As I lay dying
Open the windows and doors. Welcome the wayward breeze, biting cold, tendrils of sun, or beating rain. Worry not of the elements as they caress my motionless body. Discomfort, after all, is for the living of which I am still yet a part.
Talk as if I am myself. Even if I don't answer. Argue and disagree as we are wont to do. If you offend, I may curse you silently. Wordlessly. Or if you bore, I will likely ignore you altogether.
Weep and I will weep too. Laugh and I will laugh with you. Pray and I will remain solemn. Joke and my lifeless countenance will become that of the jester.
Place your hands on me. Caress my fingers. Cradle my chin and pinch my cheeks if the moment so moves you.
Fear not the skin of the dying. It remains sensitive even after the rest of the body has long forgotten.
Invite my enemies to peer down upon me. To dispel the last remnants of venom or perchance to regret. My family and friends too. Even those who I have long forgotten or have forgotten me.
Open my doors for all to see.
Except for the indifferent.
They are no longer welcome in my home.
Tuesday, May 5, 2015
Monday, May 4, 2015
Thursday, April 30, 2015
Does Your PCP Feel Like A Doctor Anymore?
We both agreed that it was unfortunate.
I sat on Paul's living room couch with a computer perched on my lap as he recounted the events of the last few weeks. His business flight was interrupted by severe spasms of cough and high fever. He called me upon landing, and based on my advice, went to a local urgent care center. After waiting for a few minutes, he was seen by a friendly and competent physician who diagnosed him with pneumonia. Antibiotics were started, and he was given the name of a local physician to follow up with in a few days.
Paul was never the type to rest. He took the antibiotics, and plowed through his business meetings as if he was completely healthy. Luckily, the fever abated, and his cough resolved. By the time he appeared in the physician's office, he felt much better.
The doctor was kind enough. He peered down at Paul through a conservative pair of spectacles balanced precariously on the tip of his nose. Although he appeared in his late fifties or sixties, he could type on the computer as agilely as his younger counterparts. After listening to the chest and finishing his electronic note, he declared Paul cured, and got up to leave the exam room.
Paul stammered and sputtered for a moment, caught off guard by the briskness of the doctor's exit, and asked for advice about his colitis which the antibiotics had exacerbated. The physician turned his head, and glared at his patient as the rest of his body was already leaving the exam room door.
You might want to consult a doctor about that!
Paul searched around the room thinking he was on a candid camera show. But he found no cameras, no laughing audience, or genial host.
As he recalled the visit, sitting comfortably in his own home, he figured this was the doctors way of letting him know the conversation was over.
I agreed, but couldn't help but wonder if this physician felt like so many primary care doctors around the country. He was overwhelmed by electronic medical records, rushed by a a waiting room full of grumpy patients, and reduced to a box checker, list follower, and specialist referrer. He didn't have time to deal with the really complex problems anymore.
In fact, he no longer even felt like a doctor.
Certainly not the kind he had been trained to be.
I sat on Paul's living room couch with a computer perched on my lap as he recounted the events of the last few weeks. His business flight was interrupted by severe spasms of cough and high fever. He called me upon landing, and based on my advice, went to a local urgent care center. After waiting for a few minutes, he was seen by a friendly and competent physician who diagnosed him with pneumonia. Antibiotics were started, and he was given the name of a local physician to follow up with in a few days.
Paul was never the type to rest. He took the antibiotics, and plowed through his business meetings as if he was completely healthy. Luckily, the fever abated, and his cough resolved. By the time he appeared in the physician's office, he felt much better.
The doctor was kind enough. He peered down at Paul through a conservative pair of spectacles balanced precariously on the tip of his nose. Although he appeared in his late fifties or sixties, he could type on the computer as agilely as his younger counterparts. After listening to the chest and finishing his electronic note, he declared Paul cured, and got up to leave the exam room.
