Two daughters bring their severely demented mother into the clinic. The mother is no longer able to speak, but over the last few days she has groaned more during diaper changes. Her nursing home is worried she might have a bladder or vaginal infection. To check her urine, we undress her and catheterize her. To check her vagina, we take a swab using a speculum. We spin the urine and look for sediment under the microscope. Nothing. We look at the vaginal smear under the microscope, using both a saline prep and potassium hydroxide. Nothing. We treat her for bacterial vaginosis, because it’s a condition that’s easy to miss.
“Hey Doctor Curly!”
“Hey Hungry Hippo!”
“You still haven’t gotten a haircut? Have you had one since your Bar Mitzvah?! What nice Jewish girl’s gonna go on a date with you with your hair that long?!”
Hugh Silk
“Why do you want to go into family medicine?” my internal-medicine preceptor asked.
It was an innocent enough question. I’d known from day one of medical school what I wanted to do, so I answered with confidence, and perhaps a bit of a chip on my shoulder.
“I love being with people and getting to know them,” I said. “I’ve always been this way, so it makes sense that’s what I would do for my career. I’m looking forward to having the long-term relationships and seeing where they go.”
A raised eyebrow, followed by his knowing Irish brogue: “I applaud that. My own father was a GP in Ireland. But I’m afraid you won’t find much of that in
Paul Gross
In the wake of recent events, many speak about the need for conversations about race. In our country, the implications of race are a moral issue, a humanitarian issue, a justice issue and, yes, a medical issue. (One need only examine how racial categorization affects rates of death.) But what would this conversation about race look like?
Today, Pulse’s editor provides one offering. In August, we’ll invite all Pulse readers to join in with their stories, when Race will be the theme of More Voices.
I grew up in Stuyvesant Town, a middle-class housing development just north of Fourteenth Street on the east side of Manhattan. Built after World War II, Stuyvesant Town was a leafy and desirable place to live.
I was the new doc in a small country town. I wanted to be accepted. I wanted to do best for my new patients.
She was the town matriarch. She had multiple chronic illnesses. She had the power to make me or break me.
“Your hands are cold.”
I heard these words throughout my third year of medical school, the year during which we first touched patients on a routine basis.
My hands were cold. I was nervous; how could I not be? What a strange experience for me–asking strangers to disrobe, then touching their bare skin.
Hind Almazeedi
Arwa arrives late to the clinic. Her husband is parked outside waiting for her.
“You missed your last two appointments,” I say, checking her records. It’s been four months.
“I didn’t have a ride,” she shrugs.
Many of my patients live close to the primary-care center in Kuwait where I work as a family physician, but the desert heat makes it impossible to come here on foot. Two minutes under the sun can leave you delirious, and if you have asthma, the sudden dust storms are a constant threat. Without an air-conditioned car, you’re essentially homebound.
I know this, so I don’t argue with Arwa.
H. Lee Kagan
My longtime patient Brenda let the top of her exam gown drop to her waist, stepped down off the exam table and turned to look at herself in the mirror. As I watched, she cupped her seventy-eight-year-old breasts in her palms and unceremoniously hoisted them up to where they’d probably resided when she was in her twenties.
“I’m thinking about having my boobs done,” she said. “My girlfriend had hers done, and she’s very happy with how they turned out. What do you think, doctor?”
As she spoke, her eyes remained on her reflection. Breasts held high, she made quarter turns to the right and left, then leaned back.
“I don’t like how they look now,” she said,
Maria Gervits
I miss Alba. I don’t know why, but I do. She was the most challenging patient I’ve ever had. I dreaded seeing her in the office–and yet, somehow, she won me over.
Alba was fifty-nine, with short, silver hair, a deep, gravelly voice from decades of smoking, and an attitude. She had lung disease, heart disease, depression, arthritis and HIV. She also had a complicated social situation. She’d used cocaine and heroin until her husband had died of HIV. She’d then moved in with her elderly mother and cared for her until her mother died of a stroke. Now Alba lived in a shelter right around the corner from where her father had been shot years before.
The biggest joy
Joseph Fennelly
In recent years the medical profession has witnessed a surge in burnout and depression among physicians and other health professionals. Efforts have been made to address this–for example, by offering Schwartz Center Rounds, in which caregivers openly and honestly discuss the social and emotional issues they face. Health professionals can also reduce stress through counseling, meditation or massage, or through practical steps such as cutting back on their working hours.
In the most traumatic cases–those marked by the death of the patient–physicians have yet another powerful source of comfort and emotional support. This support, offered by the patient’s family, comes within a context that allows the caregiver to accept it without forfeiting professionalism.
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