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Dr. B Gets an F

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Gregory Shumer

Flashback to a year ago: I’m a first-year medical student–a fledgling, a novice–trying to integrate countless facts into a coherent understanding of how the human body works. Professors slam me with two months’ worth of information inside of two weeks’ time. They tell us that this is a necessary process, one that all doctors must go through: we must first learn the science of medicine before we can master the art of healing.

My life revolves around tests, labs, deadlines, long hours in the library and very close relationships with the baristas at Starbucks.

In the midst of this chaos, I developed a crippling ankle condition that transformed me into a concerned patient for the first time in my life. The pain started as a dull ache that I experienced only during exercise. Then it gradually worsened, to the point where I could barely walk to school the day after I’d played a basketball game. A golf-ball-sized bulge stuck out from my right ankle, and my two months of medical education suggested no remedies.

It was at this point–worried, looking for answers and desperate to get back to normal–that I decided to see someone.

Dr. B, the orthopedist » Continue Reading.

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Angels and Phantoms

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Joanna Dognin

“Mama,” a little voice pipes from the back seat. “Why is that boy in a chair?”

The sun is beaming into the car as we sit at a stoplight, waiting to exit a store parking lot. My two-year-old daughter has spotted a young man, barely twenty, who smiles weakly as he rolls by in an electric wheelchair, collecting money for muscular dystrophy.

“He’s in a chair because he needs help moving around,” I say.

“Why?”

“Because his legs need help.”

“Why? Because they don’t work?”

“Well…”

“Why are they broken?” she asks. “Is he broken? Why is he here? Where is his mama? Mama, where is the boy’s mama?”

* * * * *

“Dr. Lobozzo, you got any kids?” Gabriel asked, calling me by my maiden name rather than the married name I’d only recently begun using.

“No,” he continued with a sly smile. “Don’t tell me. I already know. You have two sons.”

I was newly married (without children), living in one of New York City’s boroughs and working in the Manhattan HIV primary care center I’d joined after getting my psychology license. The center integrated mental health and social services into

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Dissolution

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Jocelyn Jiao

the articles went first.
then the pronouns, the verbs,
nouns. they melted away, leaving 
only memories of warmth
cradled by salivary glands.
adjectives flutter behind 
my front teeth, ready for flight.
only adverbs remain,
curled beneath my tongue–
yawning, drowsy:
the softest words of vocabulary.

the lilt of my voice has left too,
soapy Californian vowels
scrubbed clean. 
when i speak to my mother,
she complains of my consonants,
how they have begun 
to iron out cadences, climb 
over inflections, ride 
them into deep sand. she says
only my whisper remains whole.
but not for long;
already the throat whistles.

it all started at your
bedside, when your lips 
were parted, straining
to form one first, final word.
a sudden embrace of cold 
concrete made you into
some bright thing with eyes
translucent, gasping
for the comfort of
water, empty and clear–
when ebullience 
once spilled from your lips
as a sun warms an earth.

do you see? words are meant 
for creatures of air. i have no use for them;
even fish can sing.

gently, carefully, tenderly,
night arrives; it pivots and
provides no answer. i feel your name 
coil in my mouth, watch 
as it ebbs

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James and Bob

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Paul Rousseau

I think his name was James, but I can’t remember for sure. What I do remember is the day’s heat, the metal cart and a rust-colored dog. 

Like many homeless people, James carried his belongings in a grocery cart–a sort of mobile home for the homeless, but without the protection of a roof, the support of four walls or the security of a front door.

I’d just walked out of the local Safeway store into its parking lot. He ambled over from a park across the street. His eyes were narrow, his face tanned and his clothes dirty brown from weeks of sleeping in the streets.

Being a dog lover, I found my eyes drawn to the dog–a mixed breed with matted hair, worn eyes and gray hairs on his snout. He looked underweight; I guessed he weighed no more than thirty or forty pounds. He stood obediently by James’ side, tethered by a rope leash. 

“What’s his name?” I asked.

“He’s Bob–best dog there is. In fact, best friend a man could have,” said James in a deep smoker’s voice. He smiled and rubbed Bob’s back. 

Then he asked, “Can you give me some money so I

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The Cruelest Month

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Ray Bingham

One day in April, I took the assignment none of the other nurses wanted: Baby Michael. A hopeless case. 

