The Return Of The Prodigal Daughter
When I was in training, I had the mistaken belief that disease was treatable. I felt human weakness resided in the inability of the physician. If a patient deteriorated, if a battle was lost, it was because we weren't skilled enough. I studied with every extra moment. I followed the gurus and hung on each word of wisdom that flowed from their eloquent lips. I embraced the wonderful naivete, hoping against hope, that illness was curable and human fallibility could be scrubbed from our pristine souls.
There was a time after residency when I lost faith in medicine. I kneeled at the steps of a broken shrine. In ...
Source: In My Humble Opinion - November 3, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Is The Doctor-Patient Relationship Like A Marriage?
It was like we were breaking up.
She stared at the ground longingly, and lifted her eyes from time to time as she spoke. She valued my care of her mother. She would never forget how I stood at the bedside during those last moments. And then there was her own health crisis. The emergency surgery was made more bearable by my familiar face in the emergency room explaining what would happen step by step.
She couldn't afford my new practice model. She crunched the numbers, and it just wasn't feasible. She didn't blame me. She understood that like any relationship, sometimes things just don't work out. Even businessmen and se...
Source: In My Humble Opinion - October 30, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Somebody's Doctor
You won't at first.
I mean you will try. But eventually the poor gentleman cowering in bed will just become the homeless guy in room 114. New admissions will cease to be opportunities to heal or learn. You will dread the extra work. Blood on your hands will no longer be the ephemeral pulsating evidence of life recently passed, but instead will be the muck mixed with excrement that you mercilessly scrape from your soiled hands.
And in those lonesome times when you're well rested enough to surface from the meandering haze of responsibility and fear, you'll scoff at the refection in the mirror. ...
Source: In My Humble Opinion - October 27, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Credit Due
I once mistakenly believed I knew nothing. Then after many years, with great hubris, I assumed a false sense of mastery over all that lay at my feet. It was only the wisdom of experience that taught me the truth lies somewhere in the vast in between.
It was nothing really, at least to me. I was in the midst of a busy, contentious, office meeting when my mobile began to buzz. I answered with the bitter taste of annoyance whipping from my tongue. It was a nurse from the skilled facility. My patient was declining. Frazzled by my surroundings and emotionally invested, I found just about every excuse for why she was wrong.
I...
Source: In My Humble Opinion - October 24, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Cancer And Baseball
Drip. Drip. Drip.
I would eventually come to recognize the sound of lives sliding down the drain. The life of a physician would allow me a front row seat to the horrors of disease, premature death, and total financial destruction. But my earliest memories were of the small bathroom in the back of that little antiques store. The leaking faucet was just one of the many signs of the decrepit and decaying building.
Downtrodden as it was, the storefront housed a certain vitality that attracted young and sometimes lonely preteens like myself. The owner, on a fluke one morning, decided to sell his old collection of baseball ca...
Source: In My Humble Opinion - October 20, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Who Is Responsible?
But doctor, ultimately it is your responsibility.
I can hear the case coordinator clicking her fingernails against the desk through the telephone line. I admit, I forgot to specify to the nurse, when she called me ten minutes before midnight, that this was a full admission and not an observation. In the absence of my order, a nurse manager reviewed the chart and decided that the ninety five year old woman with congestive heart failure and positive cardiac markers was appropriate for observation status. Of course the order can be changed, but one day will be lost. She will have to stay in the hospital an extra night in ord...
Source: In My Humble Opinion - October 14, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
I Will Come To The Water
When I was young, I stumbled up the mountain in search of knowledge. Years later, I descended to the water when knowing no longer quenched my thirst.
I took the news poorly even though I barely knew the woman. We had talked on the phone a few times, over the years, regarding shared patients. I heard that she loved to swim.
They found her car parked in the lot adjacent to the beach. It was rumored that she was far too strong a swimmer for this to be an accident. But later there were whispers that she swallowed a bevy of pills before striding confidently into the waves that early morning. They fished her body out of the w...
Source: In My Humble Opinion - October 12, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Have Physicians Lost Their Backbone?
What ever happened to courage?
Jim came through the choleycystectomy beautifully. In fact, he did so well that in no time he was back on the basketball court. Three weeks later he was in my office with a sore, swollen leg. He thought it was from twisting his ankle the day before. And indeed, it had all the appearances of a sports injury. I examined the extremity carefully, and decided to get a venous doppler to evaluate for DVT given the recent surgery.
