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

Sleep Hygiene

Daniel Becker

Outline the night and all its objects
in black magic marker.

The world through closed eyes
needs texture 
the way tires need tread, 
brains need wrinkles, and hypnosis
needs the power of suggestion–
traction, surface area, and control
might also apply to a cat
buried alive underneath the sheets; 
if so, don’t forget the one on top.

Stay up for several nights before
the night you plan to sleep.

Oil the ceiling fan.

True or false: the bladder
is on a separate circuit?

Don’t eat in bed, especially chips.

Snoring + sleep apnea + restless legs
+ hemorrhoids + lumbago =

the human condition. The winter itch
as well would be unfair.

Use pillows to solve or suppress all of the above,
a pillow shaped like the horizon
or the supine profile of your partner, or even better 
a partner who won’t mind being used as a pillow–
together you become the mountains and their clouds, 
between the two of you a hidden canyon,
lost in your slopes there are deep limestone caves, 
hot springs, the occasional tremor 
of tectonic plates and knees.

About the poet:

Daniel Becker practices and teaches general internal medicine (an endangered specialty) at » Continue Reading.

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Stuck

I have never told this story to anyone.

It all started one night about ten years ago, three months into my internship. I was on call, having just admitted a man with a possible meningitis.

He now lay curled up in fetal position on the bed in front of me, looking thin and ill. Preparing to administer a lumbar puncture (a diagnostic test that involves removing fluid from the spinal canal), I gently pushed his head further down towards his legs.

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Ms. Taylor

Remya Tharackal Ravindran

Ms. Taylor was one of three newly hospitalized patients I saw that morning. She was a previously healthy woman in her forties, single and childless, who worked in the fashion industry. As I scanned her admission notes, three things stood out: shortness of breath, elevated calcium level and kidney failure. I read on, thinking of possible causes, then something caught my eye. Her breast exam had revealed multiple breast masses, and her chest x-ray showed fluid-filled lungs.

Everything fell into place: cancer, first in the breast and then spreading to the lungs. I was spared a diagnostic challenge, but I now had to face something more difficult–talking with Ms. Taylor about her diagnosis. Did she even know what it was? It didn’t seem so.

For me, breaking bad news is an elusive art. As I walked to Ms. Taylor’s room, I tried to recollect some of the strategies I’d been taught, like finding out what the patient thinks is going on and asking how much he or she wants to know. Still, I didn’t know how Ms. Taylor would react. I felt nervous. 

Ms. Taylor was sitting upright in bed, wearing an oxygen tube. She was a

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Grandmother

Elizabeth Kao

Today, her head is spinning, just like yesterday, 
And the day before that. She is dizzy, experiencing 
pain we can’t know unless our heads have hurt like
she hurts now. All she wants is to lie down, and
when we tell her she just woke up, she says she
can’t sleep, because we don’t understand that
she’s not concerned with the sleeping. She’s the
same with food, telling us everything tastes bad,
merely eating to keep from being hungry.

She felt nothing to be worth doing after the fence fell, 
just another part of a neglected house, but not 
so neglected as to scream injustice to the world.
No one would mind that she did nothing, nor 
would she–or more accurately, she didn’t care.
So she turned inward, after seventy-three years of 
War, raising a daughter and two sons, watching the 
grandchildren for them, then left alone because 
she seemed strong, for their convenience.

Tomorrow she will get up, eat breakfast, and sit 
in her chair. By the afternoon, she will lie down in
her bed again, staring into space, wishing the pain
but not-pain will go away. And we blame a
chemical imbalance and wonder whether we

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Pearls Before Swine

Kate Lewis

I’m a third-year medical student, and I’m starting the second day of my new rotation–a month that I’ll spend with a family physician, Dr. Bauer, in his small, efficient home-based office.

