Page 233 – Pulse

What About Bob?

Leave a Comment / Stories / Joseph Fennelly

Joseph Fennelly

The time: early one morning, thirty years ago.

The place: my local hospital.

At this point, I have been an internist for twenty years. I’ve just entered the cardiac care unit, where my patient Bob, a ninety-five-year-old man with advanced senility, has been brought because he’s having chest pain.

As I step through the door, Bob codes. The young residents and staff swing into action, rushing the crash cart over to his bed.

Quickly, I jump between them and Bob.

“Don’t resuscitate him!” I shout.

Looking stunned, they eye me as I stand there with folded arms, making myself into a human shield.

Bob lies motionless, not breathing, his monitor registering occasional spontaneous heartbeats.

Suddenly it hits me: I need to see the situation through these young residents’ eyes. After all, isn’t this a patient in the cardiac care unit? Aren’t his monitors signaling a heartbeat? And isn’t their duty to protect life?

To help them understand why I’ve staged this aggressive assault on their training in high-tech medicine, I must help them to understand Bob. They need to know this gentle, » Continue Reading.

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Cold Comfort

Leave a Comment / Stories / Mary T. Shannon

Mary T. Shannon

Leaning against the hospital bed’s cold metal rails, I gazed down at my husband lying flat on his back. Under the harsh fluorescent ceiling lights, his olive skin looked almost as pale as mine.

We’d been in the outpatient unit since 6:00 am for what was supposedly a simple procedure–a right-heart catheterization to assess the blood pressure in John’s pulmonary arteries. Now it was 3:00 in the afternoon.

Before we’d arrived that morning, John had seen the procedure as a chance to take a day off from the clinic where he practices internal medicine.

“I think I’ll go out this afternoon and hit a bucket of balls,” he’d said as we drove to the hospital. “My procedure shouldn’t take that long.”

“Are you sure you’ll be up to golfing afterward?” I’d asked.

“Right-heart catheterization is a simple outpatient procedure,” he’d answered, as if talking to one of his patients. “The pulmonary artery pressure will probably be somewhat elevated, just like the echo showed, and then the pulmonologist will decide if I need another medication, that’s all.”

After thirty years of marriage,

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In Line at the Hospital Coffee Stand

Leave a Comment / Poems / Tabor Flickinger

Tabor Flickinger

At the coffee stand as always getting tea,
so always that the ladies see my weary face
and start the water steaming without words.

I hover there with others waiting think through labs to check
imaging to glance at does he have pneumonia or pulmonary edema
has social work found her a nursing home will his family want a feeding
tube despite his end-stage dementia did I order cytology on that peritoneal
fluid when will I next see the sun it’s so

“Oh, did you take care of him before? He’s dead.”

unnatural in here fluorescent
now where was I peritoneal fluid hey I wonder who is dead

“Yes, I heard. We all had him at some point.
He was in the hospital every few weeks for his heart and renal
failure. What happened?”

“He didn’t want to suffer anymore. Had us turn off his defibrillator.
Stop dialysis. Arrhythmia. Likely hyperkalemia.”

I know the man they mean without names.
I took care of him before. He’s dead.

His heart pumped ten percent it couldn’t keep fluid out
of his lungs and felt like drowning sometimes better after
dialysis but he hated the fistula in the arm that got

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Gentle Men

The Hallway

Leave a Comment / Poems / Colleen T. Fogarty

Colleen Fogarty

Sitting here, waiting to teach a medical student.

My eyes lock
onto the windowed display cabinet of anatomic pathology specimens.

Aging bottles of shriveled dun-colored parts, pale reminders of bodies once vital.

My thoughts drift
my rib pain, localized, continuous, nagging.
my breast cancer, localized, excised, treated…just over a year ago.

What pains my rib?

Mets?
Muscles?

These tumor specimens cut too close.

I got my daughter to kindergarten; what about sixth grade?

About the poet:

Colleen Fogarty, an associate professor in the University of Rochester Department of Family Medicine, has dabbled in poetry and prose most of her life. Medical school temporarily killed her creative muse. In the years since residency, she has published creative work in Health Affairs, The Journal of Family Practice, Family Medicine and Medical Humanities. She practices and teaches writing fifty-five-word stories with colleagues and residents and edits the “55-Word Stories” column for Families, Systems, and Health.

About the poem:

“This poem is about an experience during a teaching session that brought me,

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Mother And Son

Leave a Comment / Stories / Adnan Hussain

Adnan Hussain

I judge. Even though I’m not supposed to, even though I try my best to stop myself, I still judge. Fundamentally, I guess, I’m a creature of habit, caught up in an endless current of seemingly instinctive behaviors. As a first-year medical resident, I sometimes feel acutely aware of this in my dealings with patients.

I stand at the bedside of Sharon Weathers, an unassuming woman in her mid-thirties for whom I’ve been caring over the past few days. She was admitted with excruciating abdominal pain that has proven resistant to our attempts at pain management. Each morning, I visit her to ask, “How did you sleep? On a scale of one to ten, how would you rate your pain?” And each morning, I feel a pang of suspicion–near-certainty, actually–that her pain is mostly a calculated attempt to get us to give her ever-higher doses of morphine.

This morning, Sharon looks as if she just woke up, her tangled blonde hair falling haphazardly across her face. As she struggles to sit up, I’m struck by how incongruous the cheerful polka-dot hospital gown looks on her tough-looking physique.

Sharon looks strong; she has the aura of a battle-hardened gladiator.

