Pulse newmasthead 10th anniv 2252x376px

About More Voices

Every month More Voices invites readers to contribute short nonfiction prose pieces of 40 to 400 words on a healthcare theme.



new subscription

Join the 11,000+ who receive Pulse weekly

energize subscription 
Energize your subscription
with a contribution and
Pulse vibrant

Making Assumptions

"I'm An Ass. Sue Me."

Although my training, in both internal medicine and nephrology, was excellent, I was lamentably green for some time when it came to the practical aspects of medicine. I did, however, learn one lesson early on.

One day, I rose from my office chair to greet a new patient who walked in slowly, supported by a cane and holding the arm of a much younger man, who helped her into her seat before taking his. To me, she appeared to be "old," because in those long-ago days I thought of anyone over sixty-five in such terms. 


The Patient Is Always Listening

“Excuse me? I’m lying right here, ya know. C’mon!” 

The voice came from behind the cloth curtain of the test bay, in a tone of defensive disbelief. It belonged to a patient who had Brugada Syndrome and an implanted defibrillator awaiting her stress test. 

I had been discussing Brugada, the potentially lethal and heritable “sleeping sickness” marked by unheralded syncope (loss of consciousness) and sudden death. My colleague and I were enthusiastically running through the electrocardiographic characteristics, diagnostic uncertainties, defibrillator firings and death rates when the conversation turned to the patient. 

“If she were to drop dead during exercise…” I had started to say.

I AM Taking My Medicine

It was 1962. I was in my third year of medical residency at Philadelphia General Hospital, the only charity hospital in the city.

I was in the outpatient clinic, seeing an African-American patient for the first time. I noted that he was on an anticoagulant, Dicoumaral (similar to Coumadin).

His prothrombin time (a test that indicates the level of blood thinning) was very low—in fact, outside of the therapeutic range. When the range is too low (meaning the blood is too thick) or too high (the blood is too thin), the patient is at risk for serious complications such as clotting or hemorraghing.

Without thinking, I said, “You must not be taking your medicine.”

The Lies We Tell Ourselves

Always occupied with the needs of others, medical students often put their needs and wants aside. Sometimes for an unhealthily long time.

Although the consequences of such self-inhibition are not readily apparent, they can have an insidious impact on academic and clinical performance. But the story I am about to tell is something far worse.

A Perceived Snub

I ambled with squirrels and rabbits on an urban trail overflowing with chaparral and mossy oak. Early morning bird chatter, drone of bugs in rays of sun, and the crackle of underbrush beneath my feet kept me company. My thoughts wandered brisk as the sound of river water on rock.

A man wearing a holey T-shirt and sweatpants approached me, accompanied by a large German Shepherd. The dog was off leash but seemed friendly. The man had a vacant stare, and as I passed him I gave a perfunctory smile and “Good morning.”

He didn’t even note my existence nor change his faraway gaze, and I immediately snickered at his lack of basic human decency. Shaking my head, I glanced back at him. He had stopped, looking up at the cloud-threshed sky, and suddenly emitted an unearthly wail.

Nurse Ratched, Nurse Lillian

The movie, One Flew Over the Cuckoo's Nest, became popular the year I was working on my hospital's med/surg psych ward as a nursing student. While this cult classic raised awareness about injustices in mental institutions, the public assumed all administrative nurses were cut from the same cloth as the film's RN whose name rhymed with wretched. On more than one occasion, I had to restrain myself when someone said, "Bet you're Nurse Ratched, ha, ha, ha. Only kidding."

Better Is Still an Option

Ella was a surprise sent to me by a geriatrician for osteopathic manipulation (OMT). With knees and back stiffened by osteoarthritis, Ella had found that chiropractic care and her walker kept her mobile enough to get out to family events and church activities. Now she could no longer afford chiropractic care, but visits with me--her family physician--would be covered.

I've Never Been a Mother Before

At thirty-six, I had my first child. Up until then, my focus was on my career to become an ob/gyn physician.

During my pregnancy, I chose a doctor and hospital that were not affliated with my hospital. I wanted to be a patient, not a doctor who happened to be pregnant. I ended up having a scheduled C-section; my child was breech, and no amount of encouragement would change that. 

As soon as my OB walked into the operating room, he loudly announced, “She is an OB too!” And, in an instant, the cat was out of the bag. No longer could I be anonymous. 

A Life Lived in Spite of Everything

I was called to the NICU to see a baby who had just born with hydrocephalus. The CT scan showed he had Dandy-Walker syndrome. His teenage parents were told he would be severely handicapped, so they refused permission for a shunt and wanted him to die. The NICU staff was horrified and asked me (the neurologist), "They can't really do that, can they?" I said no they can't, and immediately called the hospital lawyer. She brought a judge into the NICU who agreed, obtained legal custody and assigned guardianship to a local advocacy agency. The new guardian authorized the shunt which worked well. The boy was discharged into foster care and eventually adopted.

But then it got really interesting. Yes, he had Dandy-Walker syndrome and hydrocephalus, but he was developing normally!

Chief Complaint: Not Always What You Assume

If I did not ask, I would have assumed regaining muscle control was the "chief complaint" of the young man I was caring for during my brain injury elective. He was an active college student up until a few months ago when a tragic accident left him wheelchair-bound and dependent on nursing staff for even the smallest of tasks. 
The first time we met, he introduced himself to me through a laminated copy of the alphabet. Spelling out his name took some time, due to the severe spasticity that still engulfed his musculoskeletal system, but it was his only means of communication due to the loss of control of his vocal cords. 
"I am here to join your care team," I had told him. "I want to help you work on facing your biggest problem right now. Can you tell me what that is?"

The Warrior

When I first met my future sister-in-law—I was fifteen, she was seventeen—I assumed that her life was perfect. She was pretty, perky and popular—everything I was not. She was dating my brother, a medical school student, while I had never been on a date. I just knew her life would be a fairy tale with a happily-ever-after ending.

To Chemotherapy--Or Not!

I had breast cancer twice. My first time I made an educated choice not to start aromatase inhibitors (AIs). With early stage premenopausal cancer, overall survival rates were the same, on or off AIs. (There is 13% increased chance of reoccurrence off AIs). I chose survival rates and lifestyle. I am very active and wanted to avoid muscle and joint aches, osteoporosis and possible diabetes.  

I felt like I was in Vegas, spinning in Russian Roulette. I chose the wrong number and lost. Two years later, I grew another breast cancer on the same side, in breast tissue remaining after my mastectomy. Now there were two metastases in axillary lymph nodes. My survival rates markedly declined. I had difficult choices to try to improve my odds. 

An Editor's Invitation: Making Assumptions

As a physician, I make assumptions all the time.
When a child or teenager presents to me with chest pain, I assume that the pain is not being caused by heart disease--the thing that they or their parent are most worried about.
Yes, I do my due diligence to confirm that assumption. But that snap judgment occurs as quickly as the words "chest pain" are out of a youngster's mouth.

Reflections on Ageism

As a pre-med student, I volunteered in the emergency department of a local hospital, and I also worked as a personal trainer for MacWheelers, an exercise program for adults with spinal cord injury. Looking back, I now realize how often I made wrong assumptions about elderly patients I cared for. I assumed they were too weak and fragile for simple tasks. As a personal trainer, I was overly restrictive on which equipment they could use and the types of movements they could safely perform.


My first memory is of me asking my mother about the man trapped behind the glass of the picture frame that lived amongst the gods in my grandmother’s temple. I learned that he was my grandfather, and that he stopped breathing to go to a better place. I didn’t understand why he didn’t love my grandmother enough to take her along.