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James and Bob
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,
The Cruelest Month
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
Trauma in the ER
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
The Winner
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.
Stuck
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.
Ms. Taylor
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
Pearls Before Swine
Kate Lewis
I’m a third-year medical student, and I’m starting the second day of my new rotation–a month that I’ll spend with a family physician, Dr. Bauer, in his small, efficient home-based office.
Yesterday, my first day, a young woman named Sara came in for “strep throat.” She had dark Latina eyes, broad cheekbones and a delicate tattoo of the Chinese character for “dream” on her left wrist. She was 17 and seeking out a primary-care doctor for the first time in her life; I applauded her for taking responsibility for her own health care. Her tonsils were big and purple, covered in pus, but the rapid strep test was negative. She also reported a vaginal discharge. Dr. Bauer wanted to do a pelvic exam
Adverse Effects
Kenny Lin
Flashback to summer of 2008. I’m looking forward to August 5–the day that I’ll no longer be a faceless bureaucrat. The day that the US Preventive Services Task Force (USPSTF) will issue its new recommendations on screening for prostate cancer–recommendations I’ve labored on as a federal employee for the past year and a half.
For much of 2007 I combed the medical literature for every study I could find on the benefits and harms of prostate cancer screening. In November of that year I presented my findings to the USPSTF, a widely respected, independent panel of primary care experts They discussed and debated what the evidence showed and then voted unanimously to draft new recommendations. I didn’t get to vote, but it has
Making Headlines
Reeta Mani
“Did he die of swine flu?” demanded a scrawny man wearing a blue shirt and green surgical mask. He was one of a throng of news reporters packing the lobby of a private hospital in the heart of Bangalore, my city.
It was early August 2009, and India had just recorded its first casualty from the novel H1N1 influenza virus. This latest variant of influenza–a chimera of swine, avian and human flu genes–was raising grave concerns among the medical community worldwide. To try to contain a pandemic, countries were ordering stockpiles of antiviral drugs and initiating vaccine production on a wartime footing.
In Bangalore, as elsewhere, you