Humane Medicine — The end of something

With the exception of a low WBC count, Jonah’s blood test was normal. His ANC—absolute neutrophil count—was low as well, just a tad worrisome. “Let’s repeat it in a month,” I told his father. “It should be normal by then.”

We did, and it wasn’t. Jonah’s WBC count had dropped even lower, and his ANC came back zero. more»

Interested readers can now access my latest Humane Medicine column — The end of something: When convenience trumps care — recently published in the Journal of the American Academy of Physician Assistants.

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

All is (not) lost


Last night my son took me to see the recent cinematic release All is Lost. Robert Redford plays the part of a man alone on a sloop 1700 miles from the Sumatra strait. He is awoken by the sound of water rushing into the cabin. A large metal transport container adrift in the sea has collided with the boat, tearing a gaping hole in the forward hull just above the waterline. Redford’s character surveys the scene, then skillfully attempts to extricate his vessel from the partially submerged steel container, first with a gaff (the soft aluminum pole bends like a drinking straw) and then by the creative use of a sea anchor. Finally, the container breaks free.

From that point forward Redford’s character (he is never named) uses his wits and ingenuity to grapple with a series of setbacks, each seemingly more serious than the last. When the vessel is crippled in a violent storm, he salvages whatever essentials he can find and abandons ship to the relative safety of an inflatable life raft. With a sextant and a reference book on celestial navigation he plots his drift on a chart, moving closer each day to the major shipping lanes in the region.

Time and time again we witness the forces of nature beat the man down, while the man responds to the best of his ability. Hope is what keeps him going until the very end. Even in the midst of drifting down into the quiet depths of the sea, a ray of hope prevails.

The drama reminded me of what I have been wrestling with these past five months. From the time of the announcement that the medical practice which I helped to build over the past 20 years would be sold, I have been forced to rely on my wits for survival — first attempting to negotiate terms of employment with the new owner, then maneuvering to salvage what I could from the old. At every turn there were new obstacles to circumvent. I began a job search, went out on interviews, weighed options, sat and thought. When it became apparent I would have to leave, I devised an exit strategy. In the end a life raft appeared on the open sea.

This week I’m surveying the scene, salvaging those essentials that I will need for survival. Each day requires constant vigilance and adjustments. Yesterday I packed up the remaining files and the last of my books. Today I will notify my malpractice insurer of my departure date; tomorrow I will transfer my retirement funds to a new venue. I’ve written a final letter to my patients, folks I’ve cared for over the span of 20 years. Friday will be my last day.

All is not lost: a ray of hope prevails.

“Notes from a Healer” — A Suitable Diagnosis

I found my new patient seated in the chair, dressed in a blue and white johnny top. She had a round face and a ready smile. Thick black curly hair covered her head. I noticed that the hair growth extended down the sides of her cheeks to the angles of the jaw. more»

My latest installment of Notes from a HealerA Suitable Diagnosis — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.

The devolution of healthcare

As I search for a word to describe the workings of our contemporary healthcare system, “devolution” comes to mind. Yes, the system has evolved dramatically. We now enjoy instant communication at our fingertips in real time. We can peer into the human body with modern imaging technology at much higher resolution than ever before. Our surgical techniques are state-of-the-art. But somehow we have lost something of our humanity in the process. more»

Interested readers can peruse my latest JAAPA Musings blog post, newly published in the Journal of the American Academy of Physician Assistants.