I did not know that the first time I met Viejo was the last time I would see him as himself. At the time I was a medical student on a rotation that gave me junior physician-level responsibilities, and with it the chance to prepare for my upcoming transition, one I had worked for years to attain: becoming a doctor. A trusted healer. A source of comfort and competence. A cooperative team player. I was painfully aware of my own shortcomings—not enough knowledge or experience—but deeply devoted to the acquisition of both, and to the creation of meaningful connections with my patients.

Viejo, as his wife lovingly called him, was my first patient. His bright eyes glowed behind wide, plastic-rimmed eyeglasses, his handshake firm, his smile trusting. But Viejo’s story was an all too common tale among the low-income population my public hospital serves. Unable to afford regular preventive healthcare services, he had presented with mysterious new “back pain” that, through a CT scan, revealed itself to be late stage cancer, already metastatic to the bone. Viejo and his family—his dear, devoted family—came to us hoping for a timeframe for recovery, and instead received an estimated expiration date. Continue reading →

Red Sox Rivalry

Mr. Williams came to us as so many patients do.

“I just fell down,” he repeated, grumpily, his snaggletooth resting on his cracked, pursed lips.

Our team of eight white coats had descended upon him with rapid fire CIWA questions during morning rounds—the Emergency Department’s workup suggested his fall was secondary to intoxication—but he wasn’t giving up a single hit.

“Have you been feeling sweaty at all today?”

“That’s no one’s business but my own.”

“Do you have a headache right now?”

“I will if I keep listening to this foolishness.”

“Would you say you feel more agitated than usual?”

“Only when people like you keep asking me questions.” Continue reading →

Fury & Forgiveness in the ED

“She refused the ultrasound!” my resident announced with exasperation, updating our attending on 17-year old, pregnant Mariana, who arrived four hours ago with abdominal pain and an unpleasant attitude that rubbed nearly everyone wrong way.

We could hear the crescendo of Mariana’s expletives from the hallway, as patient transport wheeled her back into our Emergency Department (ED). “That bitch tried to stick a wand inside me!” she yelled out, to no one in particular, to everyone around her. “You all keep me waiting for four fucking hours with this damn needle in my arm and don’t tell me nothing. I’m going home.”

Part of me immediately felt empathetic to Mariana’s concerns, even if not to her attitude. As our team’s medical student, I had interviewed Mariana extensively, learning that she was not only a “G2P1,” but also a parentless, single mother living in poverty with her infant son, struggling to complete high school, and constantly fighting off bullies in her neighborhood. Mariana led a complex, stressful life. This ED visit was becoming just another complication. Continue reading →

Caring for Wounds that Won’t Heal

Simon was a young man struggling to stay afloat in the present, anchored down by traumas of his past. He was raised in a neighborhood plagued by poverty and crime, and as a teenager was shot in his spine, a merciless act by a malicious bully who thought it more humiliating to cripple his foe than to kill him outright. As a result, Simon became paraplegic, losing his leg function, his bladder control, and his sense of self-worth.

As the rest of his teenage body grew, his thighs and calves atrophied into pathetic brown sticks. Wheelchair-bound and barely 20 years old, he became so entrenched in depression that he spent entire days sitting still, allowing himself to develop pressure ulcers on his buttocks, which soon became infected and spread, like poison, to his bones and through his blood. It was a stark sight to behold, to peel the sticky beige bandages off his glowing, caramel skin, and see it suddenly wrinkle into raw, pink tissue, then plunge downward, toward bone, the cavern seeping with frothy, yellow pus.

When I first met Simon, I found his acute physical injury measured equal in devastation to his chronic illness of isolation. Continue reading →

Survivor: The Power of a Life Partner

As I sat before my computer screen reviewing Ms. W’s electronic medical record, one word gripped my attention, paragraph after paragraph: survivor. Now in her mid-60s, she had survived HIV/AIDS during an era when treatment was non-existent. She was soon after diagnosed with breast cancer, but fought through intensive chemotherapy, and survived. Then, as if one malignancy wasn’t enough, she developed ovarian cancer, and endured surgery and radiation to, yet again, survive. This time, she had come with a complicated urinary tract infection; her ureters had been narrowed by prior courses of radiation therapy, and she would need pelvic surgery to stent open those tiny canals and prevent future infections.

Ms. W’s degree of health complications is not unusual in our public hospital, where many patients show up with more advanced disease compared to patients with adequate insurance coverage and access to preventive healthcare. But it is not so common to see such survival against these great odds. There was something unique about Ms. W’s resilience, and I was interested to understand it more clearly. Continue reading →

A Buddhist and Her Cancer

I heard about Sandra in whispers at the nurses station, before meeting her face to face. “Such a lovely woman,” they would say in hushed, sorrowful tones. “Such a tragic story.” Sandra was my patient during my night shift rotation, meaning she was one of nearly fifty souls for whom, between sunset and sunrise, I addressed all complaints and crises.

Sandra, in all her loveliness, never had either.

I first met Sandra on my fifth night of being her overnight doctor. Her nurse called me around 2AM to report she was experiencing pain after a daytime procedure and needed some extra medication for relief. I reviewed the basics of her story before going to see her—a middle-aged woman with a new diagnosis of colon cancer and a few months to live—and expected to enter a room full of sadness, anticipated a pair of empty eyes.

Instead, I arrived to find a frail but grinning woman curled up in a bright red fleece blanket, surrounded by piles of books and beads that she was methodically, almost joyfully weaving into bracelets. The chair at her bedside was void of friend or family, but she seemed unbothered by this solitude. Continue reading →

Is Loneliness Making you Sick?

What medications do you currently take? Do you have any allergies? What medical conditions did your parents live with, or die from?

As physicians, we are conditioned to drill every patient with a standard list of questions whose answers could literally save a life. We investigate for drug toxicities, medication interactions, daily exposures, and family histories that shed light onto present illness.

Within our standard interview we also check off mandatory boxes to describe a patient’s “Social History”—Do you smoke cigarettes? Drink alcohol? Use drugs? Have sex?—however we are not always trained to see our patients as social beings. We are not always prompted to ask another, crucial set of questions that could just as easily save a life as uncovering heart disease history:

Do you live alone? Who will visit you here in the hospital? With whom do you share your private worries and fears? How much of your week do you spend with other people?

In other words: Are you lonely? Continue reading →