Page 233 – Pulse

Physician, Heal Thyself

Leave a Comment / Stories / Randy Rockney

Randy Rockney

After a long day’s work as a pediatrician at an academic medical center in Providence, RI, nothing says “relief” like a visit to my therapist. I don’t see him often, but he has helped me through many life transitions. I think we both agree with the Buddhist precept that the only constant in life is change.

One evening after work, a couple of years ago, I arrived early in the neighborhood of my therapist’s office. I was hungry, but there wasn’t time for a meal, so I stopped at a pharmacy to peruse the snack aisle. The smallest and cheapest option available, a bag of roasted pumpkin seeds, seemed perfect.

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What You Were Wearing

Common Thread

Leave a Comment / Stories / Peter de Schweinitz

Peter de Schweinitz

One sunny afternoon during my fourth year of medical school, I spent a day assisting a New Yorker turned rural Southern podiatrist. As we whittled dead skin, checked pulses and scheduled minor procedures, an arrogant question formed in my mind: Why did you choose the feet instead of something more impressive, like the heart?

Maybe he read my mind. Later, seeing me off to my car, he said, “I know that you medical doctors could do my job. I’m here so that you can do more important things.”

At the time, I didn’t know whether to pity his lack of aspiration or admire his humility. But a year later, when I was a primary-care intern, something happened that changed my perspective.

A patient I’d not met before, Carrie, had come for a post-operative wound infection on her ankle. This was the type of visit that irritated me–cleaning up for the specialist.

Sitting on a chair in the exam room was a slender, sophisticated-looking young woman with short-cropped hair, sleekly manicured nails and horn-rimmed glasses. Normally, I would have asked her to hop

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The Silent Treatment

1 Comment / Stories / Frances Smalkowski

Frances Smalkowski

Last year, while enjoying a two-week tour of the cultural capitals of China, I was amazed by how at home I felt. Searching my memory for the reasons behind this unexpected state of mind, I suddenly remembered Mr. Loy.

We met more than forty years ago. I was in my third year as a nursing student, doing a semester-long rotation in a large psychiatric hospital. Each student was assigned a patient for the semester, and Mr. Loy was mine.

We were expected to forge a therapeutic relationship with our patients. This was a tall order; most of our patients were diagnosed with some form of persistent schizophrenia, and few spoke in any coherent fashion, if they spoke at all.

Mr. Loy was no exception. A short man in his late sixties with raggedly balding hair, he made frequent references to “the machine on my head.” His bald spots marked his attempts to remove the machine. The machine, he said, had commanded him to kill his son. Because he’d actually tried to do so, using a large knife, he’d been hospitalized as criminally insane.

Before our first meeting, I read Mr. Loy’s medical history. Thanks to the psychiatric nursing

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Restricted Parking

Fifty Minutes

Leave a Comment / Stories / Elizabeth Tyson-Smith

Elizabeth Tyson-Smith

“I know it will kill me,” my patient Jan says calmly.

We sit in my office looking out on the river below, which glints in the fall sunshine. It is a warm day for November. Jan has just learned that her breast cancer has spread to more internal organs.

Her doctors have told her that she will not recover.

I–who have had breast cancer twice–cringe inside. Jan’s blue eyes fix on mine, but she expresses no emotion at all.

In 1990 a routine mammogram showed a bright white constellation in my breast. The biopsy was positive. I heard four words: “You have breast cancer.” I was forty-eight; I was certain it would kill me.

Jan is forty-five, married, with two young children. Although she’s been living with metastatic breast cancer for three years, her main focus in our sessions is not her cancer. When we discuss how hard it is to lose other members in her support group, she doesn’t mention herself in that context. She shows despair only when speaking about her children and how horrible it will be when they

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Closing up the Cabin

1 Comment / Stories / Robin Schoenthaler

Robin Schoenthaler

I met Burt the Monday before Labor Day. As I walked into the room, he stood up–a sturdy, fifty-three-year-old guy with a direct, sky-blue gaze. Although he was a little etched around the eyes, he mostly looked the picture of health.

Two years before, he’d had a cancer. It was treated and thought to be gone. But for several weeks now, he’d been having excruciating low-back pain; he rated it a ten out of ten. The day before, a new CT scan had revealed that his original tumor had spread to his liver and bones. A spiderweb of tumor damage in his spine was the cause of his pain.