Yesterday, my first day, a young woman named Sara came in for “strep throat.” She had dark Latina eyes, broad cheekbones and a delicate tattoo of the Chinese character for “dream” on her left wrist. She was 17 and seeking out a primary-care doctor for the first time in her life; I applauded her for taking responsibility for her own health care. Her tonsils were big and purple, covered in pus, but the rapid strep test was negative. She also reported a vaginal discharge. Dr. Bauer wanted to do a pelvic exam to check for a sexually transmitted disease (STD). He started her on antibiotics, ordered some blood tests and told her to return today to discuss her lab results and have the pelvic exam. 

Now Sara returns with her mother, wanting to know why the exam was scheduled. Impressed by Sara’s thoughtfulness, I tell her that we recommend the test, but assure her that the choice is hers. She looks me in the eye, confidently reports

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Adverse Effects

Kenny Lin

Flashback to summer of 2008. I’m looking forward to August 5–the day that I’ll no longer be a faceless bureaucrat. The day that the US Preventive Services Task Force (USPSTF) will issue its new recommendations on screening for prostate cancer–recommendations I’ve labored on as a federal employee for the past year and a half.

For much of 2007 I combed the medical literature for every study I could find on the benefits and harms of prostate cancer screening. In November of that year I presented my findings to the USPSTF, a widely respected, independent panel of primary care experts They discussed and debated what the evidence showed and then voted unanimously to draft new recommendations. I didn’t get to vote, but it has been my job in 2008 to shepherd the draft statement and literature review through an intensive vetting process and to finalize both. 

As August 5 approaches, my colleagues in public relations warn me that the last time the USPSTF said anything about prostate cancer screening, the phones started ringing off the hook. I’m not so secretly hoping that the same will happen this time.

And I’m not disappointed! After we release the statement, my normally

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The Disabled Boat

Steve Gunther-Murphy

Drifting on the sea of disease
in a cardboard boat,

never knowing when the slash
of a spinal eel
will lunge from its coral-bone cave
and cut through
the threads
of a once dancing ankle
or the push of a thigh
singing race or run.

Waiting without wanting–
as the slap of a wave
against the paper-thin stern
then bow
brings on the storm
that pummels every movement
until you slip into a coma of the wind;

your sails ripped from the mainstay
and the tar between the rails
yelling like the death of a two-year-old child.

You wake weeks 
later
and notice
that your keel is gone;

your body shakes like a rock cod against
the pith of the boat’s floor
with the hook deep in your gill;
making you talk in slow motion
and without air.

Who wants to live this life
of a shadow fish,
pulled from the depths of who you were
and gutted of simple motions
or the ability to sing glee from your gullet?

This is not the space I am.

This is not the blue

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Making Headlines

Reeta Mani

“Did he die of swine flu?” demanded a scrawny man wearing a blue shirt and green surgical mask. He was one of a throng of news reporters packing the lobby of a private hospital in the heart of Bangalore, my city.

It was early August 2009, and India had just recorded its first casualty from the novel H1N1 influenza virus. This latest variant of influenza–a chimera of swine, avian and human flu genes–was raising grave concerns among the medical community worldwide. To try to contain a pandemic, countries were ordering stockpiles of antiviral drugs and initiating vaccine production on a wartime footing. 

In Bangalore, as elsewhere, you could pick up any newspaper or watch any news channel and see headlines screaming “Swine Flu!” Men, women and children wore masks of all sizes, shapes and hues. Paranoia was at its peak: An innocuous sneeze could make people run helter-skelter for cover.

A few H1N1 cases had been confirmed in Bangalore, but fortunately none had been fatal. The local media, on the alert 24-7, were hounding any doctor associated with the diagnosis or treatment

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Triptych for John

Yun Lan


Part I: The first time I saw you

I met John 
without 
John, 
without introduction.
Cold,
cold,
cold hand.

