I came into work last night for the last time. Though I was on a service full of sick patients, I was not nervous. After three years of this, three years of people trying to die in creative ways, and my friends and I trying to stop them — I have no nervousness left. There is just nothing left for the hospital to throw at me. "Dan,” I asked my intern, ...

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We emergency physicians are often thrust into the frontline battles raging in society. The pain, blood, and emotions are so real, so thick and ever present, creating an undertone that is difficult to deny. We walk the corridors of our departments actively involved in life or death, where the span of mere millimeters might as well be miles as we explore wounds, clinical scenarios and presentations. How do we do ...

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Tom’s feet are shackled so he can’t bolt from the hospital bed when the prison guard isn’t looking. The guard places handcuffs on him when he walks to the bathroom and stands just outside the door as Tom relieves himself. Despite being treated for a deep tissue infection in one finger, Tom is in generally good shape — lean but muscular with the strong hands of a workman. Back in ...

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asco-logoI remember meeting this patient the first time. I had just started in a new position, and she was one of my first consults. Tracey* had an aggressive sex-cord tumor of the ovary that had relapsed soon after surgery, grown through primary chemotherapy and grew once more after secondary surgery and “adjuvant” pelvic radiation. I knew ...

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“Dr. Fraser, the pharmacy is on the phone for you. Line one.” I answer the call, pressing the gray, rectangular button with one hand while writing in a patient’s chart with the other. “Sarah Fraser speaking.” “Oh, hi, Doctor, we just got in a prescription of yours, but we are not quite sure what it says.” The pharmacist is gentle in her words. It was the first time this had happened. I’d promised myself ...

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My smile freezes on my face as my patient says to me, “I’m so glad you’re back – that I get to see Mrs. Lycette today!” He has been my patient for several years, and I am perplexed to hear him address me as “Mrs.” rather than “Doctor.” At the same time, I really do not think he means an intentional insult, so I keep my face neutral and continue with ...

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It’s 1 a.m., and I’m afraid this guy is going to die. He’s gasping for air, hunched over a table as I poke his chubby back and try to find a rib. Oxygen is flowing through nasal prongs at six liters per minute, and it’s barely making a difference as his oxygen saturation hovers around eighty-five percent (it should be in the high-nineties.) He’s sick, but what’s more worrisome is ...

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I spent 20 minutes listening to Michelle and asking her questions to understand why she was not taking her insulin as recommended. The appointment was for 15 minutes, 5 of which were used by the medical assistant who had to check the vitals and “do an A1c.” I did not ask Michelle whether her feet were tingling or numb. I did not ask ...

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Margaret Edson’s 1999 Pulitzer Prize winning play, Wit, tells the story of the final hours of Vivian Bearing, PhD, an English professor dying of cancer.  Early in the course of her disease, one of her doctors sees the value of her case from a research point of view and asks her to enroll in a clinical trial of an investigational therapy.  In the film version of the play, which stars ...

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Scientific evidence pointed to an extremely poor prognosis. Numbers and statistics emphatically declared her imminent demise. My 33-year-old patient was not going to survive. The physicians presented the data to the mother and recommended withdrawal of care, but she remained indecisive. She struggled for two days with the possibility of her young daughter dying. Her child was in the critical care unit in a vegetative state. It was a parent’s worst nightmare. I took ...

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