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Medicine by the Books
Brrring!
The landline in my call room trills, jolting me awake. I have a consult. I’m a third-year medical student on my internal-medicine rotation. This is my second overnight call and second week of clerkship.
“Hi, Keith!” the caffeinated resident chirps. “I have a consult for you!”
The patient is Ms. Carrera: a young woman with a history of diabetes, renal disease and a recent heart attack. She’s here because her legs hurt. Cardiology and nephrology have no explanation, so they called internal medicine—and by extension, me. My shoulders slump.
Holding Out Hope
In my twelve years as an American family doctor working in low-resource countries in the Middle East, I’ve seen and treated countless patients with little to no hope for improvement in their physical and emotional problems. Seeing patients in these circumstances is emotionally exhausting, but the importance of my role in supporting these patients continues to draw me back in.
Reflecting on the challenges they face, I often think of one in particular: a baby named Hiba.
Hiba’s mother, Layla, had received very little prenatal care during her pregnancy, as is common among poor, rural patients in low-income countries. She’d suffered from several prenatal complications, and Hiba was born via an emergency cesarean section.
Hiba’s condition was precarious.
After the Fall: What Happened Next
I live in a small town on the River Tay in Eastern Ontario. One day, I was exercising at the gym with my husband, Yogi.
I’d just finished my first leg-machine exercise. As I reached for the grungy logbook, the floor suddenly reeled out from under me.
Am I fainting?
I lurched to sit down.
“It’s okay, I’m fine!” I assured those around me. But my sudden disorientation screamed that I was not.
Wounded Souls, a Broken System and Me
I became a psychologist because I wanted to be a healer.
At twenty-five, I believed I could save lives through therapy alone—reach into the chaos of psychosis, pull people back with presence and insight and bring them home to themselves. Not with medication. Not with systems. Just one mind in conversation with another. I’d read the stories—Frieda Fromm-Reichmann, Harold Searles, Otto Will. I believed in that kind of power.
Thirty years later, in 1998, I emerged from a Christmas party on Lafayette Street, blinking in the cold, the voices of managed-care executives echoing in my ears.
“Hello, It’s Your Electronic Medical Record Calling”
I’m sitting in the waiting room at my hematologist’s office. Today is bone-marrow biopsy day—the day a drill will penetrate my hip bone to extract a sample.
The road to this moment began several months ago with a routine blood test at my annual exam. The test showed an abnormally high count for one type of blood cell. I was referred to a hematologist for further evaluation. The referral surprised me, but I wasn’t worried—yet.
I endured several more tests to rule out some conditions; however, my hematologist, Dr. Fawcett, has suggested that we move forward with the bone-marrow biopsy to get the full picture.
A Different Kind of Emergency
Curled on a gurney beneath the fluorescent glare of the hospital room lights, a girl no more than eight clutched a stuffed giraffe. Her small frame, the slight downward tilt of her eyes, and her delicate jaw and thin upper lip were the visible signs of fetal alcohol syndrome.
This was Elle, whom I encountered as a medical student during an emergency-medicine rotation.
Dialyzing in a War Zone
I was born and raised in the city of Hebron in the West Bank, the part of historic Palestine that is governed by the Palestinian Authority. I recently graduated from Hebron University School of Medicine, established in 2019. Here is a brief description of what it’s been like to study medicine here over the past six years.
To many, the existence of a medical school in Hebron comes as a surprise. Yet, under the shadow of military occupation and adversity, our education continues—demanding, unyielding and intimately tied to the realities that shape our lives.
Thank You, Betty
It’s dark outside. I get out of the car and rush into the emergency department. I’m a fourth-year medical student, and this is my last shift here.
I walk in, place my coffee on the table—dangerously close to the keyboard—and open up the electronic medical record. I’m surprised to see that there isn’t much going on. Just one new patient—a woman with some back pain.
Great, another lumbar pain–probably muscle strain, I think. I’ll give her some acetaminophen and a lidocaine patch. That ought to do the trick. It usually does.
Choosing to Believe
“We got into a fight last night,” Maria said, more to herself than to me, her fingers tracing invisible patterns on her jeans.
“About what?” I asked.
“I told Louis, ‘God doesn’t exist—because if God did exist, why would this be happening to you?’ ” she answered.
She stood and started pacing the hospital room where her son, fifteen, had spent the past two weeks.