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Doing the Math

“I can’t do it—I’ll die!”

Veronica is in tears.

I’m a family physician, working in a pain-management clinic in the Bronx. As Veronica’s doctor, I’ve asked her to see me to discuss coming off her opioid medications. It’s part of a clinic-wide initiative to reassess using these medications long-term with patients who have chronic pain.

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Migraine

It’s not the heart that gathers all the pain
of our life, it’s the head;
burning head, cremating all my movements
forcing me to fake that I exist:

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Back Pain

Back Pain

A 77-year-old woman presents with back pain.
No trauma. No radiation. No red flags.
ROS* otherwise surprisingly negative.
Her exam is unremarkable, actually pretty darn good.
FROM, negative SLR, full distal strength, sensation and DTRs.*
After the usual cautions I reassure her,
prescribe activity, no meds and the tincture of time.
She is fine with that, appreciative and pleasant.
Then she says, “Should I

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King of Pain

King of Pain

I am a retired union plumber with the state of Illinois. I’ve had laparoscopic surgery on both knees, a lower back surgery that required two stainless rods and I’m not sure how many screws, and three cervical fusions. I now suffer from neuropathy (nerve dysfunction) in my feet. They’re painfully numb: A shoe could come off, and I wouldn’t know it. I find it difficult to get around–not to mention embarrassing when I go back

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Complainer

Christina Phillips

The patient, age forty-nine, complained of abdominal pain. She was taking both slow- and fast-acting oxycodone to manage the pain, and she also took antidepressants and a sleeping aid. She’d come to the hospital several times in the past year, always with the same complaint. This time, not feeling well enough to drive, she’d come by taxi. The veins in her arms were small, threadlike and collapsed, like those of a ninety-year-old

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What If I Die Now?

 
The mood was grim in our house on this night, as it always was when my mother was at her sickest. My mother was suffering at the hands of what I know now to be systemic rheumatoid arthritis: the pain was clearly eating up her soul and body alike.
I looked at her as I helped with her evening pills, hoping they would bring some magic to lift the cloud hanging above us. I

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Overkill

Daniel Lee

Primum non nocere. First, do no harm.

I learned that in the first year of medical school. “Nonmaleficence” is the fancy name given to this sentiment, and it’s one of the four pillars of modern bioethics. In real life, it’s an impossible standard: We harm patients all the time. But the spirit behind the principle is what matters. Do the least possible harm to patients as they go through the medical system.

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Pain

Ronna Edelstein

When my friend Madeline turned seventy, she celebrated in a big way: She walked a half-marathon; she hosted a cabaret for family and friends at which she sang and told stories; she traveled to China. Now, six years later, this dynamic woman has become a virtual prisoner in her apartment. She has undergone back surgery, suffered a nearly fatal intestinal infection and, after a fall, had bolts and screws placed in her

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Giving Blood–and Other Acts of Courage

Liz Witherell

I donated blood today. I’m one of those people who doesn’t shudder at the thought of needles piercing my skin, or get queasy as I watch the blood drain from my vein into the collection bag. It’s no big deal. I eat the cookies and drink the juice afterwards, and I kind of enjoy talking with the elderly volunteers.

I think I’m lucky. I know so many people who are sickened

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Teaching the Wound

Joanne M. Clarkson

                    For LS

Assume pain, I tell them, the young, the
minimum-waged, those who work the midnight
shift with no chance for stars. We lean
over the bed of a 93-year-old man with advanced
Parkinson’s disease. His face is
frozen, even his eyes don’t seem to move
unless you watch the sheen. These

student aides are

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