Instead of answering, she hung up. She felt, I’m sure, that I was not getting it.
  • Instead of answering, she hung up. She felt, I’m sure, that I was not getting it.
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Show Me Your Saphenous Vein, James!

I wish I could say I reveled in having brought a fresh new life into the world, but a new baby is slippery, and I was scared she would fall to the floor, perhaps ending my career. I don’t remember what she looked like, who clamped and cut the cord. One thing impressed me: the sturdy umbilical cord, with its rubbery, tough, gray-white braided ropelike appearance and the three life-sustaining umbilical blood vessels twisting their course toward the baby. 

March 20, 1997 | Read full article

He did not have a pulse at one minute of age. At five minutes of age, he had a slow pulse but no other signs of life.

Deliverance

This all took about 90 seconds, barely enough time to allow the ICN team to arrive with the “crash cart” to attend to critically ill newborns. We usually have a warning when something terrible is happening to a baby during birth; this was an instance where everyone was caught off guard. I passed the baby to Tamara, who gave it to the ICN team, then I turned back toward Cheryl.

March 27, 1997 | Read full article

“Can’t we get that [intravenous] fluid to run any faster?” I asked.

The Night God Used Binoculars

Larry spoke up, to which a supervising resident responded, “What are you?” conveying that Larry didn't have the right to say anything during a code. Larry countered, “Anytime someone’s life is in danger, you have to be willing to listen to helpful suggestions.” The comment later earned him a firm personal reprimand from the chief of surgery, who told him he had to be willing to watch people die so residents could learn.

April 10, 1997 | Read full article

Most of what we do goes unnoticed.

The Bad News Wasn’t the Seizures

I don't lie to patients. Ever. But when a physician gives terrible news to a patient, within a few minutes the patient wants to know what'll happen next and what his chances of survival are, and neither Todd nor I could give reliable answers to those questions. This is the one situation I can recall in my career that I did lie.

May 1, 1997 | Read full article

I check the rectum of every patient over age 50 every year. During my second year of medical school at UCSD ten years ago, Bill, a fourth-year medical student, taught me how to finish the rectal examination.

Tell Her the Old Lady Hasn't Got Much Time Left

Women after menopause get iron deficient when they're losing blood from an unknown source, usually the gastrointestinal tract. I referred her to a gastroenterologist, who found a small cancer in her “hepatic flexure,” where the ascending colon turns 90 degrees in the right upper abdomen to become the transverse colon. Two days later, I assisted Charles, the general surgeon, as he performed a right hemicolectomy, the removal of the right colon.

June 12, 1997 | Read full article

“You must have really thought I was in bad shape to put me in here with these people."

It’s None of Your Business Whether I Kill Myself

Were her problems new or old? For about 30 seconds, she only looked at me. “Both,” she finally offered. What did her husband and 12-year-old daughter think of them? “They don’t know; I won’t tell them.” Had she ever been this depressed before? “Many times.” Was she thinking of killing herself? She replied with an affirmative nod. How would she do it? She didn’t answer. Had she ever tried it before? “No.”

Aug. 21, 1996 | Read full article

Haba (standing), the author, Tanti, baby Terry at two months, and Hatouma. I have fantasized about moving my practice to Mali.

This Must Mean Fatouma Really Loves Me

Tanti summoned me to her house to evaluate her stomach troubles. As I stooped to lower my head through the curtained entrance, I felt a bit ill-at-ease: A white man, just getting to know this family, in a Muslim woman’s bedroom ready to discuss details of her bodily functions and to touch her body. She'd be exposed in a way that her religion does not allow.

Sept. 18, 1997 | Read full article

I will do what I can for as long as I can withstand her relentless attacks.

Queen of the Button Pushers

When she calls the office I know I’m in for a rough evening. Her calls always take a long time, usually 30 minutes or more. They start with her saying in a beleaguered tone, “Yeah, well, I just wanted to ask a question..." and then she asks the question. One of her frequent concerns is, “Can years and years of stress and anxiety cause me to have hypertension and heart disease?” 

Oct. 30, 1997 | Read full article

You may have noticed that your doctor seems to have less time for you, to look more stressed than before, and to have less competent staff at the office.

Ten Guys and $7 Billion

We have a choice between Allegra, Claritin, Hismanal, and Zyrtec. When deciding between drugs, the patient and I opt for the cheapest and/or the one with the most convenient dosing schedule. But the choice is not ours to make anymore. Each insurance company has its own formulary, and we doctors must prescribe drugs on the formulary, or the insurance company won’t pay for it.

Dec. 11, 1997 | Read full article

The nursing staff gave her the last room in the back of the hallway.

Miriam’s Demise

D and E's are tricky. The bigger the fetus, the tougher it is to get out through the dilated cervix. That’s the reason most obstetricians won't do abortions more than 12 weeks after the first day of the patient’s last menstrual period. Getting a larger fetus out involves breaking and extracting the fetus in parts, and most obstetricians don’t do enough of these procedures to feel comfortable or confident doing them.

May 28, 1998 | Read full article

"If he asks where she is, please say she’s in the hospital.”

Piece by Piece

After two months of rehabilitation, Myrna could walk short distances with her walker, but it became apparent by this time that she'd spend most of the rest of her life in a wheelchair. Meanwhile, her husband Ty, once a brilliant technical writer, had lost much of his memory. He had no idea what day or even what year it was. He did, however, take wonderful care of his wife, on whom he doted every minute.

June 25, 1998 | Read full article

Terry and Jim Eichel with baby. "I decided not to use gloves."

The First Human to Touch My Daughter’s Head

I exhorted Terry to push hard, pulled straight down on the baby’s head, avoiding the use of too much force and thereby coaxed out the anterior shoulder. I then pulled straight up to get the posterior shoulder out. Usually, the baby slides out without much effort once the shoulders are out, but mine didn’t. I had to grab under the armpits and pull, as though someone was holding my child in from the other side.

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