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Keeping Secrets

Reeta Mani

Rohit walked into our HIV-testing center in South Mumbai one busy morning. I was struck by how stylish he looked in his jeans and casual linen shirt, very different than the usual patients who visit our sprawling public hospital campus. He paced back and forth in a corner, looking at his watch and whispering into a cell phone.

I guessed that he’d chosen this crowded setting because of the anonymity it afforded; here he stood little risk of running into an acquaintance who might start to wonder.

During Rohit’s pre-test counseling, he confided his fear of being HIV-positive. He told us about having unprotected sex with female commercial sex workers during overseas business trips–and about a routine insurance health checkup that had hinted at something wrong.

He was here to learn the truth.

The next day, when he came for his results, Rohit was astonishingly calm.

“Your blood sample has tested positive for HIV,” I said and, per our routine, handed him the lab report so he could see for himself.

Rohit held the piece of paper and sat, gazing deeply into nowhere. Just when I thought he might have » Continue Reading.

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Postmortem

Sandy Brown

Coming out of my exam room on a Monday morning, I saw two overweight police officers standing in my waiting room. From past experience, I knew that they were there to tell me that one of my patients had died and to collect information for the coroner’s report. Even as I geared up to hear the impending bad news, the doctor in me couldn’t help wondering how they’d passed their department physicals.

“Do I need to call a lawyer?” I joked, trying to guess which of my patients it could be.

“Michael Freund died on Saturday,” said Dalia, my office manager.

It was a shot to my gut. Mike was seventy-three years old, but one of my healthiest patients for his age. He neither smoked nor drank, took no medicines except for the occasional Viagra and played tennis with a passion. He was fit and trim, and I couldn’t imagine what had done him in.

I hadn’t seen Mike in the months since he’d come in for his annual exam, which had raised no red flags. Then I remembered that he had called me the previous Thursday with some vague complaint that I

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Medecins sans frontieres — Liberia, 2003

Les Cohen ~

I walk warily, 

searching for life
through smoking remains
of a jungle village.

My flashlight beam
slices the black haze
of equatorial darkness.
Was it Suakoko?
Fokwelleh?

No wind, rustle or drum
pierces the silence
of West African night.
Torched husks of thatched huts,
clay walls liquefied,
charred dog skeletons,
feet outstretched
as if running from Hell.
Stench of burnt flesh pervades,
stinging eyes and nostrils.

Soft footsteps coming close.
A small, thin boy approaches;
mahogany face, bright teeth
glisten in the moonlight.
Bloody machete, strings of
bleached-white finger
bones dangle over a tattered

ARMY OF ETERNAL PEACE
T-shirt.

Smiling, voice soft,
he hisses
Give me medsuh,
give me cokayh,
mistah.

No, no,
don’t kill me,
I am doctuh,
take my medical bag, wallet, watch, shoes.
I try to scream, but
no sound escapes.

He slowly lifts an

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Confessions of a 75-Year-Old Drug Addict

Arlene Silverman

The physician, a slim, young man with a shaved head and intense, dark eyes, reaches out to shake hands. I fumble to extend one hand while the other clutches a questionnaire that I haven’t finished filling out. 

“That’s okay,” Dr. Gordon says. “You can finish later.”

He can tell that I’m nervous, but seems to understand. He knows that I’ve had to sign in at a window surrounded by other patients, many younger than my own children. Some of them look dazed; others have dozed off. Still others, alert, look as if they’d just come from their job at the bank.

Me? I walk with a cane. My clothes have been carefully chosen to look presentable. I’ve come through a door labeled “Chemical Dependency Clinic” in small, discreet letters. If you hadn’t been looking for the sign, you’d have missed it. The building has no street-level windows and is in a neighborhood that could kindly be called “transitional,” rundown at its core but reluctantly yielding to gentrification.

I am seventy-five years old, and I have come to Dr. Gordon because I’ve become addicted to drugs.

While he scrolls through my

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May I Have Your Attention, Please?

