When it comes to surgery for cancer, having a “positive margin” is a bad thing.  It means that when the surgeon said he “got it all,” even though he meant it with all of his heart, likely he didn’t.  For a woman undergoing a lumpectomy for breast cancer, that positive margin means a re-excision of the lumpectomy site or alternatively, a mastectomy.  For a woman who has just had a ...

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A couple of weeks ago my nurse came to me with a request for a consultation.  Since our schedule has been packed full lately, she’s been asking me where I can squeeze patients in. She said, “I’m not sure about this one -- he says you treated him twenty years ago and he wants to see you.  But there is no new pathology so I don’t know how urgent it is.” I ...

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Where I come from, when most people refer to the Good Book, they are referring to the Bible.  This is not true for my father, because to him, the Good Books are something else entirely. He describes a scene early in his career as a plastic surgeon, when he had taken his doting mother to see his new office. Coincidentally, a lovely thank you note had just arrived from one of ...

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I don’t have much in the way of eyebrows.  They were victims of too much plucking back in the 1960’s and when you do that, sometimes they don’t grow back.  There’s a very nice woman in Solana Beach who shapes and darkens what I have left, infrequently, when I bother to think about it which isn’t very often. I was in there about a year ago when she told me, “I ...

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Ex-marines are some of the toughest patients I ever see, when it comes to dealing with pain from cancer.  And career ex-Marines have the market cornered on toughness. Take for example, an elderly friend in Kansas who woke up one morning with severe upper back pain, feeling faint, and decided as was his Marine Corps habit that a cold shower would be “just the thing.”   The cold shower likely saved his ...

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The institution that employs me is very bullish on customer satisfaction.  Having come from a fourteen year stint in private practice before I came back into the university fold six years ago, the little things that make a practice run smoothly come naturally to me. Patients are typically seen within a week of the consultation request -- same day if they are in an emergency situation.  My front office staff actually ...

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I was saddened earlier this week to read, first on Facebook as posted by his son Daniel, that Michael Palmer had passed away after suffering a heart attack and then a stroke, while going through customs in New York on the way back from a trip to Africa.  Many of you know Dr. Palmer as the bestselling author who wrote medical mystery thrillers like “The Sisterhood” in 1982, ...

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Thirty three years ago my husband and I went to Jamaica for a belated honeymoon.  We got married on the last weekend of my internship year, and immediately flew back to Boston for me to start my second year of internal medicine training.  Seven months later in the dead of winter, we flew to Jamaica to a lux resort in Ocho Rios where I spent a blissful week drinking sweet ...

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An op-ed piece this past summer by Verlyn Klinkenborg in the New York Times decried “The Decline and Fall of the English Major." As I read it, I reflected on my own experience in medical school and beyond, and I think that Mr. Klinkenborg’s message is one that medical school admissions committees should be hearing loud and clear. Despite the fact that doctors are faced with increasing mounds of paperwork ...

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When I was young, one of my favorite stories was O. Henry’s “The Gift of the Magi.”  Originally published in 1905, the short story became standard fare in public school reading classes and I doubt that there are any of you out there who have not read it.  But just in case -- the story is about a young couple, poor and deeply in love.  At Christmas, they have no ...

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