Part II: Cadaver as Decapod

John was surely a hermit crab, having four small limbs to anchor the body and six long
limbs to advance it. He gathered sea anemones on his back, and weeds in his spiny beard. He bore
stellate scars, the digitated marks of five pointed teeth. There was a constellation of them, surely
from the care of blue spined urchins. The urchins couldn’t make him stay. Did they evict him or 
had he just outgrown his home?

Surely, his soft belly was turned out to the brine, the ocean full of predators. In each eye of
many lenses, what did he see? Was he afraid to scuttle from this white ribbed shell to the larger?
Perhaps not. He trusted he could replace his old limbs. He could carry anemones to protect him.
He would fear neither octopus, nor fellow crabs, nor stars. 

We can pick at the questions, we each with ten limbs: sharp scissors, blunt scissors, olive
point probe, teasing wooden handled straight needle, thumb forceps, “fitted teeth” tissue forceps
with 1×2 jaws,

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The University Hospital of Somewhere Else

Paula Lyons

July 1. My first day as a family medicine intern, assigned to Labor and Delivery, and my first night on call, 6 pm sharp. Enviously, I watched the other interns smartly packing up to go home.

“See you in the morning–maybe!” they joked.

I glanced at the status board: eight patients in labor. And now I was “in charge,” at least in name, till 7 am report tomorrow.

Several chaotic hours later, I finished helping a Guatemalan mother of five to deliver her sixth son. My hands were trembling.

Toweling the plucky little newborn dry, I admitted the truth: Despite my University Hospital’s proud reputation as a maternity center, this woman would probably have done as well or better in her own warm, clean, cilantro-scented kitchen. At best, I was superfluous; at worst, a comical hindrance.

In shaky Spanish, I told her, “Su hijo es muy guapo y tiene salud!” (Your son is very handsome and healthy.)

“Lo se,” she replied, smiling. “Tranquila, doctorita. Todo estara bien.” (I know, little doctor. Be calm, all will be well.)

Washing my hands after the next

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Babel: The Voices of a Medical Trauma

Editor’s Note: This week, on the eve of Pulse‘s second anniversary, we offer a remarkable piece. It is the true story of a hospitalization as told from three points of view: first, the recollections of the patient (who happens to be a physician); second, events as recorded in the medical charts by doctors and nurses; and third, the version put forth by the hospital.

FRIDAY

Patient:
It is fall 2005, and I am nine months pregnant. A healthy 33-year-old pediatrician, I am a longtime patient of Doctor A and Doctor B, who delivered my two young children at this hospital. My husband and I are eagerly anticipating the birth of our third child.
One evening after dinner, the contractions start coming every five minutes. My husband and I pack our bags and drive to the hospital. I am nearly 4 cm dilated. After observation, Doctor C calls Doctor A, makes a diagnosis of false labor and sends us home. 

Chart:
9:25 pm: 33 year old gravida 3, para 2, 38 5/7 week seen in office this AM almost 3 cm. Negative PMHx, c/o contractions q 5 min. Cervix

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Depression Session

Abby Caplin

 

The chopped apple of her father’s eye,
She tastes the grapes of her mother’s drunken wrath
The barely visible slivers of silver-tongued almond
Needle her intestines as she savors
The seedless watermelon of fruitless friendships,
And endures the hard rind 
Of a body gone awry, 
To be chewed and chewed until swallowed or
Spat out. A salad of sorts
Surrounded by lemons
Home-grown, organic, bitter
And full of juice. She brings me a tough
Clear plastic bag filled with them
To our session.
“They’re the last of the season,” she tells me.
I pray this is true,
While at home, I pore through cookbooks, 
Searching for yet another recipe. 

About the poet:

Abby Caplin MD MA practices mind-body medicine and counseling in San Francisco. She helps people living with chronic medical conditions to lead empowered and vibrant lives, reclaiming their wholeness despite illness (www.abbycaplinmd.com). Abby also offers a weblog, Permission to Heal, for people who are “up in the middle of the night or down in the middle of the day” because of illness.

About the poem:

When sitting with clients, I hold the space to hear

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