His voice was gruff and his expression surly. "I don't want any more medications." His face was indented by deep clefts, remnants of eight decades of life hard lived. His tone was commanding and certain. I knew that he was fond of me, but I could feel his patience slipping. He neither asked about nor accepted his diagnosis of heart failure. I could tell him till I was blue (or he was ...

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It will start as a minor curiosity. Maybe a student will seem slightly too close to the resident on your team. When the grades are posted, you'll wonder why you didn't get honors, but he did. You might wallow for a few days. Make an offhanded comment to your fellow students. Then you'll let it go and move on. Or so you think. Until during surgery when the scrub nurse ...

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If you are planning on complying with Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), make sure to allot the appropriate time and funding necessary to update/upgrade your practice. Realize that the measures will be arbitrary, the data implementation arduous and the moments for live patient care fleeting. Expect that, no matter how Herculean the task may be, the finish line will move often and unexpectedly. Prepare to get ...

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"Too many times I feel We are losing time once shared And only when you're in ecstasy You seem to really care" I recognize the song immediately — Chuckii Booker's "Turned Away." Not the regular version, but the extended one. As the words rush over me, caressing my nostalgia, a memory, a moment comes back. I was standing behind the counter at Homer's Ice Cream on a brilliant summer morning before the doors opened. We ...

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An excerpt from Five Moments: Short Works of Fiction. “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.

  1. Rejoice in the ordinary as if you were a child seeing everything ...

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It would never have gone down this way ten years ago when length of stay was all the buzz. The CT scan would have been done in the emergency department, and the patient would either have been discharged or admitted for a quick observation stay. Bing, bang, boom. One, two, three. Instead, the CT was pushed until morning. A resident saw the patient at midnight and then not a single practitioner ...

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I waited intently as the board members rearranged in their seats and look up expectantly. Silence. I wasn't going to let it be that easy. I repeated myself and paused again. This time a few tentative answers flutter up to the podium. Hospice? Comfort care? End of life? Giving up? Now this is something I could work with. I cleared my throat and smile broadly. Palliative care is a philosophy. I can't help but ...

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To say that there is no fear in the examining room is an inaccuracy. I'm not only talking patients here. Physicians may harbor just as much worry and discontent. There are the old standbys of course: The swat team of malpractice attorneys lounging in the waiting room ready to pounce or the old demon of misdiagnosis and the consequences that may follow. Few of us talk about that sinking feeling which ...

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There is a basic communication gap between you and me. How could there not be? It's not what you expect. I say you have cancer, or heart failure, or emphysema. Full stop. A conversation ensues. This is not what I'm talking about. It's more like when I report to you a series of normal lab results, and at the end flippantly mention a slight elevation of the white blood cell count. ...

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You won't at first. But then, you will. It will start innocently. Probably even before medical school. You will have a morbid curiosity about passing ambulances and motor vehicle accidents. Your original empathy for the victim will disappear when you begin to think of them as patients ... as test cases. The commodification accelerates during the early years of medical school. Anatomy, pathology and physiology provide you a vocabulary to replace human ...

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