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Adverse Effects

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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 » Continue Reading.

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The Disabled Boat

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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

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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

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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

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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

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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

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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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Sweet Lies

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Marilyn Hillman

I can sense the question before it comes.

“How are you doing?” 

I want to answer, How do you think I’m doing, with my husband morphing into a ghost? I’m dying here. But thanks for asking.

Instead I clench my fists and deliver a cheerful response: “I’m good.” Which is, of course, a lie.

My husband is demented.

I cannot say these words out loud. Pushed to the wall, I’ll say that my husband has dementia, like it’s temporary–a virus curable by bed rest and chicken soup. Murray admits only to memory problems, while I split hairs over which verb I can stand to put next to his decline. We skitter around the truth like insects caught in a pool of light and scurrying for cover. The reality is, we’re on a steady downhill course, with Murray in frantic pursuit of words and ideas he can’t remember, while I chase after him, trying to mine precious nuggets of coherence buried in his muddy ramblings,

Murray imagines himself still capable of living a richly layered life, despite what his psychiatrist calls a severely impaired executive function system. What the hell is

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In the Pediatric Ward

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In this forest of tubes and bottles,
Children wander in sleep.
A dying bird drops
From the corner of my eye.
The night nurse floats through paths
Tending the rooted tubes,
Weighing the pause between breaths.
In the dark, a man’s voice
Stuns like a hunter’s gun.
We wait for dawn.

Last night we cried–four worn children
Facing their walls, and I,
Handing out animal crackers.
Willow’s bones are flaking
John’s eye refuses light
Paige’s ears close up and
Something is eating the soft parts of
Adam’s knee.
We know these things and we cry.

The children force the beds to do acrobatic tricks.
They’ve decorated the sheets with urine, gum, and ice cream.
Shrieking, they dribble gravy; Collages bloom on the floor.
They glue flies to the walls, punch holes in dolls and blankets.
The children are not civilized, and the women have left off makeup.

After the baths, the doctors
Visit their explanations
Upon the numbered beds.
They know about bones, eyes, ears,
For they’ve inspected the bodies.
They

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Family Business

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Joanne Wilkinson

My mother’s mother was more a force of nature than a person. Chablis in hand, stockings bagging a little over her solid, practical navy pumps, she delivered her opinions without the slightest sugar-coating. She used words like “simply” and “absolutely” a lot. “He is quite simply the worst mayor we’ve ever had.” “She had absolutely no business having four children.” My cousins and I all listened and quaked, hoping the wrath would not be turned on us. Even after my mother’s death, when you might imagine she would soften toward me a little, I still felt the need to stand up straighter whenever she looked at me. Behind her back, I called her “The Graminator.”

The Graminator had been retired for almost as long as I could remember and she had three major interests: wine, the stock ticker on CNN, and the politics of the Catholic Church, upon which she delivered opinions at every party.

I thought of her almost like Scrooge, hoarding and counting her certainties while all the people she had alienated went out to eat together in a messy, shabby, second-rate fellowship of true happiness. I felt caught in the middle: I cared

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The Case of the Screaming Man

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Paula Lyons

As everyone knows, the human body has orifices. Occasionally, these become occluded, or occupied, by things that aren’t supposed to be there. Every doctor knows this, as does almost everyone else. Who hasn’t heard, as a child, the cautionary phrase “Don’t stick beans up your nose”?

Human nature being what it is, almost every clinician must deal with foreign objects–flora, fauna–that have been put into places where they don’t belong. Sometimes, though, “beans” can materialize without a patient’s permission.

Here is one such case–a personal favorite of mine–that I’ve mentally entitled “The Screaming Man.”

I was back in the furthermost part of the clinic, arguing with an insurance company representative about the need for a patient’s CT scan, when one of our receptionists ran up.

“Dr. Lyons! There’s a man screaming in the waiting room!”

“Is he bleeding?”

“No, he’s banging his head with his hands and screaming! I think he might be crazy!”

I ran to the front. There in our packed waiting room was in fact a seemingly crazy man, screaming, dancing around and batting at his left ear with both hands. The other patients were cringing

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Death at a Distance

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Your message hung on the phone line

like his striped shirt blowing
in the last wind of his life:
softly and with dignity.
His facial bones,
and body contours
he allowed to be chiseled
to an insubstantial sharpness
by the flow of chemicals and
the relentless labor of his disease:
both polished his body to dust.
Your life that has breathed that dust
for years will, someday,
carry it to the stars,
where it belongs.

About the poet:

Edwin Gardiner, a urologist, was in private practice for thirty years in San Diego; he did his surgical training at UCSF and NYU-Bellevue Medical Center. “I’ve written since my undergraduate days at Amherst College but have had only essays and professional monographs published before. From the early 1980s on, I occasionally wrote poetry, but since retiring I’ve found poetics an essential part of sampling the temperature of my daily life.”

About the poem:

The man in this poem and I were friends for many years. This poem was a whisper of condolence to his wife upon receiving a phone call with the news of his

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