Pacing refers to spacing out your activities during the day so that you’re able to stay within the limits of what your body can handle without exacerbating your symptoms. Another way to think of it is that pacing is a way to keep you inside your “energy envelope” -- the envelope that contains your energy stores for any given day. First, an admission: Even though pacing may be the single best ...

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I’m convinced this will be a year of reflection for our family  --  as we’ve witnessed so many transitions in the past year I find myself deep in thought. As I reflect, I’m full of appreciation for the journey we’re on. I’m full of gratitude for so many of the people who have helped us along the way  --  especially the amazing doctors who have become like family.  This past ...

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Everyone immersed in the culture of medicine knows that physicians sometimes defer the discussion about prognosis to patients who are battling a life-threatening illness.  Everyone, that is, except the patient.   We arrive on your doorstep believing that our presence indicates the obvious.  So, how are we to know that we have to ask for something as life altering and important as a prognosis?  Deferring to the patient for prognostic discussion ...

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Once upon a long 18 years ago, I got sick. I was sick from a growth in my brain. The growth was found after I'd shuttled from doctor to doctor, from appointment to appointment, from X-ray to scan. It took a year. By then, my pain was clothed in shame. Undiagnosed pain does that: It draws the gaze of friends, family and providers. Everyone looks for the cause. "Soul pain," said one doctor. ...

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One of the first things they teach in medical school is that if you haven’t pretty much figured out the diagnosis by the time the patient finishes sharing their history, your doctor hasn’t done his or her job well.  Certainly, this is a bit of an exaggeration, as many diseases cause similar symptoms. As you share your background, your doctor is creating a list of possibilities of the most likely conditions ...

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When Donna Helen Crisp, a 59-year-old nursing professor, entered a North Carolina teaching hospital for a routine hysterectomy in 2007, she expected to come home the next day. Instead, Crisp spent weeks in a coma and underwent five surgeries to correct a near-fatal cascade of medical errors that left her with permanent injuries. Desperate for an explanation, Crisp, who is also a lawyer, said she repeatedly encountered a white wall of ...

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There was a lot about that place I didn't want to see or hear. The buzzing and whirring of ventilators; the loud call bells; near-dead patients; nurses running around with IV pumps and tubes dangling along behind them; the heart-stopping "Code Blue" warning; or the electrical sizzle of a patient getting shocked as someone screams, "All clear!" I didn't want to do it. Just a few days before, I had buried my mom. First ...

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The patient, age forty-nine, complained of abdominal pain. She was taking both slow- and fast-acting oxycodone to manage the pain, and she also took antidepressants and a sleeping aid. She'd come to the hospital several times in the past year, always with the same complaint. This time, not feeling well enough to drive, she'd come by taxi. The veins in her arms were small, threadlike and collapsed, like those of ...

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Eight months into a healthy pregnancy, my belly suddenly hung lower. I noticed that the baby’s movements slowed, decreased in frequency, and seemed sluggish compared to just a few days before. Concerned that something might be wrong, I called my obstetrician’s office and described what I’d noticed. The nurse I spoke with gave rote and reassuring advice: “Babies often get crowded near the end of pregnancy,” she said briskly. “Drink some ...

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An article from the Wall Street Journal caught my attention, and for all the wrong reasons. It was a review of two recent studies showing that medical trainees have difficulty diagnosing patients with complicated histories or confounding psychosocial features. At least, that’s the way I would describe those studies. The WSJ, however, used much more pejorative language, referring to them as “difficult patients,” “a nuisance,” and “an annoyance.” The ...

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