If I were a layperson or if this were my brother, I’d be hysterical. But I’m a radiation oncologist (a doctor who gives radiation to cancer patients), and this was my patient. I’d seen this kind of thing before, and I felt hopeful that radiation could help.

During our visit, I spoke frankly but moved slowly, trying to both honor the situation and help the family cope with the nightmare Burt now faced:

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Elixir of Love

Soon

1 Comment / Stories / Stacy Nigliazzo

“Wake up, Eli,” I whisper, tapping his collarbone. “I need to re-check your blood pressure.”

“Aw, come on, doll,” he snickers. “A man can’t snore if he’s dead. Ain’t that good enough?”

“No, sir,” I reply. “I need numbers.”

It’s two a.m. I’m seven hours into a sixteen-hour shift in the emergency department of a busy city hospital, running five rooms in the “sick but stable” section with Dr. Watts.

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Sick and Tired

Leave a Comment / Stories / Paul Rousseau

Paul Rousseau

“You told me you’re tired–tired of all the transfusions, and tired of being sick. Do you want to stop all the transfusions, Nancy?” I asked the woman lying in the hospital bed.

She was silent. Her husband of nineteen years, sitting nearby, was silent as well.

“What are you thinking, Nancy, can you tell me?” I asked.

Nancy, forty-eight, was suffering from chronic muscle inflammation, severe lung disease, pneumonia and–most severely–from terminal myelodysplastic syndrome (MDS), a blood and bone-marrow disease for which she had to receive transfusions of platelets and red blood cells every other day.

Fed up with the transfusions, she’d asked to speak with the hospital’s palliative-care doctor–me–for help in rummaging through her various treatment options. In fact, these were limited to two: to continue the transfusions, or to stop.

But without the transfusions, Nancy would likely die within a few days.

I was finding it extremely difficult to counsel her. For one thing, she looked so alert and vibrant–not nearly as sick as she really was. The only overt evidence of disease was the bruising on her arms and

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Job Loss

Leave a Comment / Poems / Risa Denenberg

Risa Denenberg

I’m no longer part of this operation.
I skulk back into hospital to hand over my name badge–
worn every workday for 12 years. Messy shame shines
on my face like spinach stuck between incisors.
It’s noon, people jam every hall, every sluggish line,
there are no smiles for me. I don’t want to meet the gaze
of anyone I know.

I reflect upon peaceable Christmas shifts,
ham and mashed potatoes in the cafeteria, 3 AM.
Passing comrades in corridors, news matters
only to the extent it might toss a tragedy
onto our shore. Ours is no longer
the operative concept.

Task done, on to another line to return my dog-eared
parking pass. Next stop, cashier, five dollar refund.
Finally in my car, I lean out the window,
and hand the voucher to a parking attendant.
I am holding back tears now. Damn, I’ll miss this place.
Take care, he says. First kind words all day.

About the poet:

Risa Denenberg is an aging hippie currently living in Tacoma, Washington. She earns her keep as a nurse practitioner and freelance medical writer. Recent poems with health-related

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Healing Words

1 Comment / Stories / Gretchen Winter

Gretchen Winter

As a physician-in-training, I find joy in helping to ease pain and occasionally cure illness. But I often find my greatest sense of purpose in helping patients to heal emotionally, whether by allaying a patient’s fears, addressing a lingering concern or lending a listening ear.

Having majored in communications in college, I’d assumed that the patient-physician relationship would be the easy part of medicine. I’ve learned, though, that getting it right isn’t always easy.

An encounter with a patient named Mary Collins brought this lesson home to me.

As a third-year medical student, just finishing the third week of my family medicine clerkship at a community health center, I was starting to feel competent at performing the basic history and exam.

It was a Friday afternoon, and Ms. Collins was my last patient of the day. She was a timid-looking woman of forty-three, clad in loose jeans and a T-shirt.

Steadily, I worked through the requisite questions: “Do you have any chest pain?…Do you get blurry vision with your headaches?”

When Ms. Collins said that she had a buzzing noise in her ear, my mind began ticking off the possible diagnoses: presbycusis (age-related hearing loss); Meniere’s disease (an

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