time of COVID-19, healthcare workers are stepping up to care for massive numbers of patients. Often, they’re doing this without adequate resources. At the beginning of the pandemic, our hospital administration referred to this as “crisis standard of care”–which the US Institute of Medicine defines as “a substantial change in…the level of care it is possible to deliver, made necessary by a pervasive or catastrophic disaster.”

For many American doctors this model of care is new, but I would argue that for most health workers worldwide, it isn’t new at all.

In Need of a Prayer

The new patient’s name is Emmanuel. He was sent from his nursing home to our emergency room with a cough and fever. The oxygen level in his blood is well below normal, and he’s gasping for air.

It’s my third week in the local community hospital ER. I’ve been putting in extra on-call time during the COVID pandemic. It’s been rough to get back into the emergency setting while continuing my day job as a family doctor and medical educator. I’ve been sharing admissions with the hospitalist, who’s joined me in the on-call room.

“I’ll take him,” I tell my colleague.

I Should Have Said No

Can you see this patient today?
His appointment is tomorrow,
he came all the way from Nebraska.
Can you work extra tomorrow,
we are short, just four hours extra?
Would you be able to work Christmas this year?

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