Ordinary People
Cheryl loved to dance. There wasn't a time in our house when the the kids weren't jumping up and down on the furniture, the radio blasting, and her body swaying in rhythm. Ironically, we were dancing when it happened. It was her fortieth birthday. The kids laughed and clapped as I dipped her dramatically and she sprung back into my arms. And then she crumpled. Tony, my youngest, giggled hysterically thinking it was a ruse. I clutched at her lifeless body, all muscle tone was lost.It was the emergency room physician who first used the word "stroke". But what does a plumber kno...
Source: In My Humble Opinion - October 28, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Parenting And Helplessness
Years later, I now wonder if I overstepped my boundaries.Nancy was a pleasure to have as a patient. A physician's assistant in her early twenties, we often chatted amiably during visits. Our conversations randomly ambled between personal and professional topics. She recently married and was looking forward to having children. Her gynecologic history was complicated and after a period of months of unsuccessful attempts to get pregnant, she visited a local infertility specialist.Although the workup was completely normal, one of her blood tests, while technically in range, was deemed "subpar". He...
Source: In My Humble Opinion - October 21, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Pressing Questions
Picture your shoulders thrusting forward as you slink into the nursing home or hospital at some ungodly hour in the morning. Day after day, year after year, your gait adjusts to the facade of the foreboding colossus. You become boxy, structural. Familiarity has affected you. It's not just the hospital, but the patients of course. Being a physician is just like any other human being, just magnified. You start with a basic unadorned body of armor. Certain things penetrate: the first cry of a baby as he leaves the womb. Others splatter and stain but you don't dare let them in: the sw...
Source: In My Humble Opinion - October 14, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
For Those Of You Who Worry About Me
Ruth was problematic. Well into her seventies, her body may have dulled but her tongue was sharper than ever. And she used it to lash me with complaint after complaint. If it wasn't her knees, it was her ankles. If it wasn't her ankles, it was her hips. I battled the impossible month after month, year after year. Our interactions left a bitter taste in my mouth. Nothing makes a physician feel more impotent than the stubborn problems that refuse to bend under our practiced hands.I am fairly experienced with complex medical issues. I have never shied away from diagnostic challe...
Source: In My Humble Opinion - October 7, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
The Space Between Sickness And Death
There is much to deplore in our medical system. Atrocities abound in the dark recesses of hospital wards, the over packed waiting rooms of outpatient offices, and the algorithmic hum of insurance claim denials. Yet time and again, the most vile of of insults are hurled at one setting in particular. I'm talking of the place cursed by emergency room physicians when admitting yet another poor soul with a sacral ulcer, a place spoken of by patients and families in the most hushed and fearful of terms. I am talking of the modern day nursing home.The allegations of abuse and neglect abound. The New York T...
Source: In My Humble Opinion - September 30, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Will Healthcare Reform Destroy The ePatient Movement?
In conclusion, I think the way forward for the ePatient movement is clear. You have fought like bats out of hell against the paternalistic, backwards ways of the past. It's time for you to turn your attentions to a more sinister villain.Your government. (Source: In My Humble Opinion)
Source: In My Humble Opinion - September 23, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Personal Responsibility And Chaos
She was sick. Not sick like a high fever, body aches and a runny nose. Sick like she had spent the last half a decade in nursing homes as most of her internal organs failed. There was oxygen, and dialysis, and a colostomy. She propelled herself vigorously through the crowded halls in the custodial wing of the nursing home, her wheel chair a natural extension of her body thoroughly unhampered by bilateral leg amputations. She was sick, but she was thriving. Every hospitalization, every set back, met with a perseverance and a stoicism of body that was nothing less than magical. The ...
Source: In My Humble Opinion - September 19, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Intimacy
We were intimate.As intimate as a doctor and patient can become. He had long outlived his wife and there were no children, no family, just friends. When he first came to me he was lively and active, but the years took their toll. Our visits became more regular. Every six months. Then every three.His memory started to slip. Occasionally he would look at me suspiciously when something went wrong. His mind no longer able to wrap around the intricacies of medical care, he grasped at what was left. If he forgot to pick up his prescription from the pharmacy it somehow became my fau...
