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November More Voices: Choosing

Dear Pulse readers,

Our November More Voices theme is Choosing.

As I write this, two days before Election Day, our nation is about to do some choosing of its own. And like many choices we turn over in our minds, the final outcome will not be 100 percent on either side of the scale.

In health care, decisions need to be made all the time. As a physician, I choose whether or not to recommend a test or treatment. I choose which medication to propose to a patient.

My Chiaroscuro Moment

From a young age, I aspired to enter the nursing profession. Beginning my career, in the late 1970s, I scarcely imagined how many facets of health care I’d come to know–from human-subject research to healthcare law and bioethics–or what opportunities my career would bring.

One opportunity came in the early 1980s: I went to Rome to work as a nurse at a university. During that remarkable year, I took advantage of my location to learn more about Baroque art.

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More Voice Not Knowing Test

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Suspendisse …

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Dreamy Poppy Pink

In nursing school, to learn about human anatomy, we dissected stray cats. The tiny blobs and structures inside them looked more like toys than organs; at times I had difficulty telling one part from another.

When our instructor got us invited to the medical school’s Anatomy Lab that studied real people, I was excited to finally see a complete human body. Maybe there would be straight pins with little flags for each section of the heart and brain. I expected the experience to be like our Cat Lab: clinical and unemotional.

Al Amira Abaya

 
“There are some unusual spots on my feet that I want to have examined,” says the fifty-something woman with a friendly smile.

She is wearing an al amira, a two-piece veil consisting of a close-fitting cap and an accompanying tube-like scarf. The rest of her body is covered by her loose-fitting abaya, despite Philadelphia’s sweltering July heat. I have learned that these garments are traditionally worn by Muslim women as an expression of modesty when they’re in the presence of males not in their immediate family.

Fistula Patient on Four

 
When I joined the surgical team, she was already a fixture, having languished there on the fourth floor for over two months. Attractive, in her early thirties, she wore little but skimpy lingerie–garb that seemed at odds with her belly, criss-crossed as it was with surgical scars and small holes that weeped gastric juices and intestinal fluids. On the team’s daily rounds, the surgeons would don gloves, avoid eye contact with her, hem and haw their way through a cursory exam, then quickly move on.

Only a medical student, and feeling awkward in her presence, I would trail behind, tapping out a note before hurrying off to catch up with the team.

How to Change a Diaper

Two daughters bring their severely demented mother into the clinic. The mother is no longer able to speak, but over the last few days she has groaned more during diaper changes. Her nursing home is worried she might have a bladder or vaginal infection. To check her urine, we undress her and catheterize her. To check her vagina, we take a swab using a speculum. We spin the urine and look for sediment under the microscope. Nothing.  We look at the vaginal smear under the microscope, using both a saline prep and potassium hydroxide. Nothing. We treat her for bacterial vaginosis, because it’s a condition that’s easy to miss.

An Act of Love

For sixty-seven years, my dad was my best friend. We enjoyed walking and talking, taking long drives while licking ice cream cones, traveling, and just sitting in companionable silence. 

We were best friends, but we always respected each other’s physical privacy. All of this changed when I became Dad’s caregiver. 

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