Paul stammered and sputtered for a moment, caught off guard by the briskness of the doctor's exit, and asked for advice about his colitis which the antibiotics had exacerbated. The physician turned his head, and glared at his patient as the rest of his body was already leaving the exam room door.
You might want to consult a doctor about that!
Paul searched around the room thinking he was on a candid camera show. But he found no cameras, no laughing audience, or genial host.
As he recalled the visit, sitting comfortably in his own home, he figured this was the doctors way of letting him know the conversation was over.
I agreed, but couldn't help but wonder if this physician felt like so many primary care doctors around the country. He was overwhelmed by electronic medical records, rushed by a a waiting room full of grumpy patients, and reduced to a box checker, list follower, and specialist referrer. He didn't have time to deal with the really complex problems anymore.
In fact, he no longer even felt like a doctor.
Certainly not the kind he had been trained to be.
Tuesday, April 28, 2015
Good News
Janice had come to terms with her disease. The swelling in her legs and the shortness of breath were overwhelming. Her gasping for air with almost every movement made the sedentary life her only option. Her family members had long since moved away or died.
She was alone.
The current bout of heart failure had been severe enough to land her in the hospital again. The paramedics shook their heads in disgust as they hauled her out of her cluttered, cockroach-infested apartment. The ride to the emergency room was her first trip outside of the confines of her four small walls since the last hospitalization.
Janice wasn’t depressed; she was just tired. Her heart could no longer support the mass of edematous flesh that hung wantonly from her body. The cardiologist confirmed what she had long expected. The damage to the cardiac muscle was too great. The floppy organ was pumping at less than 10% the normal strength. The blood confirmed another heart attack.
It was with grave faces that the team of doctors gathered to give Janice her options. Her prognosis was poor. She would likely die in weeks, maybe months. They waited solemnly for what they expected would be a melancholy reaction.
But they were wrong.
Read the rest of this post at The Medical Bag.
Sunday, April 26, 2015
Words
It's metoprolol.
m-e-t-o-p-r-o-l-o-l
The nurse on the other end of the phone sighs as she tolerates my tirade regarding pronunciation. They all know that I am particular about such things. For metoprolol is neither metoclopramide or metalazone, and the difference could be life altering.
I live in a world of words. Trained in a language created to parse pertinent details. Dysarthria or dysphagia? Paroxysmal nocturnal dyspnea, dyspnea on exertion, or orthopnea?
Each variant a spectrum of flavor. A morsel chewed, swallowed, and digested into its basic parts to be rattled off in staccato sentences between physicians. A meaning conveyed to bring like minds to similar conclusions. A common language among colleagues to convey a story, to solve a mystery, to make a plan of attack.
And my patients words carry similar weight. The accent on a particular syllable drawing significance unconsciously to a hidden meaning. An atypical descriptor pushing the diagnostic engine toward a nefarious path. The absence of content, words carelessly unspoken.
My patient's future becomes precariously perched on such ambiguities. My ability to interpret separates durable medical care from chaos.
So you will have to excuse me if I occasionally get caught on words. If I become stuck on pronunciation or am a stickler about meaning.
I gently correct the cardiologist as we pass in the hall.
It's Rothberg not Rothschild. R-o-t-h-b-e-r-g.
And she died two nights ago.
m-e-t-o-p-r-o-l-o-l
The nurse on the other end of the phone sighs as she tolerates my tirade regarding pronunciation. They all know that I am particular about such things. For metoprolol is neither metoclopramide or metalazone, and the difference could be life altering.
I live in a world of words. Trained in a language created to parse pertinent details. Dysarthria or dysphagia? Paroxysmal nocturnal dyspnea, dyspnea on exertion, or orthopnea?
Each variant a spectrum of flavor. A morsel chewed, swallowed, and digested into its basic parts to be rattled off in staccato sentences between physicians. A meaning conveyed to bring like minds to similar conclusions. A common language among colleagues to convey a story, to solve a mystery, to make a plan of attack.