My suspicions were confirmed when the technician called to tell me that he had found a clot in the deep veins of the thigh. Shortly after hanging up, my phone started to ...
Source: In My Humble Opinion - October 10, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Selfish Empathy
Forgive me.
I went to a funeral today. I listened intently as various friends and family of the deceased regaled in what is and what was. The rabbi at the lectern was somber. His voice floated through the room both melancholy and hopeful. As he cleared his throat to begin the Mourner's Kaddish, I was again dragged back to childhood.
Yit'gadal v'yit'kadash sh'mei raba...
This chant, this prayer, this island of familiar in a sea of horrific will always remind me of my dad. His death is my earliest remembrance of these foreign but comforting words. I listened as a child intently at his funeral. Then, year after year, in sy...
Source: In My Humble Opinion - October 8, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Death And Privilege
When I say it's a privilege I see your eyes go cross. You think I'm daft. You reason that you are to young too talk about such things, or old but healthy, or that the cancer has spread but you want to remain optimistic. And I shake my head and think of my father.
He never had the luxury.
At the age of forty, he left early one morning to round at the hospital and never came back. A small blood vessel burst in his brain causing irreparable havoc. By the time we arrived, he was connected to all the appropriate machines. Back then, there was no talk of such things as preexisting wishes. The neurosurgeon, my father's co...
Source: In My Humble Opinion - October 5, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Irl
(This would be the start of a great #hcsm joke)
@hjluks walks into the lobby of a posh New York athletic club. I am sitting by the elevators. While he approches, I marvel at how easily I recognize him. It's not that he looks so much like his twitter avatar, I just feel like I've met him before. We shake hands and embrace.
The conversation begins as if we we starting where we left off last time. But there was no last time. We exchange pleasantries and go right to substance. I look over at the elevator bank wondering if we should go up to the conference room, or just stand in the walkway. And talk forever.
Eventually we m...
Source: In My Humble Opinion - October 3, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
There Is No I In Team
I was spiking a fever.
It was as if someone flipped a light switch inside my body. I could feel the sensation rise through the chest, and trample the dazed contents of my skull. Light, however, was a poor, lazy metaphor. There was no heat, only stimulation.
My belly ached from the repetitive heaving that preceded the fever. I envisioned the sandwich I had eaten that afternoon. I pictured small bacteria crowding into the generous dollop of mayonnaise wantonly placed by the store clerk. It was food poisoning. I was sure of it.
I cautiously sipped from the glass of water on the bedside table. My mouth, parched and yearnin...
Source: In My Humble Opinion - October 1, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Are You Listening?
He was an expert in healthcare policy. He wrote nationally lauded papers on such things as evidence based medicine. He spent half his time in Washington advising one governmental agency or another, the other tucked away quietly at the VA. Originally he attended at the University, but that didn't last long.
We residents avoided him at all costs. Not only did he piss away our precious time with verbose and often tangentially related lectures, he was down right dangerous. The head of internal medicine knew it; our chief resident knew it. So schedules were shuffled, teams were adjusted. &nb...
Source: In My Humble Opinion - September 28, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
I Call Bullshit
I am hard on myself. I'm the first one to point the finger inward. Every patient that dies, every adverse outcome, I study my decisions in excruciating detail. I have high standards. I don't sugar-coat the abilities of myself or my colleagues.
As the owner of my own medical practice, director of a nursing home, expert witness, and associate director for a hospice and palliative care company, I have vast experience dealing with the pitfalls of our medical system. After seeing thousands of patients, in almost every setting over the last seventeen years, I strongly question what I have been recently reading on my twitter fee...
Source: In My Humble Opinion - September 24, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Death Is A Period Occuring At The End Of A Sentence
You are dying.
I have reviewed the Cat Scans, spoken to the specialists, and studied the labs. There are many possible treatments that could be offered, but I fear they will not stem the course of all that is happening already. The tumor is too advanced, the metastases, too malignant.
I know there are many questions about chemotherapy, radiation, and feeding tubes. I would caution you to think of death as the inevitable endpoint. There are many things we can do between now and that endpoint. Some will increase your life expectancy, and some will cause pain and discomfort. The trick is to decide what is more important to ...
Source: In My Humble Opinion - September 22, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