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Stepping Into Power, Shedding Your White Coat: Donald Berwick’s Graduation Address

2 Comments / Stories / Donald Berwick

Donald Berwick

Editor’s Note: Donald Berwick, recent Administrator of the Centers for Medicare and Medicaid Services in the Obama Administration, and a founder of the Institute for Healthcare Improvement, gave this speech at his daughter’s graduation from Yale Medical School on May 24, 2010.

Dean Alpern, Faculty, Families, Friends and Honored Graduates…

I don’t have words enough to express my gratitude for the chance to speak with you on your special day. It would be a pleasure and honor at any graduation ceremony. But, I have to tell you, to be up here in this role in the presence of my own daughter on the day that she becomes a doctor is a joy I wouldn’t dare have dreamed up. I hope that each of you will someday have the chance to feel as much gratitude and pride and love as I feel right now, joining you, and, especially, joining Jessica. Thank you very much. I am so proud of you, Jessica.

Now, I have to tell you the truth about Jessica. Jessica was supposed to be a boy. At least that’s what the ultrasonographer said when we took a look at “him” in utero. “Never been wrong,” said the ultrasound

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Catching Chickens

Leave a Comment / Poems / Daniel Klawitter

Daniel Klawitter

Morphine doesn’t do much for dementia.

I know this because my grandmother

was trying to catch an imaginary chicken

on her deathbed.

Wanting to calm her fevered thrashing,

my sister cleverly said: “It’s okay grandma.

I caught the chicken for you.

You can rest now.”

But my grandmother’s faded blue eyes

suddenly sprang wide open, and fixing my surprised

sister with a stern and lucid glare, declared:

“No you did NOT!”

And I’m still uncertain which came first:

our nervous laughter or the shock of her clarity,

so unexpected, we almost died.

I guess we all have to catch our own chickens,

before we cross the road and reach that other side.

About the poet:

Daniel Klawitter is an ordained deacon in the United Methodist Church and lives in Denver, CO, with his wife and three cats. He has a BA in Religion Studies from the College of Santa Fe, NM, and a Master of Divinity degree from Iliff School of Theology, in Denver. His poetry has appeared in numerous literary journals, including Sacramental Life, Blue Collar Review, Cyclamens and Swords, The Penwood Review and Catching Chickens Read More »

Epiphany

Leave a Comment / Stories / George Saj

George Saj

It happened one wintry night in 1965. I was in my third year of medical school during a rotation on the pulmonary service.

My supervising intern had been busy all evening admitting a dozen people in various stages of respiratory distress; they were suffering from ailments ranging from flu to double pneumonia.

It was my job to collect each patient’s sputum and culture it on a Petri dish, which would take several days to grow out. I also prepared stained slides of each sample. We did this in hopes of being able to visually identify the offending bacteria, so that we could speedily administer the appropriate antibiotic.

This was painstaking work: the intern and I had to repeatedly re-check the patients who weren’t improving. Every few hours, we’d return to listen to their chests, assessing the progression of their pneumonia. Then we’d check our findings against X-ray pictures, adjust their antibiotics, collect and look at their sputum specimens again, and wait for them to get better.

Slowly, most did. But I found the testing and re-testing tedious and unsatisfactory, as its results were incremental, subjective, often subtle and hard to measure.

At

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What is Pulse?

Leave a Comment / Uncategorised / Paul Gross

Every Friday, Pulse–voices from the heart of medicine publishes and distributes a first-person story or poem, together with a visual image or haiku, about health care.

Launched in 2008, Pulse was created by members of the Department of Family and Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine in collaboration with colleagues and friends around the country.

At a time when the pioneering work of Rita Charon has established the value of narrative medicine–an approach that places a premium on personal perspectives within a healthcare encounter–Pulse makes narrative medicine available to all and accessible to anyone.

Pulse tells the story of health care through the personal experiences of those who live it–patients, health professionals, students and caregivers. While medical care is often rightly criticized for being cold and oblivious, Pulse highlights the humanity and vulnerability of all its actors. In doing so it promotes the humanistic practice of medicine and encourages advocacy for compassionate health care for all.

Since its launch, Pulse has drawn the attention of the national media and policymakers. Widely used by medical educators to promote humanism and professionalism, Pulse enjoys a broad readership drawn to its diverse voices, compelling writing and authenticity.

Pulse welcomes

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You Don’t Have to Put Your Teeth in for Me

Leave a Comment / Poems / Karen Peacock

Karen Peacock

He pulled the covers over his shedding skin,
Put a napkin over his phlegm-filled cup
Turned the volume down on the TV
And up in his ear,
Cleared his throat through the foggy mask,
Tipped the seat down to his bedside commode
As he reached for his teeth,
And I said, You don’t have to put your teeth in for me.

About the poet:

Karen Peacock is a board-certified art therapist working on the palliative care unit at the Memphis VA Medical Center. She received her master’s in art therapy from Pratt Institute in 2008.

About the poem:

“This poem was inspired by an experience I had with a patient on the palliative care unit. He seemed to be burdened by the need to present himself in a certain way to me when I entered the room. I wanted to relieve him of this burden and allow him to be as comfortable as possible.”

Poetry editors:

Judy Schaefer and Johanna Shapiro

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fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

What About Bob?

Cold Comfort

In Line at the Hospital Coffee Stand

Gentle Men

The Hallway

Mother And Son

Stepping Into Power, Shedding Your White Coat: Donald Berwick’s Graduation Address

Catching Chickens

Epiphany

What is Pulse?

You Don’t Have to Put Your Teeth in for Me

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fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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