Buyer Beware
Gertrude wasn't able tell me herself. She was ninety years old and moderately demented. It was her daughter who called. She pleasantly greeted me as I picked up the phone.
We had a good working relationship, Gertrude's daughter and I. We navigated a heart attack and stroke, multiple hospitalizations, and many discussions concerning end of life care. Gertrude was well taken care of. She was lucky enough to have a group of helpers who were under the doting, watchful eyes of her daughter.
In fact, the last pneumonia and urinary tract infection were both treated successfully at home without need for hospitalization. I guess ...
Source: In My Humble Opinion - September 18, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Oasis
There was nothing wrong with Sarah's vocal cords. Her tumor had spread throughout the abdomen, but her voice was unaffected. Yet minutes after learning of the voraciousness of her metastases, she pursed her lips and began to communicate with head nods and hand gestures only.
I met her for the first time in the nursing home. I sat down quietly at her bedside on a Sunday morning. I was in the midst of a weekend call rotation that would last fourteen days. Then, because of a scheduling snafu, I would have a few evenings off before starting my next two week stint. Only one weekend to rest all month.
We communicated in the mo...
Source: In My Humble Opinion - September 14, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
9/11 Repost
My dream is always the same.
It’s just another day in hell. I stand on the Bone Marrow Transplant unit. There are no windows. Suddenly the building starts to shake. The ceiling cracks letting in rays of sunlight. The ground rumbles below.
Sadness, grief, and despair spew from the floor. They rise as black lava erupting from the innards of the building and drag me to the street. I am swept forward as black death encompasses the earth and moves to envelop the sun. It carries me to the east, always to the east.
*
I've never thrown a punch. Never been in a fight or carried a gun. So if you ask me what it is like to do...
Source: In My Humble Opinion - September 10, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Blood On Our Hands
I have blood on my hands.
No matter how hard I scrub, the fingers retain their burnt hue.
Many cannot see what I see; They cannot feel what I feel. They look at me with my crisp white coat, picturesque family, and all the trappings of middle class success. I am a doctor. I am to be envied. How dare I suggest that the profession that has buoyed me through this tumultuous economy is flawed? I should be thankful.
And indeed, I am, on those days when I see past the red. For there is a dark secret bouncing in an out of the minds of those who took this oath. None of us escape. Not even the ones who no longer "touch" patients...
Source: In My Humble Opinion - September 9, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Worrier In Chief
Saul couldn't have been a nicer guy. The story behind his arrival to the nursing home was long and sorted. But now we had a black gangrenous foot to deal with. The culprit, not the toe ulcer that brought him in to the hospital in the first place, but small thrombosed blood vessels from heparin induced thrombosis and thrombocytopenia, a reaction to a medication given as a precaution.
The vascular surgeon was equivocal, amputation versus watchful waiting. Toes can autonecrose (self amputate), but when the black tide of dead tissue spread towards the ankle our options became limited. As the white count began to rise, I had t...
Source: In My Humble Opinion - September 5, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
The Anatomy Of A Hospital Admission
If Hattie had but one flaw, it was that she held her doctors in too high esteem. It was not unusual for an eighty year old woman of her culture to want to please her cardiologist. So when her blood pressure came up a little high, she was too embarrassed to admit that she had forgotten to pick up the toprol and hadn't taken it in over a week. The cardiologist hemmed and hawed, he buried his head in the computer, and eventually wrote for norvasc, a new blood pressure medication. What he didn't do was ask about whether she had regularly taken her pills. He also forgot to tell her that leg swelling is a side effect of the medi...
Source: In My Humble Opinion - September 2, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
The Impatient Mistress
Leave him alone, he's talking about dying again!
My son gently pulls at one of my daughter's arms as she thrusts the other towards my face. Her delicate fingers are wrapped around a small tattered paperback book. She wants me to read to her. I squint and struggle to concentrate on the words coming from the mobile phone glued to my forehead. I make menacing looks hoping they will scare easily and run off. They stand their ground emboldened by experience. My children are all to familiar with these histrionic antics.
My son is right. I am talking about dying again. Five thirty in the evening is as good a time as any. My fa...
Source: In My Humble Opinion - August 28, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Pedestrian
I've experienced much loss in my life, both personal and professional. It's no secret that as a physician people come and go often without warning. And I worry about my patients. Not just about diseases and diagnoses, but I think about their well being. Are they happy? Do they have enough support? Are they in pain?
