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Things That Matter

Paul Gross

For me, the best part of being a doctor, and the biggest privilege, is getting to talk with people about things that matter.

“You look sad today,” I say to a patient I’m seeing for the first time–a thirty-eight-year-old woman with a headache. In response, her lower lip starts to tremble, and she wipes an eye.

As I reach for the box of tissues and hand it to her, I know that whatever has caused her tears will be more important than her presenting symptom.

A forty-five-year-old man comes in wanting help sustaining erections. When I ask for a few details, it turns out he’s having sex every single day of the week, and he’s finding it a challenge to maintain an erection for twenty to thirty minutes. When he misses a day, he has sex twice the next day “to catch up.” He has relations with his wife and also with a girlfriend who lives out of town, where he often travels on business.

Should I laugh? Let my eyes pop out of my head? Wag a finger?

Because I cherish the talking and like to think that I’m skilled at it, it’s all the more comical when I end up with egg on my face:

In the course of a visit, I learn that a nineteen-year-old is having sexual relations with her steady male partner.

“Are you using birth control?” I ask


“Do you want to become pregnant?” I ask. “Are you ready to become a parent?”

“I’m not sure,” she answers.

In violation of my own rule about never lecturing patients, I proceed to give a lecture. Or maybe it’s two lectures–about the likelihood of pregnancy, about the impact of an unplanned child on her life. Blah-blah-blah.

She listens politely.

Later in the conversation, I discover that her boyfriend uses condoms. Always. And that his using condoms, in her mind, doesn’t equate with her using birth control.

Oh, lord, I not only missed the boat, I also got on the wrong bus.

Two-and-a-half years ago we launched Pulse with the idea of creating a safe space where all of us–patients, clinicians, caregivers and students–could talk about things that matter. About events that have marked us. About words that have healed or wounded us. About our triumphs and pratfalls.

And now, 5,700 subscribers and 130 issues later, here we are–a little older and wiser, and still talking about things that matter.

As 2010 draws to a close, I’d like to thank you for your readership and to highlight three events from the past year:

(1) On May 5 I received an e-mail from Don Berwick, founder of IHI (the Institute for Healthcare Improvement) and President Obama’s nominee to head Medicare and Medicaid Services. I knew that Dr. Berwick was a Pulse reader, and now that he was becoming famous, I’d e-mailed him to ask: Do you still read Pulse? And, if so, could we use your name in our modest promotional efforts?

He responded as follows:

I don’t just read Pulse, Paul–I adore it. My daughter is a medical student, and I got her to sign up. The supply of compelling, often poetic accounts is the best around. It is a fabulous resource, and, yes, you can say I say so.

(2) Another heartfelt endorsement arrived on November 24 in the form of a JAMA book review by noted physician-author Perri Klass. The subject: Pulse: The First Year, a twelve-month collection of stories and poems beginning with Pulse‘s launch issue: 

All of the stories in this book…are told with a kind of urgency; these encounters change lives and mark memories. This collection is in some sense about writing for one’s life, making prose and poetry out of the examination room, the hospital ward, the frantic telephone call…

In this book, these moments are transformed into finished pieces of high quality, reflecting the care that has been taken in shaping the writing–but they are still real, close to the narrators, and most of the pieces evince an immediacy apparent from the very first lines.

(3) While we’ve run many wonderful stories and poems this year–a list of my personal favorites would be a long one–there was one story that resonated with particular force among Pulse readers and around the Internet.

Babel: The Voices of a Medical Trauma is pediatrician Tricia Pil’s searing account of her childbirth experience. Tricia’s story drew more comments than any other story we’ve run, comments themselves stunning for their empathy and compassion:

This amazingly lucid and heartbreaking piece gets at the core of so much that’s broken about health care…

Tricia’s stunning piece had been rejected, sometimes dismissively, by a number of mainstream medical journals before colleagues encouraged her to submit it to Pulse. We were thrilled to bring her story to light–a story that meant so much to us and to so many readers.

I hope that the arrival of Pulse each Friday has mattered to you over the past year. Rest assured that your appreciation has mattered deeply to us.

If Pulse does make a difference to you, we thought that you might like to share Pulse–this little gem we create together–as a year-end gift to a colleague or friend. For a brief time, and at no charge, you can actually give someone a subscription rather than a mere invitation to subscribe. Click on this Give Pulse to Someone link–and you can subscribe anyone you like. Each recipient will receive immediate notification via e-mail–you can even inscribe a message–and the first issue of Pulse will arrive the next Friday. (If your intended recipient already subscribes, don’t worry; we won’t send duplicate issues.)

If you decide that a book–Pulse: The First Year–would make a more fitting gift, click on the link to order from our distributor. (Amazon is currently out of stock, but we have a ready supply.) Our discounted price is $15.99 plus $2 for shipping.

As the year draws to a close, we at Pulse thank you for taking this journey with us–and for sharing and reading stories and poems that matter. We wish you the best this holiday season and good health for 2011!


Paul Gross MD

as edited by…

Diane Guernsey
Executive Editor


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