Pamela Adelstein

Statute of Limitations?

What do you do when you hear about a sex assault that happened years ago, and you currently interact with the perpetrator in your daily life? What if that perpetrator is seemingly a nice person, and you are friends with his female partner and his family?

What if the perpetrator is a patient of yours, and you are also the primary care provider for his family?

What if the perpetrator is a coworker or a supervisor at your workplace, and you spend time together in meetings and engaged in work tasks?

Stories

For the fifteen years that I have been at my current job, I have held onto my patients’ stories. Tucked into special pockets in my heart, they would be brought out whenever their “owner” came in for an appointment, where the story would take on a new form, then be stored away again. There were stories of shame and heartbreak, stories of joy and triumph. People confessed their deepest fears, shared events never revealed, and confided fledgling hopes and dreams. These stories are signs of patient-physician trust and of sacred human-to-human connections.

The Expect

Statistically, to avoid missing a case of appendicitis, one must send to the ER some patients with symptoms of appendicitis whose appendices turn out to be normal. This lesson from medical school is imprinted indelibly on my mind.

In my residency program, if a resident sent a patient to the ER, the resident was required to go the ER to evaluate them, to further their learning. However, this created a conflict of interest—if you had to meet a patient in the ER, you missed out on sleep. Hence I thought hard about the disposition of each patient.

Lipo

My patient inquires about one final issue during her appointment. After wavering for years, she’s decided to travel to Florida for liposuction. She has saved portions of her paycheck over the past year to pay her airfare, hotel, and surgical fee. The surgeon requires X-rays, an EKG, bloodwork, and preoperative clearance. And I am asked to provide them.

Often patients unhappy with their weight—and physical appearance—dream of a quick fix. With an internet recommendation of a surgeon and a few Zoom calls, the surgery is booked.

The Body Keeps the Time

Have ever felt that sense of unease on a cellular level? Like something is amiss. Like nothing feels quite right in a visceral way. That feeling sneaks up on me at certain points it the year. Like when it is time to transition back to school. Or, deep in winter. Or, the anniversary of a difficult event.

Situational Depression?

Sad, tired, and vulnerable, I plopped into my usual seat in my therapist’s office. As a third-year medical resident, I felt like a poster child for imposter syndrome. For months, my mood had been low, I was not enjoying life, and I was struggling.

My therapist gently commented, “I think it’s time for meds, Pam.”

A Routine Clinic Session

I open the door, belt out a “hello,” and peer at the patient seated in the exam room I’ve just entered. My gaze is drawn to a homemade button pinned to their jacket and then to their T-shirt. Both depict a photo of their loved one who was a victim of gun violence. The victim’s dates of birth and death are imprinted below the photo. A quick mental subtraction reveals a life ended far too soon.

Popping the Question

Last week it happened again. It starts with a hesitant smile, a subtle pause, eyes looking me up and down, and a gaze that tentatively rests at my stomach. I sense what is about to occur, and I wait like the proverbial deer in the headlights. Then comes the timid question: “Are you expecting?”

I pause awkwardly and briefly contemplate my response. Because my patient is inquiring out of love and genuine curiosity, I tamp down my sarcasm and mumble, “It’s my pants style.” The patient lowers their eyes and murmurs something apologetic.

Panic in the Outside Messages Folder

As I scan the numerous folders of my electronic medical record in-box, typically I open the “Outside Messages” folder with some trepidation. This folder contains messages from other hospitals detailing emergency room and specialist visits, hospitalizations, and test results concerning my patients.

Searching for Activism

My senior year in college, I took a course called Women and Radicalism. It was an exciting class. We studied radical movements on the left and right, with a focus on women’s participation. The course featured a weekend retreat with women activists. For two days, women took the stage to describe their causes and advocacy roles. I attended many sessions, in awe of these phenomenal women who were making a difference in the world. I noted that most of them had been thrust into their cause by a personal adverse event, such as gun violence or an environmental catastrophe.

Tug of War

A tug of war lives within me, and my physical body and soul are struggling mightily. Gratitude pulls one end of the rope, and burnout yanks the other. I feel immensely grateful that I can meaningfully contribute to people’s care during the pandemic. I’ve triaged, tested, talked with and tended to countless patients since COVID-19 began. I am blessed with wonderful family, friends and community plus a job with deep purpose and meaning. Each workday I feel enriched by those around me.

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