Adam Phillip Stern

Some sentences should never be interrupted. 

“We have the results of your HIV test,” the attending physician had begun. But fate interrupted with a seemingly endless loudspeaker announcement:

“May I have your attention, please? Would the following patients please report to the nurse’s station for morning medications….”

Nothing about Benjamin’s story was ordinary. He had been voluntarily admitted to an inpatient psychiatry unit after reporting many symptoms of depression–extreme somnolence, fatigue, thirty-pound weight loss with poor appetite, diffuse pain, decreased energy and joylessness for about three months.

Benjamin was charming, smart and eager to follow medical advice. As a relatively inexperienced medical student, I found interviewing him a refreshing change of pace from my difficult interactions with the poorly groomed individuals who paced the halls repeating nonsensical phrases and questions over and over again. Benjamin always peppered our talks with comments about current events and informed questions about his care. He could often be seen reading the newspaper or interacting with other patients or staff in a way that made me wonder whether he really belonged there.

Benjamin’s life story was as engaging as his demeanor. He had worked

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Reflections From a Senior Citizen

I used to talk of fun and games

Now I talk of aches and pains.
I used to paint the town bright red
Now at nine I am in bed.

I used to dream of lovers bold.
Now if truth be told
The only men who interest me
Are those with a medical degree.

“Why,” you ask, “have they such clout?”
Well–we have so much to talk about:
There’s my arthritis and stenosis,
Hypertension, scoliosis.

In a cozy room, alone, we chat.
We never have a lover’s spat.
So keep your handsome Romeos
I’ll always take those medicos!

About the poet:

I am ninety-five years old, widowed, with three married children, four grandchildren and two great-grandchildren. My first published work appeared in February, 1931, in The Record Book of my graduating class of Simon Gratz High School in Philadelphia. It was not until the 1980s that my work appeared in print again. I was a reporter for the Mt. Airy Express, writing on assignment twice monthly and actually being paid! The paper folded at the end of that decade. Again there was a hiatus,

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Pulse Readers’ Hopes and Wishes for the New Year

Pulse Readers

Editor’s Note: Ten days ago, we invited Pulse readers to share with us their hopes and wishes for the new year. Here are some of their responses.


For my young patients who are living with HIV, I hope for relief from the stigma that shadows their lives, their health and their futures, and for acceptance and respect from family, friends, schools and society. For youth growing up surrounded by violence and poverty and by systems of education, health and human services that often fail them, I wish for empowering systems, safe spaces and nurturing adults who will help them to dream and to realize their potential.

Cathy Samples
(Director, Boston HAPPENS Program
at Children’s Hospital Boston)
Boston, MA

——————–

After watching my daughters experience three miscarriages, my wish (and prayer) for the new year is a healthy grandchild. My oldest daughter is now six weeks pregnant, and her first ultrasound is next week. We’re praying this little one arrives in August, healthy and whole. What greater gift and wish is there than new life?

Elizabeth Szewczyk
Enfield, CT

——————–

I wish that today’s medical students

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Pulse Takes the Day Off–and Reflects Upon a Historic Christmas

Paul Gross

Dear Pulse Readers,

We’d planned to take the day off, it being Christmas and all–and then a historic Christmas Eve Senate vote gave us second thoughts.

When the Obama administration arrived in Washington this past January it occurred to me that Pulse might have arrived on the scene too late. Once health reform came into being, “the heart of medicine” wouldn’t ache quite so much. Maybe Pulse would become superfluous–like an offer of two aspirin after the headache’s gone away.

I needn’t have worried.

The healthcare reform bill that passed the Senate on Christmas Eve may be, as some say, a first step of historic proportions–a holiday gift for our nation, including some 31 million uninsured it promises to deliver access to. And yet one wonders, as others have pointed out, whether the real gift recipients won’t be the same crowd who’ve made our health system so complicated, expensive and ineffective in the first place.

Is the current legislation a historic promise of health care for all? Or a guarantee of prosperity to those who’ve mucked things up so badly?

Or both?

