Patience: it's not just a Quaker name

Today I had a patient who came in right before lunch. I thought that I could get everything done in 15 minutes, no problem. And, of course, that was where I jinxed myself. I like to think I'm a pretty good listener, but after twenty minutes of hearing about his entire cardiac history, his heart surgery, his problems getting his blood pressure medications from the pharmacy, even his snowblower, I was completely depleted in body and spirit. And when he started telling me about his wife's problem with her cholesterol medication, I just stood up and started examining him just to get him to stop talking. I thought to myself, this patient isn't nearly old enough to make me put up with his ramblings. Talk to me when you're in your eighties, buddy.

It's times like that when I realize how impatient medical school has made me. I never, ever considered myself a Type A person--you know, the kind of person medical students are supposed to be. I'm an English major, for crying out loud. And yet I see myself becoming more Type A all the time. I'm sure it's the people I'm around all day. When I was on internal medicine, my attending put great emphasis on not wasting a single word when presenting a patient. I definitely learned to be more concise in my speech, which is great. But now I find myself getting impatient with others who waste words when they talk. For a few months after that rotation, Fast and Testimony meeting was hell.

Impatience does have its virtues in medicine. Sometimes things need to be done immediately, and unless you bug the lab repeatedly or call down to radiology over and over again, it's not going to get done. A doctor should be unwilling to put up with delays or excuses when it comes to the health of a patient. Even so, healing is impossible without patience. It takes time for electrolytes to rebalance, bones to knit together, skin to reseal itself. And it usually takes even longer for the spirit to heal. A good doctor has to know how to wait. One of my favorite prescriptions is "tincture of time." Not every medical issue has to be pounced upon with feline ferocity. The body is pretty good at healing itself.

So even though I'm learning the value of impatience, I'm relearning the value of patience, too. Last week, I had a patient who, I soon realized, was going to do a lot of talking. I decided the best strategy would be to let him talk for as long as he liked. The visit lasted an hour and a half, and I could only stop him long enough to ask a medical question every five minutes. Despite all this, it was one of the most interesting and memorable patient encounters I've ever had. There's a time for patience and a time for impatience. I just hope I learn to tell the difference.

Conversation starters

Enough with the dark posts for now (just wait until you get my post on working in the county jail!). Once I was at a party, and in a sudden flash of inspiration I stated with great confidence the theory that any conversation can be jumpstarted by talking about (1) bunnies or (2) peanut butter. I've had less success with bunnies as a conversation starter, but peanut butter does seem to work as an interesting topic of discussion. Creamy or crunchy? Natural or regular? Which brand? With jelly, jam, bananas, honey, apples, or celery? So, here's your topic, commenters. Tell me what you have to say about bunnies or peanut butter.

A story from shock trauma

In January, I spent two weeks on Shock Trauma. The schedule was grueling: overnight call every three days. It seemed that once you had stayed up all night, the post call day went by quickly and then you were up all night again. I always enjoy a good trauma show on TV, and those shows led me to believe that there would be a constant stream of horribly mangled bodies, constant action, gowns and gloves being tossed around as the patient is prepped immediately for surgery. There was a little of that. But one of the very surprising things about trauma was how pedestrian it could be. A gunshot wound or motor vehicle collision could come in and leave the same day. Yes, there were a few times when there was a mad rush, with everyone in the building crowding around the bay, hoping to get a glimpse of the action. But often a patient would come in on a stretcher and the resident would calmly take notice and get up and do what needed to be done. All the same, you remember the sickest patients best. Here's one I remember in particular.

He was an elderly man who shot himself in the forehead. When we looked at the CT, we could easily see the destructive path the bullet had taken through the skull and brain. The pieces of shrapnel glowed brightly, and the ventricles were filled with a gray haziness, the blood diverted from the brain tissue, emptying from the inside. And yet the wound in the forehead was a small, ragged thing, like a burgundy crocus. The patient was put on ventilation, and his vital signs were quite good. But all the same, the neurosurgeons told us there was no hope for recovery; the only thing to do was to allow the family to say goodbye, then stop the ventilation and allow the patient to die.

