It’s 9:30 a.m. on a Wednesday, I get on the elevator, and I hear a man in his 40s, having a conversation on his cell. He says: “He had a brain bleed yesterday, and they had to put a breathing tube in, they don’t know how much damage his brain has suffered at this point.” He gets off on the adult ICU floor. I quickly think “that sucks” and carry …
Am I the cold and detached physician?
I’ve been practicing as an interventional pain management physician for over six years. It was a long road to get here — four years of medical school, four years of residency in anesthesiology and one year of fellowship (in addition to the four years of undergraduate education). So people say, “You must really love what you do.” Sure, during residency there was light at the end of the grueling tunnel …
The painfully fine line of pain management
Perhaps one of the hardest things about medicine is cross-coverage, that is, to be the covering doctor for your partners, whether for the occasional night, weekend, or longer. It’s not something done only in oncology. All specialties in medicine have this system, which allows us to have lives outside of our hospitals and clinics. What’s …
Cross-coverage has made me aware of the art in medicine
I met David on the internet. It was to become on of the closest, most intense relationships of my life. For you see, a few months before he crossed my path his daughter finished the same protocol for the same type of brain tumor that my daughter just had started. They had successfully traversed the waters that to me were completely unknown — and frankly terrifying. On the pediatric brain tumor listserv, …
Everyone needs someone to be a safe harbor
For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications.
As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable …
The fall of the digital rectal exam
As the patient talked, I found myself nodding my head. In so many ways, she was just like me. Highly educated, a professional, a woman who had worked hard and long to get where she was. And then cancer took it all away, or at least that’s the way she described it. She was diagnosed with metastatic cancer one year …
How silence can help us learn from our patients
When it comes to colon cancer prevention, the polyp is the key player to know. Colon polyps, called adenomas, are precancerous growths originating from the inner lining of the colon wall. There are other types of polyps in the colon which are not considered precancerous, but for our purposes in this article, we will consider the terms colon polyp and adenoma to be …
What you should know about colon polyps
Part of the challenge in oncology is the balance between hope and reality, and that is probably the most important thing to strive for for patients living with metastatic disease. Often times, the important conversations relate to treatment options, goals of care, and patient preferences (i.e., how frequent the visits to the doctor and for …
The challenge in oncology: balancing hope and reality
It’s 10 p.m. on Wednesday night, and I’m finishing up my notes for my patient visits from this morning while I do my bowel prep for my colonoscopy tomorrow.
Now, I know we can argue the biomechanical challenges of doing both of these tasks at the same time, and this certainly may be TMI, but it struck me as I was sitting there trying to do both of these things how …
Doctors: Don’t forget to take care of yourselves
Bruce Wilson, MD, is a hospice doctor and former cardiologist who was diagnosed with pancreatic cancer in February of 2017. In the months that followed, he publicly discussed events as they unfolded on a CaringBridge blog. The irony of the situation was profound: a hospice doctor being handed what some consider a death sentence. A physician who dedicated his career to changing the conversation about end of life care now …
Radical realism: A hospice doctor prepares for death
It was a long December.
A few years ago, my husband of 37 years got his death sentence: recurrence of liver cancer with mets to his lungs and lymph nodes.
He had a “Whipple” — a surgical procedure for pancreatic cancer — on Dec 24, 2015, and the surgeon discovered liver cancer too. So it was a 16-hour surgery. We were told he might die on the table.
His eyes haunted me as …
My husband was dying. I was being ignored.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 63-year-old man is evaluated for severe mid-upper back pain following a minor fall 1 day ago. He also notes progressive fatigue of 6 months’ duration and a 6.8-kg (15-lb) weight loss. Medical history is notable for an 80-pack-year smoking history, although he is currently a nonsmoker.
On physical examination, temperature is 37.3 …
MKSAP: 63-year-old man with mid-upper back pain
In a recent episode of the television series, The Good Doctor, a patient played as Robbie Ato does not tell his doctors he has a history of cancer. You can see his surgeons stare in disbelief as one consulting surgeon recognizes the patient’s name and then alerts the team leader that she treated him three years ago for cancer.
This is one of the very most troubling and dangerous acts of …
The Good Doctor shows us the value of time
Harry understood at last that he was not supposed to survive. His job was to walk calmly into Death’s welcoming arms … All those times he had thought that it was about to happen and escaped, he had never really thought of the thing itself: His will to live had always been so much stronger than his fear of death … It was over, he knew it, and all that …
The lessons of Harry Potter and the Deathly Hallows
7 a.m. began as it always did; the overnight doc was threatening to quit while rubbing her bloodshot eyes and smearing mascara beneath them. Between heavy sighs, she listed the patients transferring into my care ending with Mr. Mandel.
“He’s eighty-something,” she explained, “hospice care. Cancer with metastases. Came in from home because family ran out of morphine and he was in a lot of pain. Anyway, he’s actively dying now, …
Here’s what death really sounds like
So stated one of our children in their autobiography assignment for school. I kept reading, curious what would come next.
“My dad usually stays home and cleans up, and takes care of the pets.”
I thought for a moment. “That’s very good, honey, but do you think you could write something else about Dad?” I suggested. “He does other stuff too, add some more nice things.”
“OK, how about … ‘And he takes …
“My mom is a doctor; my dad is a dad.”
I see these couples quite often: the man has been prescribed androgen deprivation therapy and his partner is distressed. He no longer has erections, although for some that had been a problem for years. But even then, they tell me, he at least tried occasionally. Now there is nothing. No hugs, no kisses, no hand holding, no touch. The partners are …
The loss of testosterone and how that affects the partner
This article was originally presented as student remarks at the 2015 Harvard Medical School commencement.
At the end of medical school, I always return to a musing, a zen koan of sorts from Dean Jeffrey Flier. At my white coat ceremony, a close friend and current resident, Dr. Nina Gold was chatting with the dean about the heft of our newly bestowed bright white coats. He asked her, in one beautiful …
A cancer survivor embraces the light of going to medical school
I am a gynecologic-oncologist. I work in the high-stakes realm of cancer care. I strategize complex treatment plans involving surgery, radiation, chemotherapy and the newer biological agents to treat the myriad of disease that we call collectively “cancer.” Cure — or at least control — requires urgent and timely administration of these modalities along with various imaging or blood work to assure that the treatment prescribed is effective. I love …
Dear insurance doctor: You are not my peer
A white coat ceremony address to the University of California, Riverside School of Medicine, August 4, 2017.
“It takes a village” is one of my favorite proverbs, an African proverb, that resonates with each of us on this monumental day. There is without a doubt that every one of you worked very hard to get into medical school. However, this difficult journey was supported by dozens of important individuals: teachers, …
The white coat symbolizes 2 important commitments
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