One thing seems clear: the most meaningful health reform

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Babies

She tells me she wants to have a baby,

my daughter who was my baby
so many years ago.

Everything comes back to me–
the waiting, the wanting, the whisking
off to baby-earth, that angelic place,
passing through life
with its normal sounds, smells, and sights,
into the realm of women’s starlight, bright
as Polaris, a celestial universe of power,
revolving so far away
that only women with growing
babies under their swollen, milk-gorged breasts
could inhabit this land.

Just for a moment, I want to have a baby again.
My aging body with its downhill breasts
and lost uterus aches to soar to that planet.
I want to feel life inside wiggle its
bowed, floppy legs, delicate arms,
those rubbery appendages not yet knit together.
I want to feel it somersault at
the top ledge of my ribs, understand
that surprising quiet of knowing
something inside me will come…
without him.

Just for a moment I want
every muscle in my baby-battered
body to unite for the same cause,

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An Intern’s Guilt

Anna Kaltsas

“She’s been here for two months already. She’s very complicated; you’re going to be spending a lot of time with her and her family,” my fellow intern said as she began signing out her patients to me. 

It was my first rotation in the medical intensive care unit, and I was terrified. I was in my first few months as a “real” practicing physician–a title that I still felt uncomfortable with. If a nurse called out “Doctor!” I wouldn’t respond, thinking that she couldn’t possibly be referring to me.

My fear mushroomed as my co-intern rattled off the patient’s problem list–bone-marrow transplant, shock liver, congestive heart failure, anemia, coagulopathy, sepsis, acute renal failure, ICU neuropathy, encephalopathy, ventilator-dependent…I knew what these meant, I just felt overwhelmed to see them all in a single patient.

Her name was Laura. Her story was impossibly tragic. A newly married, successful young professional, she’d visited her general practitioner two months back, complaining of weight loss and a headache, only to have blood tests reveal devastating news: leukemia.

Her first inpatient chemotherapy treatments had been followed by a bone-marrow transplant, then by complications from chemotherapy. A barrage of serious infections had

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Mom

Diane Guernsey

By this time next week, my mother may be dead.

In a sense, she’s been dying for a long time. This leg of her journey is the last in a decades-long trek with Parkinson’s disease.

She lies there, her head small and delicate on the pillow. Her hair is a wispy white thatch; her throat muscles are rigid, as if she’s just lifted a huge barbell. But her breaths come slowly, with long pauses in between, as if she’s nearly too tired to go on. Her brown eyes stare up sightlessly, lids half-open.

This nursing facility is part of a stepped-care retirement center where my parents moved more than ten years ago, anticipating the day when my mom would need more help than Dad could give her. They lived in an apartment there for years, while Parkinson’s slowly chilled my mom’s brisk, jaunty gestures and muffled her lively, Texas-inflected conversation into an inaudible murmur. (We all knew that this was inevitable, even though she received the most up-to-date drug regimen.) When a stroke unexpectedly felled my dad seven years ago, my mom, then 80, chose to move into the facility’s nursing wing.

About a

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Cleft

As Caroline was born

the doctor saw
the split
from lip to nose–
purple rimmed,
going down deep–
Deep enough
to hurt
generations.

And the imperfect doctor,
tired of wounds
tired of divisions,
saw the small
wholeness
Chose that moment
Chose tenderness
saying simply,
She is beautiful.

And the imperfect mother,
tired of pain,
held her child,
touched the tiny,
ragged face
Chose that moment
Chose acceptance
crying softly,
She is beautiful.

About the poet:

Jon Neher is clinical professor of family medicine at the University of Washington in Seattle and associate director of the Valley Medical Center Family Medicine Residency Program. He is editor-in-chief of the newsletter Evidence-Based Practice and a frequent contributor of essays on medical education to Family Medicine.

About the poem:

This poem was written to capture the layering of emotions that occurred the day I unexpectedly delivered an infant with a cleft palate. I was new to my career, and this was a novel challenge for me. Since I had no professional scripting

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