The Art of Medicine — When care goes beyond the patient

I check my morning schedule: this 1-month newborn well-child check, with no additional patients booked for the next half-hour, is certainly a satisfactory start — but in this business, without warning, things can go south in the blink of an eye. more»

Interested readers can now access my latest Art of Medicine column — When care goes beyond the patient — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.

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The Art of Medicine — Keeping one step ahead of the need to know

It always behooves one to crack the books before the final examination. more»

Interested readers can now access my latest Art of Medicine column — Keeping one step ahead of the need to know — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.

The big tree and a jelly donut

“The men have come with their big machines to cut down the big tree on our street.  Should we go out to see them?”

My grandson claps his little hands together.  “Good!” he says.

I drape a scarf around my neck and slip my arms into my coat, then I hold his coat up for him.  “Push,” I say, and he pushes his little arms through the sleeves.  “Zip up!” I say, pulling the zipper up to his chin.  “Hold on to your hat, Harry!” I say, as I pull the woolen cap with the white letters over his head and tuck his ears underneath.

“Let’s go!” he says, racing to the door.  We step out onto the back stoop and make our way through the gate and down the driveway to the street.  Up ahead we can see the barricade and the orange sign announcing “Road Closed”.  The big trucks and the machines are parked bumper to bumper along the curb beyond.

I reach for my grandson’s hand and guide him across the street onto the grassy lot by the church.  We stand in the center of the expanse and look up the small rise to where the men are standing between the dump truck and the cherry picker.  A couple of them have sat down on the curb, hard hats in their laps, wiping their brows with their sleeves.  One tall man motions us closer.  “Does he want to see the trucks?” he asks.

“Trucks!” my grandson says, his eyes lighting up.

“He knows all their names,” I say, “dump truck, cherry picker, front loader, chipper.”

“Is your name Trouble?” one of the men asks, pointing with his chin to the letters on my grandson’s cap.

“Tell them: ‘Trouble’ is my middle name,” I say.

“Big truck!” my grandson says, pointing to the dump truck.

The men laugh.  “Come along, I’ll walk you two down past the vehicles to the end of the work zone,” the tall man says.

“Will you be taking down the other two trees as well?” I ask the man.

“No, we’ll do some heavy pruning on one and light pruning on the other.  They’ll have to come down eventually, but for right now they appear to be healthy — not like the one we took down yesterday.  A good portion of it had split off during that big wind storm we had last month.”

“Yes, we saw it lying in the street.  I tried to count the rings in the stump, but it’s so scarred and uneven.  How old do you figure it was?”

“Hard to say.  These trees were probably planted around the same time that the church was built — 1881 or thereabouts, somewhere around 140 years, give or take.  Maples usually last a century and a half, so that’s about right.”

“I guess everything has its allotted time,” I say.  “Just like us.”

The man looks off and nods his head.  “That’s right,” he says.  We walk past the barrier on the far end.  “I’m afraid you won’t be able to come back this way,” he says.  “We’ll be working again soon.”

“No problem. We can find our way back to the house around the block,” I say.

The man holds up his hand, smiles, and retraces his steps to the vehicles.  My grandson and I turn left at the corner and walk the short distance to the back of the church to see another dump truck parked in the lot.  I lift him up to see the inside of the bed.  Afterward, we walk back down to the corner to cross over to the sidewalk on the opposite side.

“Hey, Trouble!” a man’s voice booms from the work zone.  It’s the tall man again.  He approaches us with a shallow white box.  He holds it out and lifts the lid.  Two powdered jelly donuts sit nestled inside.  “Go ahead,” he says, “take one.”

My grandson looks up at the man, then he looks at me.  “It’s okay,” I say.  He reaches out his tiny hand and grabs one of the donuts.  “What do you say?” I ask him.

“Thank you,” he says.

The man smiles.  “The other one’s for you,” he says.

“Boy, oh boy,” I say, “this is our lucky day!”

The man nods his head and turns to go.  We look both ways for cars, then cross the street.  My grandson takes a small bite of his donut.  “How is it?” I ask.

“Good!” he says.

We walk down the street, eating our donuts.  “Look!” I say.  Parked in the lot outside the fire station sits a big yellow front loader.  “Come, let’s go see.”

Once more we cross the street.  The wheels on the front loader are big, about twice as high as my grandson.

“Big yellow machine!” he says, beaming as he stands in front of the big bucket, his small arm raised, half-eaten jelly donut in hand.

The Art of Medicine — Falling through the cracks

In clinical practice some memories never fade — for a variety of reasons.

Interested readers can now access my latest Art of Medicine column — Falling through the cracks: A matter of substance — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.

The Art of Medicine — A Christmas gift

The mother sits quietly beside her husband, holding the swaddled infant in her arms. With pen in hand the father studies the form on the clipboard before him. Their 3-year-old son vies for his attention, then drops to the floor, whining by his feet. more»

Interested readers can now access my latest Art of Medicine column — A Christmas gift — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.

Beyond burnout

The issue of clinician burnout may be taken to another level, that of moral injury, defined as an inability to provide high-quality care and healing in the context of healthcare delivery. more»

Read more in my latest entry on the Musings blog of the JAAPA Editorial Board here.

JAAPA is the official publication of the American Academy of Physician Assistants.

The Art of Medicine — Making it up as you go along

“He’s pitching a fit in there!” the nurse goes on. “Won’t even let me take his temperature. The mother’s upset because she said they had to wait too long. It’s only been 15 minutes.”

Silently, I smile as I approach the closed examination room door. I find the boy clinging to his mother’s neck, sobbing. “Oh my, someone’s upset,” I muse. more»

Interested readers can now access my latest Art of Medicine column — Making it up as you go along — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.