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Please Don’t Ask

 
“Please don’t ask” was my silent plea to my patient as I entered the exam room. I knew if she did, I would start crying, and not for the first time that day.
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Hearing Voices

Robert Burns

“She’s been hearing voices,” says Adala’s nephew Diri. “She hears them every night.”

The three of us sit in an examination room of my private geriatrics practice. I’ve been in a community-based practice in Memphis, Tennessee, for nearly twenty years.

Adala is a tall, slender woman. Dressed in a gray-blue guntiino, a long piece of cloth tied over the shoulder and draped around the waist, she has her head covered with a shawl. Her gaze shifts from her nephew to me; her eyes search my face and then stare silently at the floor. Despite the differences in culture and language, she is like many of my patients brought by a family member. She’s not here by choice; she came in

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Brave New World

Rosalind Kaplan

I think a lot about quitting medicine lately. A lot.

Then I have a morning like yesterday morning:

I see a patient I’ve known for more than twenty years, caring for him through an adrenal tumor, a major gastrointestinal surgery and now renal failure, for which he needs a kidney transplant. As we review his last set of labs (stable, thank goodness), he is sanguine, hopeful. He may have found a donor, and he might make it to transplant without dialysis. He has to live–he has a wife and a child.

Next, I mess up my schedule entirely by spending more than half an hour with a patient who only came in to talk–not about herself, really, but about her

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Hope Lost

In 2004, Barack Obama delivered the keynote address at the Democratic Convention. He entitled it “The Audacity of Hope.” At the time, as a wide-eyed, innocent medical student who had just finished her third-year clerkships, I wondered if the medical profession had not only lost this audacity but, furthermore, if we discouraged our patients from “the audacity of hope.”

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Heart and Soul

Fredy El Sakr

“Help!” I yelled out of our open apartment door.

I was seven years old, and my family had recently emigrated from Egypt to the US. We’d been feeling elated that week because, after months of interviews, my father had matched into a pediatric residency.

That morning he’d awakened feeling nauseated. My mother and sister went to buy some soothing food. I noticed that he’d vomited in the bathroom; now he was feeling worse.

He knew it was serious, because he put on his brown leather jacket and lay back in our blue recliner, waiting for my mom to return and take him to the emergency room. Now and then he’d look at me reassuringly with deep, dark, pain-stricken eyes,

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Abuela

 
The abuela was a standard admission of my internal medicine rotation. “CVA” said the medical record, which meant this Guatemalan grandmother, or abuela, had suffered a stroke. She was visiting the U.S. to help care for her first grandchild, who was due any day. She had felt fine until, suddenly, her diabetes, high blood pressure, and high cholesterol had imploded. In quick succession, she’d experienced a stroke, a 911 call, and the ER. Uninsured and undocumented, she’d been stabilized and transferred, serendipitously, to our nationally renowned rehab hospital–a stroke (no pun intended) of luck for this far-from-home 54-year-old.
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Learning to Trust

 
I admitted Hiral Jacobs, a twenty-something college student who’d collapsed in her dorm, directly to the ICU from surgery.

The OR report said she’d received two units of blood and was still intubated. Given my forty years of ICU nursing, it sounded routine.

“By the way, the patient is Muslim.”
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Before Ultrasound

Mary looks not too bad for having a two-week-old baby only now getting good at nursing. He looks content. His weight is not quite where I would like to see it, but not worrisome.

Lifted in my hands, his tone is great, his gaze intensely locks on mine. Put back down, his arms and legs flail enthusiastically. Cheeks are chubby, soft skin is pink. He passes the gestalt test – no worrisome sense that something is not quite right.

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At Day’s End

Marc Tumerman

This is a story of two deaths. That these patients’ stories intersected on the same morning, in the same building, in two adjacent rooms, has left me thinking about them now that the day is almost done.

I was surprised to see Mrs. Stevens’ name on my schedule today. She came to the office last week, and I felt sure that she’d be too weak for another visit. But I was glad she’d made it, as I’ve become quite fond of her.

She’s seventy, and dying of metastatic lung cancer. She’s a lifelong smoker, but at this point I’m not worried about cause and effect, accountability and responsibility. None of that changes what I must do now as her physician.

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Speeding Ticket

I’m an ob-gyn, so the middle of the night is like a normal workday for me. I view the drive in at 2:00 or 3:00 a.m. as my transition time from interrupted sleep to an important moment for my patient and spend it reminding myself to make the shift from fulfilling my needs to theirs.
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A Stroke of Faith

 
“SIGNED OUT AGAINST MEDICAL ADVICE,” declared the last line of the ER physician’s note, bold and foreboding.

I quickly skimmed through the rest of his chart. Mr. Lopes was an elderly Haitian man, a recent immigrant, who had visited the local emergency room for a bad headache, only to discover that his blood pressure was astronomical. Apparently, Mr. Lopes and his family considered him too sturdy a man to be retained at the hospital overnight, labeled as sick. So he fled.

And here he was, weeks later, to meet his new doctor. “BP: 190/100” read the nurse’s note in red.

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The People a Doctor Worries About

 
The middle of the night is when I worry about a patient like Olevia, whose oldest son was shot and killed at the age of 23. He left behind his baby mama and his two baby girls. Olevia didn’t have enough money for his funeral expenses, so she had to promise to pay in installments over the course of the next two years. So she gets a reminder of his death every month in the form of a bill.
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