The doctor-patient relationship is a bidirectional investment. Over years of visits, I have become intimately familiar with the people who inhabit my exam room. I ask about their families and hobbies, not to be a more avid physician, but to be a better human being. I am not just pedestrian. Making the right dia...
Source: In My Humble Opinion - August 25, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Girls, Fast Cars, And Healthcare
It wasn't that I was so enamored with the girl herself. But as an awkward teenager, when a member of the opposite sex takes an interest, you tend to notice. We had gone on a couple of dates; spent some time together. So it took milliseconds to accept the invitation to join her and a friend for a ride in her new white Volkswagen Jetta. I slid into the back, and tried to nonchalantly fasten the seat belt. She hopped into the drivers seat with her best friend by her side.
Moments later, we were off.
The radio blared and the windows were open. My hair flew spastically in a multitude of directions. I patted the wayward tendr...
Source: In My Humble Opinion - August 19, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
A Review of @danielleofri What Doctors Feel
When I started residency in July of 1999, I felt confident that I was doing my life’s work. I came to the hospital early the first morning. The chief physician brought me to the third-year resident who was covering the patients who would become mine. This was the resident’s last day of training. I will never forget the phrase my chief used when introducing him.
He said, “This is John. You’re taking his patients. Today is his last day of residency. He can’t be hurt anymore!”
My thoughts raced. What did he mean “can’t be hurt”? Who was hurting him? And why couldn’t he be hurt anymore? Unfortunately, I w...
Source: In My Humble Opinion - August 16, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Departures And Arrivals
Thomas should have died long ago if not for a secret weapon. Neither faithful medicines nor dedicated physician could battle the ravages of age and disease with the simple clarity of the love of his daughter. Indeed, congestive heart failure and general frailty were no match for Leslie's unbending will. She nursed him back from all exacerbations. She slept by his side during every nursing home stay. And she prepared his home triumphantly for each return to health even though he was getting sicker.
Her father's debility was in stark contrast to Leslie's own vigor. She visited me occasion...
Source: In My Humble Opinion - August 11, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Why Doctors Lie
The oncologist shook his head as he walked out of the room. He still held a paper towel in his hand which he used to wipe the last remnants of soap and water. He tossed it into the trash, and looked in my direction. We talked for a few moments. The cancer was more widespread than originally thought. The surgery exposed a belly full of metastases. The options for chemotherapy were thin.
I entered the room with a heavy heart. I sat next to the bed, and listened before beginning with a litany of questions. The post operative pain was well controlled. The patient had been ...
Source: In My Humble Opinion - August 9, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Sacred Ritual And Twitter, Some Thoughts On @nprscottsimon Live Tweeting His Mother's Death
It was another perfect Los Angeles day. My family and I sat on the veranda of the hotel as the midafternoon sun cascased gently onto the shoulders of the onlookers. We collected in rows of chairs that were covered in white linen. The music marched forward, and the wedding party assembled cleanly in pairs of twos. We all knew what was coming next. Of course there would be some variation, but most have been through enough weddings to be familiar with the routine.
We use rituals to mark our sacred events: beginnings and endings, birth and death, and even marriage. We gather our loved ones, our communities, to celebrate or mo...
Source: In My Humble Opinion - August 5, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Regression To The Menial
I was far ahead of my time.
The cachectic middle aged man had been admitted to the hospital fifty times in the last calender year. The other residents and I joked that new graduates only truly became interns after they had Leon on their service. He suffered a range of chronic illnesses, mostly respiratory, that were overwhelming to his mentally challenged mind. He often would walk off the floor with discharge instructions only to appear in the emergency room minutes later complaining of shortness of breath.
I liked Leon. He was soft and gentle. His lack of mental capabilities only made his kindness more endearing. He wa...
Source: In My Humble Opinion - August 1, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Are We Dumbing Down American Medicine?
I guess what is so utterly frustrating is that the guys up there don't see what is going on down here. The march of healthcare reform continues with little realization of what it feels like to be one of the tiny peon foot soldiers on the ground. We are not deaf. We hear the politicians and policy wonks. We read as non clinician "doctors", ivory towered administrators, and the business and public health degrees tell us how we are being obstinate when we balk at the "grand" reform being shoved down our throats.
If those darn doctors would just step in line!
Those of us providing care on a daily basis have an alternate per...
Source: In My Humble Opinion - July 29, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
