The patient in front of me is trying to die. Elderly and frail, he is lying in bed. His ribs outlined under the skin that should be smooth. His temples are concave where they should be flat. Both are an outward display of internal damage from his lung cancer. More striking than his cachexia are the strained muscles in his neck and his pursed-lip breathing. He is working hard for ...

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“Mr. Jones, how are you this morning?” I ask. A muffled, incoherent reply. “Are you in pain?” “No.” I perform a brief, perfunctory exam — it's unchanged from yesterday. I then glance at his breakfast tray on the bedside table — still untouched. The plastic mug is still full of watery, lukewarm coffee, the rubbery pancakes on the plate are still intact. This is at least the third morning that my patient — who ...

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The first thing I remember as I regained consciousness, lying in a hospital emergency room, was hearing a nurse ask my mom if I was allergic to any foods. With my eyes still closed, I said, “asparagus,” thinking this might reduce the chances of anyone serving me what was then a dreaded vegetable. “Asparagus,” repeated the nurse, making a note on my admission form. And then, with a chuckle and what must ...

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How many people does it take to change a lightbulb? Five. One to hold the lightbulb, four to hold and turn the table the first guy is standing on. This was a mean joke towards people from a certain town in an area of the world I happened to live in for a few years. In some countries, a certain town or city takes ...

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My last admission on my last call day of the year; only one patient stands between me and freedom. Freedom from the endless calls. Freedom from self-doubt and anxiety. Freedom. She sits propped up in the ER bed, her husband dutifully by her side with encyclopedic knowledge of her long medical history. She is visibly weakened by the daily fight, yet her smile remains radiantly defiant as if to announce: “I’m ...

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Your brain is a three-pound hunk of biological tissue. And though it’s nothing more than a conglomeration of specialized cells, it generates the taste of cheesecake, the ecstasy of enchantment, and the misery of suffering. Amazing, right? I certainly think so, though I find myself among a shrinking minority. Whereas the eyes of our medical forefathers were turned toward the heavens in search of answers to seemingly unknowable questions -- ...

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My hospitalist medical group consists of as great collection of atheists, agnostics, and skeptics as you will ever find.  But we all agree that quality is our religion.  We believe to our last breath that patient care is sacred and an invaluable gift.  And so, as with all faith, there is no halfway.  You believe, or you stand around scratching your head asking what those other fools are worshipping.  Just ...

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"Management's overall aim should be to create a system in which everybody may take joy in his/her work." - W. Edwards Deming "Your skin is not thick enough to hear me yell for even ten minutes!" a 92-year-old patient's family member shouted at me while attending a care plan meeting. I was soon asked to leave the room left with case manager, social workers and mid-level managers. Later that evening, as I claimed ...

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I was approaching 24 hours in the hospital and waiting for my partner to come into my operating room so we could do “hand-off." That's when I spend 15 minutes going over all of the events of the surgical case and explain my patient’s health history, his current status, my current treatment strategies, the heart ultrasound findings, and our plan for the rest of the case. As I was awaiting ...

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Every time I walk into a bookstore, I pass Paul Kalanithi’s When Breath Becomes Air and am reminded of a specific anecdote he shared. Kalanithi, MD, was a seventh-year neurosurgery resident and his lung cancer had metastasized – a process which was only being controlled by a new drug his oncologist had decided to try. But one day, Kalanithi had severe nausea and had to be hospitalized to stay hydrated. A ...

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