Literature

“This is not your usual quality of work. Please resubmit when you can.”I totally forgot writing that, and in retrospect it looks harsh.But more than a decade later, that student reminded me and said being seen and treated as aperson changed their life.You don’t necessarily know when you transform someone’s world.

Resident Clinic TherapyHow was the weekend?We talk sports, partners, kids, pets… life.90’s movies & song references.Pop culture quotes from our youth.Residents enter. . . We pause. . . staff the visit. . . teach. . . un-pause.We laugh. . . we bond. . . we connect.Background noise from dragon and keyboardsclacking.Re-charges me for the rest …

Continue reading “The Locker Room”

Patients cough, die.Then a Black man says“I can’t breathe,”His neck under a knee. Two threats now:violence and virus At my clinic, shattered glass.A rock on the exam-room paper.A Black patient apologizes:for crying mascara on my white coat.I listen to her heart, her breath,and try to breathe.

Her bruised body records her trauma.Her hands clench and unclench.She whispers, “They will say I should have known.”He’ll declare, “Look what you made me do.”I reach out tentatively to touch her hands.A single tear lines her cheek.After the examination and photographs, she sits quietly.Her hands clench and unclench.

Kneeling by her bed, they started to pray.I watched respectfully, and turned to leave,knowing Haldane’s work on the efficacy of prayer:an exercise in futility (but comforting at night).Next morning I met her properly, sat up on pillows,enjoying breakfastfrom a box her children had brought from outside.She smiled, symmetrically.

Slowly, I insert the needle, withdrawing the straw-colored fluid from John’s lung cavity. Only 35 years old, his extreme shortness of breath brought him in. His x-ray shows a right-sided whiteout, with his thoracentesis the first step to his eventual cancer diagnosis. I see his future of chemo, resection, and radiation. And then I cry.

The yellow balloon continued inflating.It enveloped the bedside nurse, then myself.Soon the whole room was awash with dingy mustard light.There was so much pressure, with nothing to relieve it.Inside the balloon, I saw him, scared and strong.Shaking my hand firmly, he thanked me,ready to die with his dignity intact.

My exam room is evidently too plain for my favorite adult patient, whose cognition may be lower than most, but whose wisdom is much higher.He wears his interests on his sleeve. And belt buckle. And hat.“What you need in here is a picture of Godzilla, a Rodin, and a megalodon.”I don’t disagree.

He is admitted for end-stage Parkinson’s diseasewith acute delirium.I ask,Why won’t Neurology see him?Why is he still restrained in bed?Why won’t a skilled nursing facility accept him?Why can’t hospice help?Why does it take so long?He asks,How will it end?How will I die?I don’t know.

Caring for patients is harder some days. “I killed my cat. He was biting and clawing me. I knew he was scared, but I just shook him hard to make him stop. I feel terrible and don’t want to be that person.” I’m glad it wasn’t his baby. Sad about his cat. Sad for him.

Outside, dark and quiet with softly falling snow.It’s Christmas Eve.I see blasts on your bone marrow slide.I am waiting for the flow cytometer. You are waiting too, sweet child.Finally, data–B-lymphoblastic leukemia.Cancer and I will now ruin your holiday.I pick up the phone and tell your hematologist the news.

Has been fifty years since entering the Universidad de Buenos Aires at the historic Manzana de las Luces. After these many years in academia, is troublesome to see the emergence of anti-science and irrationalism, but for the sake of my grandchildren I hope the forces of darkness will go back to their caves of ignorance.

You said you weren’t afraid of death, but dying. We talked about comfort, expectations, grief, hospice. You got sicker and sicker, but always allowed my students in the room. I asked one time, and you said even dying you couldn’t stop being a teacher. Quietly, softly, patiently, you taught them more than I ever did.

New world virus. Acute Leukemia.Suffering alone, “no visitors allowed.”Wicked pain forbidding sleep.Relief, please –Groggy,Footlong eyelashes obstructing vision.Beetles crawling up left arm.Kidnapped by night nurse: (malicious intent).No one knows.Orange walls, secret room.Must escape!Pack bags – Push IV pole – RUN! My iatrogenic delirium.(Courtesy of opiates and sedatives)

Supplementary Motor Area(Not the one the belly surgeons worry about)Median premotor cortexFrontal aslant tractContralateral akinesia, normal reflexes, and tonePreop warningFamilies worriedPatient confusedI am frustrated90% recovery in weeks to monthsReassure the familyDo they believe me?Do I believe?All relieved by improvement at post-op visit

Treating poverty with metformin is hard.“I want my inside to match my outside,” she said.Where others see a political punching bag, I see people.And they see me.In seeing each other, we are helping each other.I provide care.They remind me of why I went into medicine in the first place.

I am a pharmacist; my dad is dyingI am his advocate–we are visiting his care team nowI understand the words and translate for my familyI understand what’s happening to his aging bodyI know what the others don’t—it won’t be longToday, can you please help me be his daughter?

I received a national leadership lecture award.I gave this lecture to my colleagues.My family heard me speak—my voice, my words.My son said: “I have never seen you so animated!I guess you leave it all at work.”He has a point:I missed so many opportunities.Leaving it all at work.

War or COVID-19, you choose; I’ve done both. From Iraq, you go home in a year.From COVID-19, you come back tomorrow.In war, they give you a medal.In COVID-19, they give you 3 shots plus.Get hurt in a war, they send you home.Get hurt in a pandemic, you come back tomorrow.