Tyrek’s mother and I must have spoken for two hours in the Pediatric Intensive Care Unit, covering every topic but the one that was glaring at us: death. A fourteen-month-old child is not supposed to die–and even though I knew the situation was dire, I couldn’t bring myself to face it. So I excused myself, sat down with her son’s chart and stared blankly at it.
I first met Tyrek and his parents when he was just three months old. Tyrek had Down syndrome, clubbed feet and a large sternal scar on his chest from surgery to repair a complicated heart defect. Despite his bad luck, Tyrek’s most impressive characteristic was his cheery disposition. His mother was a tall
Movement disorders can be horrifying. Afflicted persons are solidified or contorted. They may flail so violently that a fork endangers their lives. As a beginning neurologist, I assumed that all such patients curse their fate. Once I got to know Brian, though, I realized that I could be wrong.
Brian and one of his brothers had inherited Wilson’s disease, a rare, genetic movement disorder that had spared their eight siblings.
People who have Wilson’s disease can’t handle dietary copper properly. It accumulates in–and poisons–the kidneys, liver and brain. Avoiding foods rich in copper does not halt the progression of the disease, but it helps. If patients are also treated early and consistently with a drug such as penicillamine, which
It was a quiet knock on my door that morning. So quiet, in fact, that I wondered if I was dreaming. Maybe if I went back to sleep it would go away.
Nope. There it was again: soft but persistent. This time I knew that it really was a knock, and it really was on the front door of my one-room cabin. What I didn’t know was that I’d be hearing that knock for the rest of my life.
I got up, tired and rumpled, and pulled open the door. A young woman I’d never seen before stood there, barefoot and wearing the simple white linen dress of the campesina (as a woman who works the land is called in rural
By the time Mrs. Zhang came to see me, her headache, left-sided weakness and facial numbness were two weeks old. Like many Chinese immigrants in this country, she’d hesitated to seek medical care because of language and cultural barriers and her apprehensiveness about Western medicine. In fact, she hadn’t seen a physician in the ten years since she and her husband had come to America. Only after a friend told her about me, the sole Chinese primary-care physician in a small Pennsylvania town, did she and her husband come to see me.
Mr. and Mrs. Zhang struck me as a typical older Chinese couple. With smiles on their faces, they bowed repeatedly to everyone in
Roger looked up at me over the oxygen mask, his eyes drawn wide by the sores stretching his face. He lifted a hand for me to take.
“I’m glad you’re here,” Jen had said before I’d entered his room. “They’ve taken him off a lot of the medication. He’s very lucid, but he’s depressed and scared.”
The previous fall, Roger and Jen had begun couples therapy with me. They were both thirty-two and had been together for ten years. Three years before they came to me, Roger had been diagnosed with leukemia. A bone-marrow transplant had left him cancer-free, but his prognosis was guarded. He and Jen argued frequently, his desire for independence clashing with her insistence on managing
It all begins one Sunday morning when Mrs. Morris, a 75-year-old retiree with a heart condition, trips on her way out of church. She falls flat on the sidewalk, can’t get up, and ends up in our Bronx emergency room. A CT scan shows a pelvic fracture, and she’s admitted to our inpatient team.
When I join the family medicine residents to see Mrs. Morris the following day, she can’t get out of bed. She’s got short, unruly white hair and a gee-whiz expression that charms us. “What a pain!” she says. Given how close she lives to the brink–terrible circulation has cost her one heart attack and several toe amputations–I’m impressed with her good cheer.
Things looks promising. Follow-up
His history was Dickensian. As a little boy, born with an IQ of about 80 and a wandersome nature, he’d toppled onto the train tracks and gotten run over. How he didn’t die is a mystery–this was more than fifty years ago, and he lost both legs up to his hips–but live he did.
I met him in the hospital, where he’d had surgery on the pressure sores that came from long hours perched in a wheelchair. When I asked him to roll over so I could see, he hoisted his whole body (200 pounds without legs!) out of the bed via the orthopedic trapeze. His arms were massively strong, his disposition was sweet, and he spoke and behaved
John G. Scott
“Dr. Scott, this is Dr. Font.” The call came from my mother’s cardiologist as I was about to see my first patient of the morning. “Your mother is worse. You’d better come as soon as you can. I don’t think she’ll survive the day.” Those blunt words shattered my denial: I had convinced myself that it was possible to fix the cumulative, lifelong damage wreaked on my mother’s heart by her atrial septal defect, a congenital condition.
I thought back to the time, weeks earlier, when I’d gone to visit my parents. The vibrant, life-loving, intellectually engaged woman I knew so well was beaten down by her illness. Pain clouded her eyes and lined her face. I could
My practice is in a small rural Wisconsin town just down the road from a large military base. I see soldiers pretty regularly these days; they stay here for several weeks of pre-deployment training before shipping off to Iraq. They come from all over the country–men and women of various ages, some single, some married and with families. Their health-care needs aren’t too different from those of my civilian patients: maternity care, chronic illness management and the usual scrapes and bruises. I like having them on my schedule; their Boston accents and Georgia drawls make a pleasant change from my neighbors’ familiar, made-for-radio Midwestern monotone.
I don’t dwell much on what these soldiers do for a living. I do