Oh, how I remember this well: The wicked snowstorm that paralyzed many cities, year after year. I was driving my van to work as it slid on black ice and directed me down a hill towards a large church. I had no control and could only pray that I didn’t hit that large telephone pole. When my van finally came to a stop, I realized I had missed the telephone …
Essential personnel safety: the hypocrisy of hospital snow policies
The world has slipped out of rhythm,
like a clock knocked from the wall
that still insists on ticking,
though the hours no longer agree.
Nothing aligns with the way it lived
in my body a year ago.
Then, there was a sense of ballast.
Morning came without dread
clinging to its edges.
I could rise,
place my feet on the floor,
and believe, perhaps naively,
that the ground would hold.
I believed the voices we chose would,
at minimum, remember us.
That disagreement was …
Finding balance in political turmoil: a poem on resilience
For half a century, the “gold standard” of labor safety has been a single, flickering line on a screen. But as recent reporting confirms, that line is often a lie. Our obsession with isolated fetal heart rate patterns has created a surgical “false positive pipeline,” driving C-section rates to historic highs without actually reducing the incidence of cerebral palsy.
The myth of the “failed” test
The skepticism surrounding EFM often stems from …
Artificial intelligence and the future of fetal heart rate monitoring
“Mom says she talks to me every day now.”
The son told me this during a clinic visit. His 82-year-old mother, once painfully lonely, now smiled again. She told everyone she spoke with her son every morning. He asked about her day. He reminded her to take her medication. He listened to her stories.
There was only one problem.
She was not talking to her son. She was talking to an AI voice …
The hidden dangers of AI voice assistants in elder care
An excerpt from In Search of Dignity: A Lifetime of Reflections.
Several years before her death at the age of 55 years due to complications of cerebral palsy, my sister Ellen was again in hospital, this time in intensive care and on the brink of respiratory collapse. To say cerebral palsy had shaped her life is an understatement, in that it molded nearly every facet of her being, from the …
The Platinum Rule in health care: Moving beyond the Golden Rule
Most people expect a heart attack to announce itself with unmistakable force, crushing pain, shortness of breath, a dramatic collapse. Mine arrived quietly, unnoticed, and remained hidden for years. What I discovered in 2026 forced me to revisit events from 2018 and 2019 and confront how easily critical medical information can slip through the cracks when communication fails.
A routine appointment reveals a hidden past
On Jan. 8, 2026, during a routine …
Silent heart attack symptoms: my missed diagnosis story
I cannot claim to have been the one who nurtured our garden. That credit belongs to my wife. She is the one who waters the plants faithfully and notices when something needs care. I am more often the admirer, the one who pauses to appreciate a flower that seems almost too beautiful to belong in an ordinary backyard.
Among the plants that brought me the greatest joy was a passion vine. …
The passion vine: a lesson on restraint in medicine and life
The way hospitals traditionally staff is burning out nurses and killing patients.
A single call-in or unanticipated census spike creates heavier patient loads for front-line nurses. Research published in the Journal of the American Medical Association found that surgical patients have a 31 percent increased likelihood of death within 30 days in hospitals with 8:1 nurse-to-patient ratios, compared to those with the optimal 4:1 ratio.
Further, when nurses were asked why …
Predictive staffing in health care: Solving the nurse burnout crisis
Every reproductive endocrinologist knows that ovulation is triggered by estradiol. In our textbooks, the sequence is clear: Estradiol rises, triggers an LH surge, and ovulation follows, culminating in the formation of a corpus luteum, which produces progesterone to support implantation and pregnancy. It is straightforward and reassuringly precise, and it forms the backbone of our clinical practice.
Yet, from the very beginning of training, we are instructed to use artificial ovulation …
The Dozortsev-Diamond paradigm: Is progesterone the true ovulation trigger?
It is very cold in Islamabad. These days, I feel overwhelmed by joblessness, the constant lack of money, an upcoming medical exam, and the slow progress I am making in life. Apart from studying for my upcoming medical exam, the most consistent part of my routine has become counting money. I check all my bank accounts, calculate every remaining rupee, and make small, anxious plans about how I will manage …
Winter in Islamabad: Finding hope in the daily struggle
After working close to 20 years in this medical-surgical ICU, I thought I was an expert. Infallible. I could do it all.
