Saturday, April 1, 2017

Letting Go

You can let go now!

As Hannah's granddaughter clutched at her skeletal fingers, the blanket fell to the side revealing the faded serial numbers on her forearm.  The family gathered, yet again, to say goodbye.  This time her acrid breath had lost humidity, her respirations dry and raspy, the extremities mottled with a bluish tinge.

Death had visited the neighborhood before.  Lounged in the parlor.  Nibbled on crackers and tea.  But letting go was not so easy. Sure the signs were there.  There were the bouts of unconsciousness lasting days.  The hours of irregular breathing with long gaps.  The clutching of chest and recitation of prayer.  All followed by merciless, unrelenting recovery.

Hannah wanted to die.  At least that is what she told the doctors.  She sang it in her sleep and whispered to the hallucinations that pranced on her pillow.  She refused medications.  She spurned nourishment.  She pulled at the tube thoughtlessly plunged into her abdomen a few hospitalizations prior.  She hissed at the Rabbi as he entered her room.

Why won't you take me?

They said she was a survivor.  A code they used in order to avoid talking about dark things. Guilty things.  She was forever marked by the fact that she didn't succumb.  She didn't die.  She was scarred somewhere deeper, more profound, than the ugly thing on her forearm.  She was marred by persistence.

Most of her family died decades ago during the war.  A whole lineage erased. And yet she persisted.  Her colon removed, her brain stroked, her heart fibrosed.  And yet she persisted.  The years passed, friends and lovers gone, a child or two perished.  And yet she persisted.

Persistence had entwined her DNA, calcified her bones, and cascaded past blood cells forever traveling in circles.

Her body was failing, but her spirit couldn't let go.

No matter how much she begged and pleaded.

It didn't know how.


Five Moments, now available on Amazon.  

Also available, I Am Your Doctor: and This is My Humble Opinion.


Friday, March 17, 2017

Drip Drip

Get out.


It was not so much the words as the overall tone of the interaction.  The doctor-patient relationship had been generally affable.  There was the usual exchange of pleasantries over the years.  Questions about family, children and grandchildren.  It was a good relationship.  Until Harvey got sick, that is.


Originally there was weight loss and fatigue.  The initial physical exam and slew of testing showed nothing but a frail, cachectic, middle aged man.  A few cat scans later and he was in the oncologist's office discussing chemotherapy.  A regimen was decided on, and therapy began the next day. 


Therapy was hard.  Nausea. Retching.  More weight loss.  Far from feeling better or cured, Harvey could feel the clothes slipping from his emaciated body.  It was as if life itself was drip dripping away as the chemo bulldozed into his broken veins.  And this pissed Harvey off. 


He lashed his family.  He cursed his friends. He spun into a whirlwind of the most resistant depression. A depression, his therapist would later tell me, whose only salve was anger.  While the anger allowed him to carry on, often he left those around him scorched.


His doctors were no exception.  We often spent half of each visit withstanding abuse before getting down to the business of the appointment.  He blamed us for the cancer.  He blamed us for the lousy response.  He blamed us for the side effects of his abysmal treatment.


So when I walked into the hospital room to tell him the scans showed his latest chemotherapy had failed to stem the red tide of death, I have to admit that I had already somewhat detached.  How could I not?  Although he was fairly lathered by the results, it was the mentioning of hospice that finally led to my expulsion.  His wife ran after me with tears in her eyes.  I'm quite certain that she paid dearly for her kind act of decorum.


Harvey died shortly thereafter.


I am prone to remember the pleasantries Harvey and I enjoyed before his health deteriorated.  I am neither disturbed nor saddened by the anger.  I cannot even say that I would not have been the same way if I  had been lying in his hospital bed.


What surprises me, in retrospect, is how little he affected me.  How his anger didn't penetrate the hardened shell. 


Over my career I have been yelled at, cursed, blamed, hugged, and even loved by my patients.


And like the poor life force oozing out of Harvey's beleaguered body, it drip drips down my back.


 And into a forgotten puddle on the ground.


My new book:  Five Moments, now available on Amazon.   

