Joanna has always been more dramatic than my other patients, but this time she seemed so much more distressed and fidgety than before. I had to ask, “How are things at home?” That was her cue to ask me to bring in my medical assistant, who has now become her friend, to help with translation. She did not want me to misinterpret anything she told me, in her broken English. And so we switched to Spanish.
I was a second-year ob-gyn resident, back in the mid-1980s, when I met her in the clinic. She stood out because she could speak English—Queen’s English, to boot. She was friendly and happy. She anticipated her delivery with joy. I saw her several times in the clinic and again in the labor room, when we celebrated her son’s birth.
But here’s what she didn’t tell me: She had been a sex worker.
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There was the bed bent in half,
the needle in the wrist,
the crack of bathroom light under the door.
Your father tried to sleep in the hospital cot
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It was just another day at the outpatient plastic surgery clinic where I am training as a medical student. A middle-aged man walked in with multiple scars on the back part of both hands. At first glance, they looked like bite marks. On closer inspection, I saw exposed bone. What was I seeing? This didn’t make sense.
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24,576.
The number alone is staggering. Twenty-four thousand five hundred and seventy-six deaths due to homicide in the United States in 2020, per the CDC estimate. This number, however, leaves out much of the toll of violence, a reality that became clear to me after an experience in clinic one afternoon.
In the first months of medical school, we’re taught that patient autonomy should be one of a physician’s guiding tenets. The doctor provides diagnoses, prognoses and treatment plans, but ultimately it’s up to patients to make decisions about their own care.
As a family doctor, I often tell patients: “Only you can know what the right decision is for you. I’m here to provide information and recommendations and then to support your decision.”
But over the past year, as my father’s memory deteriorated and his life drew to a close, I learned about the ways in which our medical system limits patient autonomy.
During his last months, my father said repeatedly, “My brain is in chaos.”
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When I entered elementary school in the 1950s, I practiced hiding under my wooden desk in case a Soviet bomb was dropped on my school. By the time I took early retirement as a teacher in 2003, I was leaving a middle school with a locked-door policy; the principal told us if we ever heard over the loudspeaker that “Mr. Lock” had entered the building, we should immediately lock our classroom doors and gather our students on the floor, away from the windows.
I’ll call him Rocky. In a drive-by incident, his father was killed, and Rocky, age one, was shot multiple times.
His initial resuscitation was heroic—he received medicines to support his blood pressure, underwent emergency surgeries and was still attached to machines to support his breathing—but by the time I met him, the drama of his shooting had receded: He and his medical team had settled into a stable routine.
Though I suspect that the team had expressed their grief earlier on, I found this sense of calm jarring and unnatural.
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Dear Pulse readers,
A few years after my father passed away, my mother was visited at her New Jersey condominium by one of her favorite nephews, who drove down to visit from Canada.
Something happened–as I recall, it was a misunderstanding over a condominium parking space that my cousin was using. In trying to sort this out, the son of a friend of my mother’s became enraged and suddenly, without warning, punched my cousin in the face, knocking him down.
June More Voices: Gun Violence Read More »
I stare at the prescription bottle with instructions: Take once a day. Pill count-30. Refill until this date, the following year. I have a heart condition, Hypertrophic Obstructive Cardiomyopathy (HOCM), and I need the pills to decrease the blood pressure to and from my heart.
What Do I Do on the 31st Day? Read More »
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