The Art of Medicine: The big and the little

The patient squats by the step stool in the examination room, peering at pictures as she turns the pages of the little big-book. She squeals with delight at the moo cow; she claps her tiny hands at the puppy dog and looks up at me expectantly to validate her joy.

Her mother sits in the chair opposite, leaning forward, elbows resting on her knees, only the hint of a smile on her face. “So what do we do this time?” she asks in a slightly defeated tone of voice. more»

Interested readers can now access my latest Art of Medicine column — The big and the little — 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: Dispensing empathy in the pediatric setting

Slowly, the student nods her head. On this, the last day of her pediatric rotation, she has learned a valuable lesson: listening to the patient with an empathetic ear will generally hold you in good stead. more»

Interested readers can now access my latest Art of Medicine column — Dispensing empathy in the pediatric setting — 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 distant close encounter

I glance at the encounter form and step into the examination room. A young boy sits on the examination table. A man, presumably his father, stands off to the side by the back window, chatting on his smartphone. more»

Interested readers can now access my latest Art of Medicine column — A distant close encounter — 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: Moments without an ICD-10 code

Cellphone conversations during medical encounters turn me off; ofttimes I seethe beneath my carefully orchestrated demeanor. But somehow this time it’s different. more»

Interested readers can now access my latest Art of Medicine column — Moments without an ICD-10 code — 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.

Anticipatory guidance: Not just for patients

“There you had the opportunity to see what sometimes happens when we fail to provide proper anticipatory guidance to parents. Things devolve into disasters, and they’re much harder to fix.” more»

Interested readers can now access my latest Art of Medicine column — Anticipatory guidance: Not just for patients — 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.

When powders and potions won’t do

Practicing good medicine does not always mean prescribing medication. When powders and potions won’t do, sometimes education, a little reassurance — and advocating for the caretaker — go a long way.  more»

Interested readers can now access my latest Art of Medicine column — When powders and potions won’t do — 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.

Communal grief

“Use’ ta be the fambly was fust. It ain’t so now. It’s anybody.” —Ma Joad in “The Grapes of Wrath”

I pull up to where the town cop stands in the wide expanse of macadam, roll down my window and look up into his face. He’s sucking on something; it might be a plum pit. Whatever it is, he spits it out into a loosely clenched hand. “Just to let you know,” he says, matter-of-factly, “it’ll be at least a two-and-a-half-hour wait. The line runs all the way around the back, and that doesn’t include the folks on the inside.”

I nod my head, drive to the back of the parking lot and pull into an empty space. I leave the windows down a crack, lock the car and walk across the way to the end of the line. The folks at the back acknowledge me with nods of their heads. Shortly, I hear footsteps behind me.

“Dr Brian, we meet again — for the second time in 24 hours.”

I turn and face the father whom I had seen the previous evening at the after-hours care center. He had brought his little girl in after discovering that she had eaten a combination of cough drops and cold tablets. Thankfully, the ingredients were largely inert.

“How’s your daughter?” I ask.

“Oh fine, ornery as ever,” he smiles. Then he says: “Wish we were meeting under happier circumstances today.”

I drop my eyes and shake my head. “I just found out from a former co-worker at the old practice. I missed the obit in the paper.”

“I figured it would be jam-packed,” the father says. “They said that when the doors opened four hours ago, there were already fifty people here.” He glances at his watch. “Seven-thirty now. Looks like it’ll be at least another two hours before we get inside.”

We inch forward as other people step in line behind us.

“It’s bad enough when an elderly person passes away. He was only seventeen years old.”

“Did you know the family?”

“We all grew up together in the same part of town. I went to school with his uncle. I guess everybody’s a wreck.”

“Rightly so. I can’t imagine….”

“I’m regional director for a hospice program,” he says. “We deal with a lot of veterans. It’s tough when one of them goes. We had one fellow who was terminal, no family, all his buddies were gone. It was sad. We asked him if there was anything he really wanted to do. He said he wanted to ride down Main Street in the town where he grew up. We contacted the local VFW. Over two hundred vets showed up to line the street when they drove him through — quite a moment.”

We stand together in silence. The line inches along. People exit the building. One woman hails the father I have been talking with. I recognize her voice. She looks different from when I last saw her, but the voice is unmistakably the same. Twenty-five years ago we worked together in the same office. I had taken care of her children at that time. She crosses the parking lot and disappears behind the rows of vehicles.

The line moves forward. Finally, we reach the entrance. A man in a business suit opens the door and ushers us into the closeness of the foyer. The line of humanity snakes in and out of rooms adjacent to the hallway.

I study the faces as we inch along: familiar faces, all in line; brief smiles, acknowledgements, nods of the head — former patients, former families with whom I had at one time sat in small examination rooms over the past four decades.

But today I am not their healer; today I am not their doctor. Today I have come as a fellow mourner to pay my respects to the family of man and share in the communal grief.