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The Resilient Heart
Paula Lyons
He was applying for a job on a refuse truck working for the City. This is a very good job for someone whose hiring prospects are otherwise limited. Excellent benefits, all state and federal holidays off, health insurance for oneself and one’s family, physical exercise in the fresh air. (All right, this was Camden, New Jersey, so exercise in some kind of air.) And one more plus: If the team is efficient and hardworking and get through their rounds by 11:30 am or noon, they can take the rest of the day off, yet get paid as if they’d worked the whole 5 am-to-1 pm shift.
I was the doctor doing his pre-placement physical exam–designed to determine if the potential employee has
One More Child Left Behind
Brian T. Maurer
Making the diagnosis might be straightforward, but sometimes getting adequate medical care poses a more formidable challenge.
It was the end of an exhausting afternoon in our busy pediatric practice in Enfield, Connecticut. I had just finished seeing what I thought was the last patient of the day, only to find yet another chart resting in the wall rack, a silent signal that one more patient waited behind an adjacent closed door.
His name was Aaron. Six years old, he sat on the exam table cradling his left arm in his lap. The most striking thing about the arm was the large bluish bulge on the side of his elbow. His mother stood by his side; his grandmother sat in
Second-Guessed
Andrea Gordon
It was a good night, but it’s been a brutal morning.
As a family doctor who does obstetrics, I generally enjoy my time with laboring patients. When I arrived on the maternity floor last night to start my call, things looked pleasantly uneventful. Several patients were in labor. Only one wasn’t progressing well: Ana, age twenty-two.Â
I was told that Ana had come to the floor two days earlier, leaking puddles of clear fluid but not contracting. She still wasn’t contracting, even after two days on pitocin, the drug that causes or strengthens uterine contractions.
To add to this difficulty, there was Ana’s shift nurse, Barbara.
Barbara and I had a history. Another night, caring for a very annoying patient,
Steep Sledding
Jonathan Han
“Don’t worry,” my doctor said.
I barely heard what he was saying; lying there in the hospital bed, I was caught up in contemplating the diagnostic procedure I was scheduled to have the next morning.
“With these anesthetics,” he continued, “you won’t feel or remember a thing after it’s over.”
“Okay,” I answered weakly, signing the consent form with unaccustomed legibility. But could I really forget the emotional trauma of these past twelve hours?
I’m a physician, and blessedly accustomed to standing on the other side of the health-and-illness divide. But after four days of crampy abdominal pain, my self-diagnosed “gastroenteritis” had horribly morphed into a “rule out carcinoma” directive. Now I faced another twelve hours of waiting–reviewing
Late Again
Paul Gross
One thing I love deeply about being a family doctor is that I get to take care of people–body and soul. A patient comes into my exam room with a litany of physical symptoms (“My shoulder…my knee…my stomach…so tired…this nausea…”) and then, in response to a questioning look, suddenly bursts into tears.
It’s all mine to deal with. The shoulder. The stomach. The tears. I get to gather the pieces and see if we can’t put this broken person back together again.
What a privilege.
And yet the joy of primary care is also its curse. With each patient, I have to keep track of everything–the trivial and life-threatening, the physical and mental, the acute, the chronic and the preventive. And
The Emaciated Infant
Paula Lyons
The police had been called to the house by a neighbor who said she heard children crying and hadn’t seen the mother in two days. It was the middle of a night in July, and the children’s wails would have traveled through the project windows left open to catch cooling breezes.
Paramedics provided transport to the hospital, but the normally cynical and well-defended police were so outraged that they also came to the ER, where I was the resident on call.
The police came to find and punish those who had neglected this waif, but I also sensed that, despite their tough exteriors, they came also to vent their impotent rage and to seek reassurance that this tiny, dirty, appealing thing
Chris
Lisa deMauro
My big sister Chris, 55, had recently returned to her first career, nursing, when she wrenched her back one day while helping to lift a patient. After weeks of physical therapy proved unhelpful, her internist ordered some tests, which indicated that her back injury might signal something more sinister. She’d had a lumpectomy for a “stage 0” breast cancer five years earlier, and her doctor advised her to make an appointment with the newly appointed head of a brand-new cancer center nearby.
Chris and I were nine years apart–a difference that precluded any sisterly rivalry–and we’d always been very close. She’d occupied a central role in my life: first, as a playful second mother to me, then as my ideal of teenage glamour,
Looking for Respect
Ashrei Bayewitz
This may sound strange, but I secretly looked forward to my colonoscopy.
I was excited to see the people in the colonoscopy suite–the receptionists, the nurses and my doctor. I knew that they would like me, because I would be brave and respectful. That’s what’s always happened since I was diagnosed with Crohn’s Disease ten years ago. During my multiple colonoscopies and countless doctor visits and other outpatient procedures, I invariably build up a rapport with someone, be it a doctor, nurse or staff member. I’ve always been a good patient, and now that I’m a second-year medical student as well, I can understand their work a little better. I expect them to sense my goodwill and to treat me in turn with
Tug-of-War
Jo Marie Reilly
As I teach first- and second-year medical students to take patient histories and to perform physical examinations, I always feel humbled and privileged–energized by their compassion, enthusiasm and facile, curious minds.
Occasionally, I feel particularly challenged–especially when I’m teaching a student who, though bright, is struggling to acquire some of medicine’s basic skills. As we journey up the learning curve together, my responsibilities can conflict: as a teacher, I want to nurture an aspiring student physician, yet as a physician, I must ensure that patients receive appropriate care.
Now, sitting quietly in the corner of the room and watching a young medical student interview a county hospital psychiatric patient, I begin to feel this tension.
“What brought you into