I left my ICU comfort zone, my lifelong nurse friends, and ventured out. Nothing could stop me.
For a different hospital system, I became a critical care resource nurse.
This very large hospital system would dictate what unit I would go to and for how long. I truly thought I could …
Why I left the surgical-trauma ICU: a nurse’s story of burnout
How one reframing changed the way my patients think about me, and their health.
Every day, a patient sits across from me, arms crossed, waiting for me to tell them what pill to take. Or worse, waiting for confirmation of what they already believe: that the medical system has nothing real to offer, their doctor is just a middleman for pharma companies or an insurance shill, and that the answer to …
Rebuilding patient trust through the evolutionary mismatch framework
In engineering, a feedback loop is meant to stabilize a system. In medicine, feedback guides us toward better outcomes. But in applied behavior analysis (ABA), feedback has become a trap, recycling failure under the guise of science, and leaving children and families caught in its circuitry.
The closed circuit
Stevens’ feedback loop diagrams are elegant in their simplicity: arrows circling back, showing how inputs and outputs can stabilize a system. In healthy …
Applied behavior analysis criticism: the closed feedback loop
The moment I decided to become an American-trained dentist, I was holding a textbook in India. I was a first-year dental student in India when it happened. I had just bought my textbooks for the semester, the thick, heavy kind that feel important in your hands, and I started flipping through them.
Page after page, I kept noticing something. The authors. Their names. Their affiliations. Almost all of them were from …
Navigating the international dentist U.S. pathway
My wife is dying.
The day has yet to be determined, but the causes are certain. Stage 4 metastatic pancreatic and liver cancers will allow her a few weeks more in which to say goodbye to a large circle of family and friends. She has decided not to undergo chemotherapy or radiation that at best might extend her life by a few weeks, at the cost of the quality of whatever …
Lessons from 47 years: long-term marriage and palliative care
The repeal of the “X-waiver” in the Consolidated Appropriations Act of 2023 was widely celebrated as a long-overdue step toward expanding access to buprenorphine for opioid use disorder (OUD). By removing the requirement for supplemental training and a special DEA designation, policymakers hoped to normalize treatment and reduce barriers for clinicians.
Yet nearly two years after, buprenorphine prescribing remains inconsistent across the country. Only one in four Americans …
Why buprenorphine prescribing still lags after the X-waiver repeal
“Why are you studying that? Philosophy won’t help you save lives.” If I had a dime for every time someone said this to me, I could single-handedly fund an entire class’s medical school tuition. Being a pre-medical student who majored in philosophy feels like being the only person asking “why” in a room full of people asking “how.” I have thought to myself many times that there is no balance …
Philosophy in medicine: Why doctors need to ask “why”
He came in wanting to get his smile back. I did not know he was also asking for his life.
He sat down in my chair and did not say much at first.
That happens a lot in a MassHealth practice in Massachusetts. People come in with more than just one problem. They carry shame, years of avoiding problems, and a lifetime of being told by systems, situations, and sometimes even their …
Treating methamphetamine-associated dental disease in safety-net clinics
In my first week of anesthesiology residency at the Hospital of the University of Pennsylvania, I learned two things at once: how to keep other people breathing and how it feels to lose your own air. My chest filled with liters of lymphatic fluid. A scan showed lungs that looked like lace. The diagnosis was LAM, lymphangioleiomyomatosis, a rare, estrogen-sensitive lung disease that overwhelmingly strikes women in their reproductive years.
At …
Reproductive care for rare diseases: the missing playbook
“Overdiagnosis is a myth that has been created by a handful of individuals who provide no care for women with breast cancer.”
This quote by Dr. Daniel Kopans encapsulates a long-standing and intense debate in the medical community regarding cancer screening.
In the Dec. 9, 2025, issue of the New York Times, Gina Kolata quoted H. Gilbert Welch, MD, on his perspective that “treatments need to be balanced with the consequences …
The myth of cancer overdiagnosis: Why screening saves lives
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