Lists guide our lives.  Some are easy, even fun, like a menu or shopping list.  Some are simple tick-offs for work, like my wife’s honey-do list.  Others are frightening, like a draft list.  Some are melancholy, such as the inventory in a Will.  We are inspired by our bucket-list.  Finally, some are exciting, but stir conflict, like a wedding invitation list.  I have a list, which makes me slightly anxious, a little depressed, and which takes modest courage to open ...

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I remember it was raining outside when I told Ester she had metastatic stomach cancer.  She cried, as her son sat silently holding one thin hand in two of his.  After a while, she asked, how long did she have to live?  I explained it depended on how well the chemotherapy worked.  She smiled gently, as one humoring a silly child, and said that there would be no treatment. After ...

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At the graveside, they still talk about judgment, intelligence, and the wisdom that is the practice of medicine. Deans and health care leaders wax poetic as they tell stories of great cures to lift in memoriam remarkable healers. Yet, though we bow to Hippocrates, Osler, and Salk, the time has come to mark a revolution in human history: The art of medicine is dead. It is not that doctors have fallen from ...

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Contrary to what my wife and colleagues think, it is not all about me. Well yes, I do get lonely sitting at my desk late at night, when my wife is busy, and the long-ago-moved-away kids are not available, and there is nothing running on NASCAR.  Nonetheless, it is not really about my needs.  I am talking, of course, about why I give patients my cell phone number. It is printed ...

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Her name is Joann. She has cancer. As that disease goes, it is not much, probably curable, one of those “if you have to get cancer, this a good one.” Still, she sits across from me, her skin pale, eyes tight and she rhythmically grasps her cold, moist hands. She fails to gain any comfort from the knowledge that she is going to be OK. Why? I have not told ...

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With thousands of cancers, thousands of families and thousands of deaths, I came to see deep time. I absorbed the finite nature of existence and gained a long view. Not just yesterday’s tests, today’s battle and tomorrow’s treatment, but the loss to come. I do not know when the reaper will arrive, but understand he will. I mourn each patient before we meet. I have learned not to cry. Call it ...

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When we think of pollution, we think of our planet: stripped forests paved asphalt black, sterile red rivers, brown-gray skies and creeping slums over once virgin land. We imagine massive dumps of civilized waste, the extermination of species and temperatures which bake the earth like a neglected oven. We mourn the global home in which we live, neglected, abused, in ruin. Do we ever think about ourselves? That is one of ...

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For soldiers, there are many fears.  Will I do my job?  Will I succeed in my mission?  Will my colleagues in arms be harmed?  Will I be injured?  Will I die?  For the American Muslim who volunteers to engage the enemies of the United States on foreign soil, there is a new worry.  What will my home country do to my family while I am gone? Recently, Dr. Ghazali A. Chaudry, ...

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Medicine is a paradox. To save, we cut with sharp knives. We ignore pain so that it will light the path to diagnosis. We give toxins to destroy toxic disease. We scold our neighbors when they neglect their health, even as we work ourselves to exhaustion, eat too much and evade exercise. We comfort the families of our patients while ignoring our own. There is one contradiction, which, by its very ...

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It was recently pointed out that one of my partners had made an error in a patient’s electronic hospital chart. Did I want to correct the mistake? Curious, I looked at the computer screen. There in 12-point-black-on-white Cambria was the culprit documentation. The words were: “Our therapy goal is palliative. Prognosis is good.” Now, this was clearly not what the author had intended. In common practice when someone is so sick that ...

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When patients and their families seek hospice care, they are thinking about how they will die. They want to be without pain, shortness of breath, loneliness and, above all, fear. They want to end their lives with those they love, in a place they know, with respect and support. They want control. They want dignity. We all know this, and try to provide it as friends, family and caregivers. Nonetheless, ...

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Not long ago, I overheard a frustrated hospital leader ranting about the poor performance of a physician. It was not that the doctor was screwing up surgeries, ordering the wrong drugs or missing obvious diagnoses. Actually, the physician was rather adept at healing his fellow man. The doctor’s failures concerned length of stay (far too long), sloppy medical records (incomplete, loaded with cut-and-paste) and a temper, which while not directly abusive ...

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In my home, we have two conversations: politics and medicine. The most vociferous discussions are around their product, health care.  We know doctors on the right and left, Democrat and Republican, boisterous blues, rebellious reds and garrulous grays. Respecting opinions and debate, we love ‘em all.  However, no matter on what side of the aisle they stand, which lever they pull, they share one trait.  All physicians are deeply conservative.  ...

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Man has been dying on a regular basis for millions of years — should we not be end-of-life experts by now? Why do I feel the need to devote pages and hours to this depressing topic? Is there a goal to my project, beyond venting the shared suffering which soaks my soul? What is my purpose? For humans, denial of death and marginalizing its effect on our lives is a major ...

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Fall brings school buses, a freshening breeze and an avalanche of meetings.  There are seasonal sales, myriad projects and the splendor of colored leaves.  The season is also announced, again and again, by a particular peculiar and perilous decision, which, no matter how much I try, I do not fully understand. Frankly, I just don’t get it.

“Jane, it is time to start chemotherapy.” “What are the side effects?” “Well, this is powerful ...

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I recently spent an evening with a group of medical oncology fellows as part of a small panel discussing career alternatives. There were doctors who worked for pharma, academic medical centers, hospitals and a couple of us representing private practice. The questions and comments taught me more than I could contribute. I was surprised to learn not just about jobs and personal futures, but about something basic: the difficulty in ...

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David was 42 when he died from stomach cancer. He spent the last year of his life receiving useless chemotherapy and debilitating radiation. David was in terrible pain all of the time. He stayed in bed for months as cancer destroyed his ribs, back and lungs. Finally, David was rushed to a hospital, plugged into a breathing machine and pierced by countless IV drips. He died despite a battery of tests, ...

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Smoking and drinking caused the cancer, which Ed ignored for a long time. By the time a doctor looked at the hole in his neck, the mass had congealed the base of the tongue to the right side of the jaw and burst through the skin. A steady drip of pink tinged, foul saliva ran down the side of Ed’s neck. Ed, not being able to chew for months, was ...

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2:15 a.m., July 2, 1981. Its 83 degrees outside in a loud, humid Chicago night, but here the scrubbed air is chilled, dry, while white tiles reflect the occasional nurse, who appear and vanish, and the rhythmic sighs of the machines, gasping somewhere down empty halls, are occasionally interrupted by a frantic chime. My first night in the unit and my first patient’s chart.  Papers spill from the accidentally opened binder ...

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Autonomous dissection by the internet. We all do it, but is taking an online medical selfie really a good thing? Disease, prognosis, and treatment explained in exquisite, exhaustive, confused, nonspecific and erroneous detail, which often yields the wrong diagnosis, recommendations for irrelevant therapy and wildly inaccurate conclusions, resulting in confusion and fear. Given this common reality, should patients avoid computer self-investigation entirely and leave e-research to the “professionals?” The bad Patients, left ...

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