May 29, 2015

two little letters

     What a strange appearance after my name those two little letters make.  As if my name weren't long enough.  And oddly enough, separated by a comma.  A mere pause.  What stories there must be in the telling of the addition of those two little letters?  In this instance, a play with a professional actress, Megan Cole.  And what should this play be about?  An English professor dying of cancer.  What other role would I be "volunteered" for, of course, but an arrogant oncologist fellow trying to grasp his own humanity as life beats it either from him, or into him, depending on the point of view.  But it was a deep honor to be bear witness to Megan Cole's performance of death.  And life.  Just as I take the stories of all the patients who have helped me add those two little letters, hers is no less of potent tale.

May 22, 2015


Through many countries and over many seas
I have come, Brother, to these melancholy rites,
To show this final honour to the dead,
And speak (to what purpose?) to your silent ashes,
Since now fate takes you, even you, from me.
Oh, Brother, ripped away from me so cruelly,
Now at least take these last offerings, blessed
By the tradition of our parents, gifts to the dead.
Accept, by custom, what a brother’s tears drown,
And, for eternity, Brother, ave atque vale
‘Hail and Farewell.’

May 16, 2015

the devil's hour

     For, he thought, it’s a special hour. Women never wake then, do they? They sleep the sleep of babes and children. But men in middle age? They know that hour well. Oh God, midnight’s not bad, you wake and go back to sleep, one or two’s not bad, you toss but sleep again. Five or six in the morning, there’s hope, for dawn’s just under the horizon. But three, now, Christ, three A.M.! Doctors say the body’s at low tide then. The soul is out. The blood moves slow. You’re the nearest to dead you’ll ever be save dying. Sleep is a patch of death, but three in the morn, full wide-eyed staring, is living death! You dream with your eyes open. God, if you had strength to rouse up, you’d slaughter your half-dreams with buckshot! But no, you lie pinned to a deep well-bottom that’s burned dry. The moon rolls by to look at you down there, with its idiot face. It’s a long way back to sunset, a far way on to dawn, so you summon all the fool things of your life, the stupid lovely things done with people known so very well who are now so very dead – And wasn’t it true, had he read somewhere, more people in hospitals die at 3 A.M. than at any other time . . . ?
      ......So what do we do? We men turn terribly mean, because we can’t hold to the world or ourselves or anything. We are blind to continuity, all breaks down, falls, melts, stops, rots, or runs away. So, since we cannot shape Time, where does that leave men? Sleepless. Staring.
Three A.M. That’s our reward. Three in the morn. The soul’s midnight. The tide goes out, the soul ebbs. And a train arrives at an hour of despair. . . . Why?
- Something Wicked This Way Comes by Rad Bradbury

     I know the passage well and I know I have used it before.  But as I sit here sleepless at 3 am, the passage becomes a talisman that protects me from myself.  I use the gifted writing as a defense to avoid relying on my own words as that would require rising up from the deadness within to draw breath, and give my pain its own language.  I naively assumed that graduating and starting residency would ease the transition of my own soul.  But here I am, still awake at 3 am.  Plus ça change, plus c'est la même chose.  The things change, the more they remain the same.

April 7, 2015

staying home

     I will be staying home at UT Houston for my residency training in Family Medicine.  Although my wife says it's lowercase md until I finish residency.  Then I can be a true uppercase MD.  She says she has to keep me humble.  Never have two letters meant so much.  No, it's not the letters.  It's what I underwent to earn them.  Those and the gray hairs.

March 27, 2015

dr death

     It seemed a befitting end to my medical school career.  The patient was dying.  Late 70s, history of Stage IV cancer, now with sepsis and respiratory failure.  All attempts at weaning the patient from the ventilator failed.  The patient's heart failure worsened the situation as fluid backed up into the already damaged lungs.  Then the kidneys began to fail which was the tipping point.  As I said, the patient was dying.  The family had been presented with end of life care on multiple occasions.  They refused.  They wished to keep going.  It was clear that the patient was in pain - groaning, writhing, restless, high heart rate.  But everytime we sedated them more, the respiratory condition got worse. 

     So on my last morning rounds of medical school, I stood tall, my voice loud so the entire group could hear and began, "just because the family wishes to keep fighting does not mean we lose sight of the obligation to the patient, who happens to be in pain from bone metastases.  It is clear that with multiple failures at weaning her from the ventilation, her respiratory failure is not improving.  In fact, it's getting worse judging by her compromised heart function, chest x-ray, the blood gasses, and her worsening acidosis compounded by renal failure.  What's the harm in keeping the patient comfortable?  She is dying either way.  She might as die without pain."  The attending nodded at me and told the nurse to bump up the fentanyl.

March 17, 2015

match explained

For those of you confused by The Match, join the club. I don't pretend to like it, understand it or defend it. Here's the official explanation, though. Wikipedia is pretty good, too. As the number of medical students has increased relative to residency positions, I'm not sure if the "logic" would still hold today. All I know, this is just one of MANY hoops to jump through. You stop questioning them pretty quickly to retain your sanity and to not lose sight of the real goal - to become a good doc. At least I did. But having come from the private sector first, I MUCH prefer the model of having job offers to consider and weigh against each other than this rolling of the bones.