And my patients words carry similar weight. The accent on a particular syllable drawing significance unconsciously to a hidden meaning. An atypical descriptor pushing the diagnostic engine toward a nefarious path. The absence of content, words carelessly unspoken.
My patient's future becomes precariously perched on such ambiguities. My ability to interpret separates durable medical care from chaos.
So you will have to excuse me if I occasionally get caught on words. If I become stuck on pronunciation or am a stickler about meaning.
I gently correct the cardiologist as we pass in the hall.
It's Rothberg not Rothschild. R-o-t-h-b-e-r-g.
And she died two nights ago.
Tuesday, April 21, 2015
Sunday, April 19, 2015
Legacy, Some Thoughts On The Death Of Jonathan Crombie
My wife loves Anne of Green Gables. And every so often she scours Netflix or Amazon Prime looking for the movie to play for the kids. She is almost always unsuccessful. Last night, however, she was able to find a version on you tube (with Spanish subtitles none the less). She popped a bowl of popcorn, and we all settled down to watch this ageless classic.
We were engrossed. How could you not fall instantly in love with "Anne spelled with an E". Her hyperbolic and histrionic nature all the more endearing as the plot grows. Of course, you can't help but like Gilbert also. At first painted as a bully in his opening scene with Anne, it becomes clear that his jeering words are a school yard ruse to hide his growing affections.
It was around the half way mark that I sadly saw the breaking news on Facebook, Jonathan Crombie (the actor who plays Gilbert) died of a brain hemorrhage.
All the sudden, for me, the story took on greater significance. Unlike his family and friends, I will never know what kind of man Jonathan Crombie truly was. Yet his art, his acting, will leave an indelible mark on those of us who grew up with this timeless story.
Of course, it all makes me contemplate legacy. My father, who died from the same malady at a similar age, left behind a wife and three young boys. There are also countless patients, physicians, and students who remember his influence thirty five years later.
We all hope that the best parts of ourselves live on long after we have passed.
Legacy is an especially prickly issue for those of us who yearn to create. The builders, actors, artists, poets, and writers. For most of us, the act of creation is a lonely and solitary process. The birth of our "art" is often a complicated and painful labor of love. We continue day after day, year after year, not for glory or recognition, but because we have to.
That which we produce, the performance we act or the words we write, are the distilled parts of ourselves that we leave for the world. Long after we are gone and our families have mourned, maybe there will be a little something left.
A word, a phrase, a small bit of wisdom that will find the wayward stranger and bring knowledge, understanding,
or a comforting salve for unhealed wounds.
We were engrossed. How could you not fall instantly in love with "Anne spelled with an E". Her hyperbolic and histrionic nature all the more endearing as the plot grows. Of course, you can't help but like Gilbert also. At first painted as a bully in his opening scene with Anne, it becomes clear that his jeering words are a school yard ruse to hide his growing affections.
It was around the half way mark that I sadly saw the breaking news on Facebook, Jonathan Crombie (the actor who plays Gilbert) died of a brain hemorrhage.
All the sudden, for me, the story took on greater significance. Unlike his family and friends, I will never know what kind of man Jonathan Crombie truly was. Yet his art, his acting, will leave an indelible mark on those of us who grew up with this timeless story.
Of course, it all makes me contemplate legacy. My father, who died from the same malady at a similar age, left behind a wife and three young boys. There are also countless patients, physicians, and students who remember his influence thirty five years later.
We all hope that the best parts of ourselves live on long after we have passed.
Legacy is an especially prickly issue for those of us who yearn to create. The builders, actors, artists, poets, and writers. For most of us, the act of creation is a lonely and solitary process. The birth of our "art" is often a complicated and painful labor of love. We continue day after day, year after year, not for glory or recognition, but because we have to.
That which we produce, the performance we act or the words we write, are the distilled parts of ourselves that we leave for the world. Long after we are gone and our families have mourned, maybe there will be a little something left.
A word, a phrase, a small bit of wisdom that will find the wayward stranger and bring knowledge, understanding,
or a comforting salve for unhealed wounds.
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