Page 247 – Pulse

Ripped From the Headlights

Leave a Comment / Stories / Maureen Picard Robins

Maureen Picard Robins

“Get a notebook,” he said.

Dr. Altman and I stood face to face on the pediatric surgical floor of Columbia-Presbyterian Babies & Children’s Hospital. It was the first week in December. A metal crib–it seemed more like a cage or prison–separated us. In this center space lay my yellow heart: my eight-week-old daughter, wounded by surgery, dulled by morphine, our whispers flying over her.

It had been nearly twenty-four hours since Dr. Altman opened the baby’s abdomen and held her tiny intestines in his hands, untwisting them like a fisherman untangling his line; nearly one day since he’d performed a Kasai procedure, fashioning a conduit so that bile could tremble down to her small intestine; one thousand four hundred and forty minutes since I’d been ripped from the headlights of the speeding car known as biliary atresia, a rare condition in which the duct from the liver to the small intestine is blocked or missing.

“There’s a lot to learn,” Dr. Altman said. “Write down all your questions. There is no way you will remember all this.”

There was only one question I wanted to ask, and I didn’t dare.

Besides that, there were so many other » Continue Reading.

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A View From Nepal

Leave a Comment / Stories / Caroline Jones

Caroline Jones

The farmer wanted to know why his three-year-old son couldn’t walk or talk.

I sat opposite him in a dark, cold classroom converted into an examination room for a four-day medical clinic last spring in the village of Lapa, high in the Himalayas.

Wind whistled through the stone walls; rain pounded on the tin roof. The room’s single ceiling bulb kept flickering and dying; I had to use a camping headlamp to see my notes. And communications were hampered, to say the least: We conversed via two translators–from English to Nepali, from Nepali to the local Tamang language, then back again. It sounded a bit like the telephone game, and had similarly uncertain results.

Still, one look was all I needed to make the diagnosis: Down syndrome. I found the telltale single hand crease, eye folds and wide gap between the first and second toes and asked about the boy’s medical history: he’d never seen a doctor; sometimes he had diarrhea, fever or a cough.

I thought back to my journey here, the last leg of which had begun five days earlier. With two other doctors, I had left Nepal’s capital, Kathmandu, on a winding, bumpy, eight-hour Jeep

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Running Out of Metaphors

1 Comment / Poems / Howard Stein

Howard F. Stein

His rapidly metastasizing cancer
was not his only problem:
He was not only running out
of life, he was running out of metaphors.
Metaphors had sustained him
for the four months since
they discovered the spot.
He started out
losing weight as “The Incredible
Shrinking Man”; then he became
Gregor Samsa for a while;
briefly he was the consumptive Violetta,
soon followed by Ivan Ilych.
He even remembered Susan Sontag
and Solzhenitsyn and so railed
at his wasting. He leaped
from metaphor to metaphor the way
a stone skips over water. He asked
all the questions everyone asks,
but felt no comfort from
the answers.
Companions and kin beset him
like Job’s friends. He graciously refused
their unctuous offerings, their leaden words.
Thinking could no longer save him.
His only balm now was his love for his son.
He had at last found something that had no metaphor:
This time, love would have to be enough.

About the poet:

Howard F. Stein PhD, a psychoanalytic and medical anthropologist, is a professor in the Department of Family and Preventive Medicine at the University of Oklahoma Health Sciences Center in Oklahoma City, where he has taught for nearly thirty-one

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Thanksgiving Reflections

1 Comment / Stories / Pulse Team

Pulse Writers and Editors

Editor’s Note: This Thanksgiving tugs hard at the emotions. While an economic gale roils the world, our freshly chosen captain stands on deck, pointing out a new direction for our battered ship of state. At the same time, each of us has personal joys and sorrows to contemplate. We asked Pulse’s writers and editors to take a moment to share their reflections.

This year, I am thankful for my four quirky little grandsons, my three loving children and my beloved husband of almost forty years. I am especially thankful that the country we share has a chance to find its way again and to call all of us, young and old, toward a future that can still be bright and full of promise. –Johanna Shapiro

I’m thankful for my daughter, and for how she kicks and growls in delight when I enter her room at 6 a.m. –Joanne Wilkinson

As one who came of political age in the 1960s, I remember as only a young man can the losses of JFK, RFK and MLK. As an older man, I’m all too aware of the fragility of any single human life. But I will be grateful this Thanksgiving for

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Hospice

Leave a Comment / Stories / Joanne Wilkinson

Joanne Wilkinson

My patient’s beagle is very quiet. He lies next to the brown leather living-room chair she used to sit in when I would come to see her at home. His nose is down on his paws, and his round eyes look up at me, up at the nurses, the home health aides, the family members who go back and forth between here and the back bedroom. He is very alert, but silent. He stays perfectly still.

My patient’s sons want to know things. How much longer will it be, will she be in pain, what will the end be like, will she be conscious? Should they take the rest of the week off from work, should they call the son in California and ask him to come? Yes, I tell them. Bring the relatives from far away, call in sick to work, get the minister, the undertaker, the cousin with the good voice who wants to sing at the service. It won’t be long.

They pace back and forth in the kitchen, stirring the air with their movement. Their footsteps shake the house’s foundations. Would it have been different, they ask, if we’d caught it earlier, if she’d

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little black boy

My Patient, My Friend

1 Comment / Stories / Larry Zaroff

Death is not always the same. Quantity, fixed: one per patient. Quality, variable.

Doctors see many deaths, of different kinds. This is true of any doctor, whether or not he or she is a surgeon, as I am.

It’s easier for the doctor when death is expected, following a long illness, a chronic disease. Harder when it’s unforeseen–the heart attack, the accident, the gun shot, the sudden death in a young man or woman who seemed a conqueror.

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Halloween Horrors

In the Taxi to the MRI

Entry from an Intern’s Journal

Leave a Comment / Stories / Jennifer Reckrey

Jennifer Reckrey

Editor’s note: Over the next months we’ll be carrying occasional pieces by Jennifer Reckrey, a family medicine resident in New York City. Each week while she was an intern, Dr. Reckrey recorded some of her experiences as a brand-new resident. Today’s story is from week number six.

How do you convince someone to do something they don’t really care about?

This week I took care of a 58-year-old woman who came to the hospital with one week of fevers, diarrhea, burning with urination, and abdominal pain. Though she probably had an infection, the CT scan she got in the ER didn’t reveal its source. It did, however, show that something was wrong with her uterus and ovaries. If the odd-looking mass was an abscess, it needed to be drained. If it was a cancer, she needed a very different sort of treatment plan. And to find out what was going on, she needed an MRI.

When I first asked her about it, she quickly agreed. She’d had MRIs scheduled in the past (her outpatient gynecologist was concerned about her too), but had always missed her appointments. She seemed glad for the chance to get this cumbersome test over

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