Sunday, March 12, 2017

Five Moments Book Excerpt

“Dad . . . you can let go now.”
Thomas heard his daughter’s voice from a distance. It awakened him from his reverie. He relived those five moments of life and took their lessons seriously.
Rejoice in the ordinary as if you were a child seeing everything for the first time.
Unconditional love can lift you up. 

Forgive yourself over and over again. 

No matter how much we deny it, we are who we are.
Some of the most difficult battles are those in which we choose not to fight.

Thomas opened his eyes and smiled. He looked at the faces of his family before him. After all these years he finally got it. He understood the meaning of existence that eluded him till now.
Eternity . . . Immortality . . .
His family was now joined by numerous others. Thomas’s friends and colleagues, his patients and students, even the man he once gave a five-dollar bill to on the street. They were all there. He gave a part of himself to each of these people. And each of them had given a part of themselves to others. There were thousands, if not millions, of people in the room with Thomas.
His life had meaning. Like a rock falling into a pond, his goodness made a small splash with the people around him. But the waves from the rock rippled throughout the pond. Thomas would live forever. Parts of him were dispersed into the world. And those parts would live and thrive. Thomas’s body was dying but his soul was strong. He felt oneness with his fellow man.
For a moment Thomas thought if he just had enough strength he could share this beauty with his family. But then he realized this was not the sort of thing someone could teach. Each person had to experience it himself.
Isabella’s word’s came back to him as he drifted off.He remembered sitting on the kitchen floor with his daughter and granddaughter the day she almost choked to death.
“See, Dad? It wasn’t all in vain.”
Thomas experienced one last thing before he died.A cool sensation started at the back of his head and washed over his cheeks, shoulders, body, and into his toes. With pure joy, he recognized this as the first sensation he felt upon exiting the birth canal.
Beginning and End. Birth and Death. They were all intermingled in this beautiful dance called Life.
Thomas’s heart stopped.

Taken from Five Moments, now available on Amazon.



Monday, March 6, 2017

When A Loved One Dies

At first you'll query reality.  You will hear your own words, but they will be foreign; apart from you.  The ground will still reassuringly push back against your toes when you walk out the room, but you will wonder if they are your feet-your ground.  Like in a movie, you will negotiate the world convincingly.  Yet, you are an actor playing a part.  A role.  It is not the real you.  

Be assured that this will pass.  Life has changed incomprehensibly in a fraction of a moment.  It will take a few more moments for your psyche to advance accordingly.  This is not disconnection.  This is not denial.  It's shock.

Grief will not be far behind.  Overwhelming, discoloring, disjointed grief.  Some will try to ignore it.  Others will wallow.  How you manage this grief says more about who you are and less about the gravity of the loss.  There is no correct way to map this journey.  We each travel this road separately.  

My gentle advice to you dear traveler, is remember that separate does not mean alone.  Others will not feel what you are feeling, but that does not prohibit sharing parts of your journey.  The most arduous, at least.  Surround yourself with people and things.  Even if they have lost your interest.  Even if they have lost meaning.

Interest and meaning return.  The sun rises and falls.  You will not break.

By far, the greatest danger lies ahead.  In the days and weeks and years.  You may be plagued by a demon so fastidious it will devour your hours, conscious and otherwise.  It will haunt long nights and merciless days.  It will cause the ground to shake relentlessly under your feet, knocking you off balance.

I'm talking of guilt.

You will feel guilty for not spending enough time, or spending too much.  For not calling the nurse right away,  or calling too quickly.  For pushing the morphine that last time, or withholding it.  Even the quiet and peaceful deaths end here.  It is loves last grappling with earth-shattering loss. We are not programmed to let go of that which we cannot control.

And we can't control death.  So we feel guilt.

This guilt will plague you.  It will turn grieving from a process to a permanent state.

Don't let it.  Your loved one died because it was time.  Nothing you did would have changed that.

Forgive yourself.

Let this forgiveness be one last act to honor the dying.  


If you like this post, please order my new book of short fiction, Five Moments.

Wednesday, March 1, 2017

Five Moments Now Available



If Thomas were to write his own eulogy, these surely wouldn’t be the five moments that he picked.  In fact, it’s safe to say that these were memories tucked away in his subconscious.  Yet as he lay on his bed anticipating death, he relived these precious minutes as if they just happened...

