A friend of mine plays a mean game of poker.  She comes out ahead in Atlantic City, finishing near the top in hold ’em tournaments.  She is a poker savant. Not long ago I asked her secret to playing the game so well. “I learned to play cards when I was being trained to treat cancer.” “Oh,” I said, “the discipline, memorization, patience and statistics?” “No, that is when I learned not to ...

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The Institute of Medicine of the National Academies has released their long anticipated 500-page report, titled ,"Dying in America – Improving Quality and Honoring Individual Preferences near the End of Life." This is a critical addition to the ongoing conversation about health care in the United States and makes observations and conclusions, which we need to consider and understand.   They conclude, as has been said before, that we waste ...

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“All your patients will die. Maybe not today, but someday.  The defining fact of life is that it ends.  Only a fool would dedicate their career to fighting something that can never be beaten.  Therefore, a doctor’s task cannot be to fight death.  A doctor’s task is to heal when possible and prevent suffering always. Our calling is to support life. Fighting death may deprive patients of the opportunity to ...

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August 17, 2010. Maris is a 57-year-old woman in excellent health.  She has not seen a doctor in years. Divorced, she lives by herself, but spends occasional evenings with her daughter and son-in-law.  A successful businesswoman, Maris gardens, serves on the board of a community theater and plays a mean game of bridge. It is 10:11 a.m. when Maris presents to the emergency room. Three hours earlier, her legs became wobbly while ...

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7:00 a.m. Lights on.   Coffee, black and a banana. Paperwork.  27 patient visits, 3 emergencies, 35 phone calls.  Lots of computer time. Some laughs and a few tears. Paperwork.  Last family meeting.  Coffee, black.   In between: Thursday. Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range ...

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What do eggs, roofing nails, men’s haircuts and plastic cups have in common? A bizarre fraternity ritual or my Saturday morning honey-do list?  Gasoline, copying paper and paperclips?  Shopping for a mobile accounting office?  Nope.  What these items share is that who ever makes them, wherever you buy them, they are essentially the same.  They are commodities. They do not vary significantly in construction or quality.  The only way to ...

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A baby’s smile reflects the purity in their heart.   An infant’s world is a marvelous place of possibility and love.   Children see themselves as special, capable, even omnipotent.   Time teaches failure, loss, and mortality.  How much we lose of that original perfection, that first excitement, that natural confidence, determines how we face the challenges and tragedies of life; whether we will be happy.  It may even determine how we cope ...

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I knew immediately it was a problem.  It was not just that Faith’s cancer had spread with innumerable masses in her liver, golf ball-like tumors in her lungs, punched out holes in her bones.  It was not that the chemo, third round and toxic, had failed.  Those were awful things.  Rather it was her response as I began to tell her.  As soon as I said, “I looked at the ...

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Once upon a time, I was a lifeguard.  This was the natural result of swimming fairly well, Red Cross training, and team competition.  I saw myself as a handsome, tanned guardian at the ready.  OK, I was prone to self-delusion.  When I became a doctor I carried over that image of high-perched protector on stilt chair, whistle in hand, rescue float close, ready to dive to the assistance of a ...

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I have written many columns urging doctors to be honest with their patients, especially about difficult news.  Too often patients are lead on false hope therapy rides, rather than empowered with honest information so that they can cope with their disease and future. Doctors are not the only ones who can keep a painful secret. I admitted Sarah to the hospital late on Saturday night.  For over two years, she had ...

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