Friday, November 8, 2013

the oath of maimonides

(author's note:  this post isn't funny and isn't entirely about medicine...)

you may have heard or read about this event two days ago -- a young man, sasha fleischman, was badly burned while asleep on a city bus after a fellow student set his skirt on fire.  sasha identifies himself as agender, neither male nor female, and occasionally wears skirts.  when i read about this my gut reaction was of course, horror.  how could someone do such a thing?  and in such a public and aggressive way?  and why does a boy in a skirt invoke such anger and hatred?

at the same time that my heart was sinking, it was also lifted up by the beauty and hopefulness of sasha's self-love and self-acceptance. that he loves himself enough to know that this is who he is, and that he accepts himself enough to openly express himself through his dress is a joyful and inspiring thing to me. but, as this shows us, the bravery of self-actualization sometimes requires incredible vulnerability.

so what does this have to do with medicine? well, events like this, intimate acts of hatred between one human being and another, make me think of the oath of maimonides.  maimonides was a twelfth century physician, astronomer and jewish philosopher.  similar to the hippocratic oath, maimonides' oath was a call to the physicians of his time to 'do the right thing.'   the part of the oath that i love the most is this:

     'may i never see in the patient anything but a fellow creature in pain.'

in my mind, i have adopted it as 'before and above all else, see the human being in the person in front of you' and i think of this every day in my medical life, usually right before i enter the exam room. it sounds simple enough, but it is so easy in my job to center myself on the illness, the chief complaint, the test results, the computer screen, and the dozens of other tasks i must attend to with each encounter, that  i need to make a conscious effort sometimes to center myself on the patient.  when i say that oath to myself, then i can relate to my patients as persons, as individuals with real suffering, not simply as a list of medical problems or test results.  when you do this, you open your heart to your patients, and i believe you become a more compassionate physician.  i am far from perfect at this.  ask any of my patients! i have my harried days when i want to close myself off from my patients' pain or suffering, when i want to just check all the boxes and move on, but i do try to hold this tenant in my mind with each person i see. (i'm getting bogged down in this paragraph but i think you're getting what i'm trying to say...)

so getting back to sasha -- i believe there is something in the oath of maimonides for all of us. an opportunity to see the fellow creature in front of us as a suffering human being.  not as a boy in a skirt, but simply as a person to whom we are intimately connected by our shared humanity. that is what maimonides asked of his fellow physicians then, and what i hope for sasha and all of us now.

Tuesday, November 5, 2013

may i have the envelope please...

you may already know of my aversion to the proffered envelope or other item in the exam room (sure to contain something gross).  so when my patient reached into her purse and pulled out a sealed envelope, i ran from the room inwardly cringed.  in this envelope, she told me, were the pinworms she had pulled out of her carpet.  she described their pale bodies and hooked mouths to me in great detail.

i bravely pulled on my gloves and set out a drape to catch the worms.  i carefully unsealed the envelope and shook the contents out onto the drape.  oh, dear.

which of these things is a pinworm?

 a)  a down feather
b)  a piece of a pretzel stick
c)  the stem from a grape

answer:  d) none of the above

what is this woman's diagnosis?

answer:  sadly, hallucinations related to her underlying dementia.

Monday, November 4, 2013

the sounds of medicine

awesome sound:
the abbreviated ring of the phone before it kicks over to the answering service on friday afternoon.

not so awesome sound:
your pager going off at three am sunday morning. (that would be the patient who is too polite to wake her dentist...)

awesome sound:
the jet of fluid as it hits the side of the vacutainer telling you that you're in the pocket of acites you are trying to drain from your patient's abdomen.

not so awesome sound:
the whoosh of air sucking into the IV site as you pull a wide bore central line (but no so bad as the voice inside your head that is now saying oh, crap...)

awesome sound:
the rapid, but gentle and happy, thump of fetal heart tones

not so awesome sound:
silence when there should be none.

an honest answer

i asked my COPD patient how his breathing was, and he answered, 'expensive.'