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Breaking Bad News
Bad news is like a lump of red-hot coal that lands in your palm–and that you can’t let go of, no matter how badly you’d like to.
I was tossed the burning coal over twenty years ago, when I was thirty years old and fit as a fiddle. Or so I thought. I also happened to be a first-year medical student, having my head filled with facts large and small about the human body.
Then something started to go wrong.
Coming Full Circle
Stacy Nigliazzo
Only thirty minutes into my evening ER nursing shift, and I was already behind. My first patient was a pregnant teenager with heavy vaginal bleeding. “About three months, I guess,” she flatly replied when asked about her last period. As we placed her legs in the stirrups for the pelvic exam, torrents of blood and water rolled into the kick bucket on the floor.
Dr. Parkman had barely opened the speculum when we saw it. I knew she couldn’t see the doctor’s face, but she could see mine. Shielding her from my expression, stunned and speechless, I cowered as best I could behind her left knee.
There it was. Tiny, pink and perfect. Her baby’s hand, so small that it would easily fit
Brain Cutting
Emma Samelson-Jones
The page came to my resident, who grinned and looked over at me, his hovering medical student. “You should go to this.”
I looked down at the pager.
“Brain Cutting. 2:30 PM. Room B157.”Â
Text pagers are the indifferent bearers of all news. Emergencies–“Smith, BP 60/30, Room L721”–appear in the same font as messages seemingly borrowed from a teenager’s cell phone: “OMG, the harpist in the hospital lobby is playing ‘My heart will go on’ from Titanic. WTF?”
I dutifully took the elevator down to the hospital basement and opened the door to the morgue. The medical examiner and a group of neurology residents and students were gathered around a steel table, its sides sloping gently down to a central drain.
As more
Heart to Heart
Janani Krishnaswami
I first met you in pre-op. It was my first week as a third-year medical student; my white coat was still white, the hidden interior pockets empty and the ten gel pens neatly tucked in my front pocket still leak-free. Stationed on a surgery rotation, I had officially spent twelve hours in the operating room–a frantic, exhausting blur of standing on tiptoe, gripping surgical retractors and struggling to avoid contaminating the sterile operating field where the surgeons neatly clipped and cut. You were the next case. From your chart I knew the barest facts: your name was Marie; you were forty-five years old, diagnosed with invasive breast cancer and scheduled for surgical removal of both cancer-ridden breasts
As I made my way to
Hard Facts and Fiction
Brian T. Maurer
At Daniel’s first visit, it had been like pulling teeth to get this fourteen-year-old slip of a boy to talk. Despite my thirty years experience as a physician assistant, I hadn’t made much headway. I’d pose a question, and his mother would jump in to answer it. He’d slouched on the exam table, staring at the floor. Occasionally he’d lift his eyes to meet mine, then quickly look away.
Daniel’s mother had said she was concerned about him. He didn’t sleep at night; he couldn’t get up for school. He’d missed so much that he was in danger of failing his grade, and the year wasn’t even half over.
Daniel’s mother was not much taller than her petite, quiet son. She was
Miscarriage
Jessica Bloom-Foster
From the moment I walk into the room, she breaks my heart. She has just been sent to obstetrical triage from the ER, where an ultrasound has revealed a twenty-two-week pregnancy and a cervix dilated to four centimeters–halfway to delivery stage. She is moaning from her labor pains and moving restlessly on the narrow cot.
I am a second-year family medicine resident in a Midwestern hospital, and well past halfway through a busy call night. She is a thin, dusky-skinned woman, and she looks at me with wide, dark eyes full of sadness and pain. Her hair is pulled back with a nylon rag, and most of her front teeth are missing. Her face seems long and gaunt.
I take a rapid history
See One, Do One, Teach One
Lisa DeTora
Back when I was in graduate school and working as a medical writer, a physician told me that the key to learning medical knowledge was simple: see one, do one, teach one. It was a clever (and effective) way of convincing me that I was qualified to teach something–like how to write a report–that I’d only attempted once myself.
Now, on days when nothing goes right, I find myself thinking back to that expression–and to the years when I used to see and do more, before I tried to teach anyone anything.
Soon after college, I worked at a private outpatient facility supervising the care and treatment planning for eighteen developmentally disabled adults. I was, in my own fashion, hoping to make a
Wounded Messenger
I pulled back the plunger, sucking lidocaine from the bottle into the syringe as I prepared to lance Jimmy’s abscess. A voice in my head kept repeating, like a mean-spirited parrot, that I’d never done this procedure before–not even under supervision, and certainly not by myself…
I’d met Jimmy two months earlier. He’d come into our clinic with a fever, shortness of breath, a horrible cough, and a crumpled paper photocopy of a chest x-ray taken at another clinic. They’d diagnosed pneumonia and given him a course of antibiotics.
But now a month later, still coughing and drenched in sweat every night, he’d come to see us. He was pale, perspiring, exhausted and in pain.
Intern’s Journal–Surprises
Jennifer Reckrey
Editor’s note: Jennifer Reckrey is 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 doctor. Today’s stories are from weeks number nine and twenty-five.
Week Nine
I dreaded my rotation in the Intensive Care Unit. Though all the tools to keep a body alive are right there, their continuous bells and beeps jangle my nerves. I’m always afraid that in this place I will be called on to act decisively and invasively. And my mind will go blank. I will hesitate, and that hesitation will make an already awful situation worse. But even more than that, I dreaded this rotation because I think of the ICU