Source: In My Humble Opinion - September 11, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Are We Emasculating Our Physicians?
On the face of it, the phone call was relatively innocent. A family member was confused about the test I scheduled. Apparently the lab refused to draw the blood. When I inquired why, I was informed that the patient hadn't been fasting. I calmly explained to the daughter that fasting was not necessary. Recent studies had shown little effect on lipid panel results and I was using the glycosylated hemoglobin to asses diabetes. The daughter, however, said the lab technician was steadfast. They wouldn't draw the blood unless my order specifically stated: no fasting necessary. Furt...
Source: In My Humble Opinion - September 8, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
All Of These
You want to know what it feels like to be a doctor? I want to know what it feels like not to be.There has never been a time that I wasn't a doctor. There are things that one strives towards and things that reside in ones bosom before the act of becoming has yet occurred. This has been my birthright. I could no more have chosen a profession than I could my gender, my parents.That is not to say that my future was carved in stone. I suffered as did my brethren through self imposed asceticism, my head buried in text, my eyes watering, my intellect at times crying for mercy. I did this not out of w...
Source: In My Humble Opinion - September 3, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
The Last Thing On Our Mind
She was having excruciating pain in her pelvic area. I pulled the sheets down cautiously and noted the bruising encircling the waist and inching towards the thighs. I finished my exam and retreated to the nursing station of the skilled nursing facility to comb through the chart. ER records, floor notes, consultations, but no X-ray of the pelvis. There was no mention of pelvic pain.The emergency room physician had dutifully ordered a cat scan of the head and neck to rule out injury. The hospitalist had noted a fourteen point review of symptoms. The social worker had informed the patient that sh...
Source: In My Humble Opinion - August 31, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
The End Of Days
Sometimes my day is like a book. The first chapter may begin in the darkness of a self imposed corner as a phone call is made. A voice, full with the thickness of slumber, answers unexpectedly.I think today is the day.No matter how many years I have been discussing death I still find myself using poor euphemisms. The bain of medical school teaching, I often struggle with the directness. Your mother will die today. So cold. So hard to muster the courage and keep one's voice strong and confident. I used to shy away from such dire predictions. I no longer do. Better to tel...
Source: In My Humble Opinion - August 20, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Why Come To The Doctor In The First Place?
William was doing great. His C Diff was finally gone after a month taper of vancomycin. He was stronger. The nursing home staff reveled in how much progress was being made over such little time. It seemed every one was ecstatic, except for, of course his family. Every step this octogenarian took forward was accompanied by a litany of concerns and complaints from his daughter.If he was not gaining weight, she wanted to know why. If he then put on a few pounds, she wanted his diet restricted. Through each "emergency" I calmly talked her down. I often spent thirty minutes ...
Source: In My Humble Opinion - August 12, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Diaspora
I fully reject this notion of wholeness.I have never been whole. More like an incomplete conglomeration of parts, friends, lovers, and family have all received a bit of me. As I have given myself freely. And I worry, as a physician especially, what will be left. As I tend to the sick and dying I wonder if that which is transferred will be lost forever with the frailty of the heart beat, the rattle of the lungs. Much better to be an obstetrician, I reason, who bestows each piece upon a burgeoning miracle. There is great longevity in such things. But as I rest at the bedside in those last ...
Source: In My Humble Opinion - August 1, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Doctors Behaving Badly?
A dozen set of eyes stared upwards. The nurses ate their pizza and glanced back and forth between me and the dry erase board that I had recently filled with incomprehensible scrawl. I had given this lecture many times; said the words over and over again. And yet the response was always surprising.Why do you think physicians get angry and annoyed when you call?A simple question. Every day clinicians yell at nurses. They bully, they prod, they rush off the phone before fully answering questions. I have done it many times myself. The phenomena is so common that most nurses and secreta...
Source: In My Humble Opinion - July 29, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