Born almost four months premature, weighing barely a pound, he was now all of six days old. His entire body wasn’t much longer than my open hand. As he lay motionless on a warming bed with the ventilator breathing for him, the night nurse gave me report: serious intestinal infection, bowel surgery, septic shock, multiple antibiotics, infusions to support his failing heart, transfusions to replace the serous drainage seeping from the surgical incision on his darkened, swollen belly. 

“Take good care of him,” she finished. “He’s been through so much already.” 

As experienced nurses, we both knew that a premature infant rarely survives so many medical complications.

Tiny and sick as he was, his parents Frank and Tonya loved him. Midmorning, they came to visit. They were a young African-American couple–he, tall and wiry; she, shorter, with thick, wavy dark hair. They both looked so weary. 

With the attending physician, Dr. Moore, I joined them at Michael’s bedside. Trying to be compassionate but honest, we described the progress of Michael’s infection and his grave prognosis.

Still, when Tonya held

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Third Party

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Mary E. Moore

Tipping forward to escape
the wheelchair’s confines, the ancient one
pleads with her feet, “Go home.”

It’s her companion who volunteers 
the Chief Complaint: “Ever since her stroke,
Mother’s back seems to hurt.

Her doctors say there’s nothing can be done, 
but I thought that perhaps a specialist ….”
She strokes the old woman’s shoulders. 

“Does it hurt here, or there, or if I touch this?” 
My fingers probe among birdish bones.
Ignoring me, the patient whimpers, “Home.”

When the daughter’s eyes register pain, I say,
“I’ll inject this spot near her sacroiliac joint.
It may provide relief, in any case do no harm.”

I fill in the charge sheet attached to the chart.
Low back pain. Trigger point injection. 
Return PRN. But how should this be billed?

With the old woman’s medical insurance?
With the daughter’s?
Or should I pay for this one?

_______________

Editor’s Note: PRN is an abbreviation of the Latin phrase pro re nata, which in English means “as needed.”

About the poet:

Mary E. Moore earned a PhD as an experimental psychologist, but after working in a hospital, she decided to study for an MD. She became a rheumatologist, ultimately heading the division of rheumatology at Albert Einstein

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Trauma in the ER

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Michael Gutierrez

It was 5 pm on a cold November day. I was a third-year medical student heading into my first night on surgery call.

Changing into my scrubs, I wondered what it would be like. I knew that we had to carry a “trauma pager” and, when paged, get to the ER as fast as possible. There my job would be to listen as the ER physician called out his exam findings and enter them on a history-and-physical form.

I felt a mix of things. I was excited about the learning possibilities, but I also knew that whoever gets wheeled through the ER doors is someone’s daughter, son, mother or father. I decided not to think too hard–I’d just take what came my way and organize my thoughts later.

The night started off slowly. I checked on a patient our team had operated on earlier and added a couple of people to the next day’s surgery list. If the evening stayed this mellow, I might have time to study in the call room and get some sleep before rounds the next morning. 

Around midnight, my pager went off: “29 y/o female; head on motor vehicle collision; laceration of head;

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The Winner

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Majid Khan

I pull up on the side of the road on this rainy British summer’s day. The rain doesn’t make it easy to get my doctor’s bag out of the trunk, which I do in a hurry so I can make my way to the house where I’ve been asked to visit a 37-year-old man named Kenneth.

This really isn’t ideal. Now my bag is wet, my papers are wet, my trousers are wet and my mood is wet. I didn’t want to do this visit anyway, but I’m still in my last year of training before becoming a full-fledged GP, and I’ve been given the task by one of the senior GPs in the practice.

“Cough/temperature” says the note the receptionist has scribbled. But while reviewing this patient’s records at the surgery I’d also spotted the words “demyelination” and “bed-bound”–words that had triggered my resistance to coming at all.

I knew this visit would upset me. Kenneth has an autoimmune disease like multiple sclerosis that is slowly destroying the sheaths covering his nerves. Kenneth is only nine years older than me.

The brown wooden door opens, and a plump, smiling lady wearing an apron welcomes me in, tells

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Sleep Hygiene

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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

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Stuck

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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

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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

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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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