By Megan Masten
I recently had the opportunity to spend a month at a free health-care clinic in Flint, Michigan as part of my third year Internal Medicine clerkship.
I am in an underserved medicine program and I have a deep interest in working with people who have characteristically been left out of healthcare. I loved working with the population who receive their healthcare services at the free clinic – I have mostly been impressed with patient’s willingness to feel vulnerable. I have spent my third year of medical school in a variety of medical settings, and my favorite type of patient interactions are the ones where patients are willing to be completely honest with me and share things about their life that they might be ashamed of or have complicated feelings about. I feel like I am doing what I’m called to do when I get to have difficult discussions with people about medical and non-medical issues that affect their lives, and my ability to have these discussions has been strengthened by my time at the clinic.
I spent time with a patient at the Free Clinic who opened up to me about his mental health issues. He was recently started on a new antidepressant medication for depression and anxiety, and he was open and honest about his challenging feelings. He shared with me that he was feeling really depressed and had frequent suicidal ideations – and he was quick to say, “I’m sure you don’t struggle with depression, I’m sure your life is really good.” It was such an important and unexpected conversation to be had; although I don’t personally struggle with depression at this point in my life, I can’t say that I never will, and I can’t say that I don’t understand how he feels. I shared this with him, and I shared with him the fact that I have family members with depression and bipolar disorder who have been suicidal in the past.Read More »
By Nalini Juthani
On a bright early morning while getting ready for work, suddenly, something went “Swoosh” in my head. I saw double and felt dizzy with eyes open. Horrified, I returned back to my bed. In a few moments I began to play out various scenarios in my mind. Each potential diagnosis that flashed in front of me had an ominous outcome although my mind was clear. I woke up my husband, a physician, who examined me and said “I am calling our neurosurgeon neighbor”. It was a remarkable Friday when the world seemed to be crashing down on me.
I was a 40-year-old, happily married doctor with three loving young children. Our family had just moved into a new home. I was also enjoying a successful academic career. I wanted to live. I was simply afraid to die!Read More »
By Angira Patel
When I started my medical training, my pediatrics residency program banned all pharmaceutical sponsorship of activities. No free lunch in the middle of the day, no fancy dinners at expensive restaurants, or trips to conferences paid for by a pharmaceutical company. Even my lab coat was unadorned by the colorful pens given by various drug representatives. At the time, I remember thinking a pen or a free lunch would never influence how and what I prescribe to my patients.
As a young trainee, I did not appreciate why my residency program took this stance, but I do now. Read More »
By David C. Leach
It has been more than thirty years since she first came to see me – a vital woman in her early seventies who had detected a lump in her breast on a self-exam. A diagnostic work up confirmed cancer and the smallish lesion was removed. It never recurred. By the time a second lump appeared in the other breast we had come to know each other. She was now in her late seventies and this lump also proved to be cancer. It was removed. Postoperatively in the hospital she looked a bit depressed.
She was not an alcoholic, however, she had told me that she enjoyed an occasional martini before dinner. I did something I had never done before and have never done since. I brought a Waterford crystal glass containing a nicely mixed martini to her hospital room. She accepted it without comment. We talked while she sipped. She told me that she had discovered and joined the Hemlock Society. In her words: “Dr. Leach, I know that given your lily white ethics you would never countenance euthanasia so I joined the Hemlock Society. I now know what to do and you needn’t trouble yourself.” I thanked her for her consideration and we talked briefly about her concerns and choices. In my opinion she was not at risk for suicide. She knew that this lesion also was small and with negative nodes would likely not recur. What she wanted was to be empowered to make her own life decisions. I assured her that she was. . .
Read More »
By Joe Burns
The elderly female patient was a frequent visitor of the dermatology clinic. Her physician had provided routine care for her, removing suspicious spots for decades. Today she was presenting for an exacerbation of her psoriasis. We entered the room and the patient was visibly distraught. She was wearing a wrinkled t-shirt and old jeans, a stark contrast to her usual Southern Lilly Pulitzer dresses. As we began taking her history, she broke down, bawling over her psoriasis…
Read More »
By David C. Leach
An old joke begins by asking that you imagine a man drowning 100 feet offshore while a conservative and a liberal are observing. The conservative throws him a 50 foot rope and says: “swim the extra distance, it’s good for you.” The liberal, on the other hand, throws him a 100 foot line and then promptly drops his end of the line in order to go and do another good deed.
While offering insight into our politics the story also illuminates some of our habits around caregiving in our current healthcare system and the policies supporting that system. Certainly individual stories of near heroic caring can be found, but the system itself is designed around processes and structures that seem to diminish the importance of the caring relationships at the heart of our work. Caregivers frequently depend on work arounds. What would it take to develop a system that respects, rewards, or at least enables genuine caregiving?
Caregiving, of course, is an attribute of humans, not systems. To care for another requires a voluntary opening of the heart to compassion; it requires noticing and acknowledging the uniqueness of the other and a willingness to enter into their context. Keenan defines mercy as the willingness to enter into the chaos of the other. (1) The biblical story of the Good Samaritan (Luke, 10:33) illuminates an interesting attribute of caregiving that may indicate why humans can care and systems cannot; the clue is in the voice of the verbs used. The story is well known: a traveler has been assaulted and robbed. Two others pass by without helping while the third, a Samaritan, “was moved by compassion” and stopped to help. I believe that the passive voice of the verb is not an accident. The first step in caring is to allow oneself to be moved by compassion. “Be compassionate” doesn’t fit naturally on a to do list; the initial step is not a “doing” but an emergent openness when one has been moved. Subsequently there may be many action steps, but it starts by being moved by something greater than the caregiver…
Read More »
By Marsha Miller
Almost ten years ago, I wrote a story about my experience navigating the healthcare system as a young woman with a myelomeningocele baby. It was a story about “forgiveness” because my baby was two-months old before his back was closed, his brain shunted, and his prolapsed rectum repaired. It was a system failure. Now, I would like to talk about how different medical encounters can be when a person with a disability is an adult rather than a pediatric patient…
Read More »