And so begins my new book of short fiction, Five Moments

This collection of short stories approaches the foibles of the human condition, often as seen through a physicians view point.  Crafted over years, each draws from my experiences as a caregiver, a parent, and human being.  

During the marketing of my last book, I Am Your Doctor And This Is My Humble Opinion, I found that above all the interviews, reviews, and assorted media-It was you, the reader, who carried the greatest impact.   

So if you like what you read here week to week, please...

Buy the book!
Share on Facebook!
Tweet on twitter!
Rate on Amazon!
Post to Linkedin!

You are the most effective marketing force.  Your help is much appreciated.  

Five Moments can be purchased here.
I Am Your Doctor And This Is My humble Opinion here.  


Sunday, February 26, 2017

Neither Was Mine

There are parts of medicine that are horrendous.  Moments too painful to recount.  Events that will break even the most innocent participants.

And then there is unspeakable magic.

I live for the days when a patient comes to the office with a particularly vexing set of symptoms.  Specialist after specialist bows their head in disagreement.  Laboratory values whisper falsehoods  with jeering tongues.  Symptoms are transient, physical exam signs inconsistent, and in the midst of head scratching an answer mysteriously appears.  Maybe a common presentation of a rare disease.  Or a rare presentation of a common disease.

Explaining with words so fast that sentences jumble.  Ideas merge.  The patient shakes their head enthusiastically less because of deep understanding, and more because they know that my excitement means that finally the answer will unfold like a blossoming flower selflessly bearing its pollen.  I will eventually slow down enough to present a cogent explanation.  And things will get better.

It lifts me up when a patient sits down beside me after yet another round of chemo.  When, at the end of the day, I have a sparing moment to settle in for intense conversation.   I bite my tongue, become quiet, and listen.  I hear of hopes and dreams.  I hear of pain and suffering, joy and fear. We talk like doctor and patient.  Like friends.  Family members.

We get past the intangibles of life and death, and move on to the more palpable like dignity.  Upon finishing, we leave the room in strength.  We leave the room with resolve.  We leave the room with tears in our eyes.  All of us.

And I love when an unwitting pattern is recalled from the deepest depths of memory.  The clock is ticking.  Heart beats rise and fall rapidly.  Knowledge accrued from past struggles presents itself at the most opportune time, and a life is saved.

On the triumphant drive home from the hospital, with the radio blaring, I remember the patient whose back such life saving knowledge was attained.

And I rejoice that all their suffering was not in vain, and neither was mine.

Wednesday, February 22, 2017

A Difficult Patient

I have come to believe that humility is an essential component of wisdom.  Never have I found this more true than in the practice of medicine.  In fact, for almost every atrocious professional error in judgment I have made, I can pinpoint the exact moment where I stopped being humble.

Yet time and time again, humility quickly disappears when dealing with the difficult patient.  In fact the label, difficult, assumes the problem lies within the patient and not the technique being utilized by the care provider. Already blame is turned outward and personal responsibility abandoned.

A few years ago, when I was in a group practice, one of the senior partners had a particularly needy patient that somehow showed up on all our schedules from time to time.  Her aged joints carried her into the exam room to their own particular hobbled rhythm.  She paused before each sentence, her voice barely above a whisper.

Her litany of issues was long and nonsensical.  And this was always the precise moment when humility left the room.  We all became convinced that her complaints were largely psychosomatic.  And we were right.  It still amazes me at how cavalier I can be when I think a solution is either simple or non physiologic.

It was only after several visits that the need for a thorough exam became apparent.  I tapped my feet and waited outside the door for what seemed like an eternity as she undressed and climbed into the unflattering gown.  My stethoscope stumbled over the heart as if its mighty muscle had not thumped hundreds of thousands of beats.  Auscultated the lungs absentmindedly untouched by the unmeasurable volumes that glanced the porous surface.

My hands fumbled over the fibrosed joints that absorbed the shock of a child's prance, a young athlete's stride, and an ancient shuffle.

My conceit, however, unshakable as it was, was shattered by the faded serial number tattooed on her forearm.

And my humility, once again, was restored to a respectable level.