Soon, the patient's son came; he wore a long, wool coat, looking as though he had just left a business meeting. From across the room, I could see the absolute blankness on the son's face; it was the face of someone who cannot begin to fell, who had to see everything in perfect clarity first. And then, only minutes later, he left, walking quickly, his face consumed with grief. Later, the resident told me that when he went to talk to the family, they were arguing. Some maintained that they could never imagine Dad doing something like that, that he had seemed fine. Another protested that she knew something was wrong, that Dad had been preparing for this for the last few months, that he had been giving away his possessions and making funeral arrangements, that it should have been no surprise at all.

The patient was extubated and the curtain was drawn around the bed. Two nurses kept watch at the patient's bedside. Not long afterwards, the nurses started to clean the bay, and I saw that the tracing of the electroencephalogram was flat.

In medicine, it's the small glimpses into the lives of your patients and their families that give your work meaning. From a strictly physiological standpoint, this was a simple case: a bullet, a brain, death. But seeing the patient's son, hearing about the family's quarrel: these conjured up whole worlds of grief and pain that revolved like planets around that hospital bed. One bullet had changed a thousand lives irrevocably. When I think about that, I realize that medicine isn't about the bullet or the brain. It's about those thousand lives that change when you place your stethoscope on a patient's chest or when you scribble a prescription. And it's about the thousand-and-first life that changes: your own.

Happy birthday, Billy!

In honor of my sister's birthday, I went on an F. Scott Fitzgerald pilgrimage here in Baltimore, and here are the results. Fitzgerald had important family ties to Baltimore; he was named, after all, for his relative Francis Scott Key, one of Baltimore' most famous citizens. Some of the most difficult years of Fitzgerald's life were spent in Baltimore. But Fitzgerald seems to have enjoyed Baltimore as well; I found the following quote in an article about Fitzgerald's time in Baltimore:

Baltimore is warm, but pleasant - I love it more than I thought. It is so rich with memories. It is nice to look up the street and see the statue of my great-uncle (Francis Scott Key.) And to know Poe is buried here and that many ancestors of mine have walked in the old town by the bay. I belong here, where everything is civilized and gay and rotted and polite. And I wouldn't mind a bit if in a few years Zelda and I could snuggle up together under a stone in some graveyard here. That is a really happy thought and not melancholy at all.

On 12 February 1932, Fitzgerald brought his wife Zelda to the Henry Phipps Psychiatric Clinic of the Johns Hopkins University Hospital in Baltimore. This is where Zelda completed her novel, Save Me The Waltz.

On 30 March 1932, Fitzgerald left Alabama and stayed at the Hotel Rennert, which stood at the corner of Saratoga and Liberty streets; it has since been torn down. Here's a picture from an old postcard.


From 20 May 1932 to November 1933, Fitzgerald rented "La Paix," a house on the Turnbull estate in Towson, just outside of Baltimore. There, Fitzgerald completed Tender is the Night, and when Zelda was discharged from the Phipps clinic, she came to live there. I read somewhere that "La Paix" was torn down to make room for St. Josephs Medical Center; I went to Lapaix Lane in Towson to see if there was anything to see, but no luck. But here's a picture from the Maryland Historical Society; you can see more pictures, including interior shots, here.


On 26 June 1933, Zelda's play Scandalabra opened for a one week run by Vagabond Junior Players. Here's the Vagabond Theatre, at 806 S. Broadway in Fells Point.


In December 1933, Fitzgerald rented a house at 1307 Park Avenue, in Bolton Hill. It's the house in the middle with the unfortunate dark gray paint job. It was hard to find a spot on the street to take a good picture. There's a plaque on the front that says that Fitzgerald lived there, but since it was between two open windows that look right into the living room, there was no way of taking a picture without seeming really, really creepy.


A few blocks away, at the corner of Bolton and Wilson streets, is a small park named for Fitzgerald. There's not much there, unfortunately.


Fitzgerald stayed at Johns Hopkins Hospital nine times. The first was in August 1932, when he had a tentative diagnosis of typhoid fever. He would also be hospitalized for alcoholism and chronic inactive fibroid tuberculosis. Fitzgerald wrote half a dozen stories about Hopkins, including "One Interne."


Zelda suffered a relapse and returned to the Phipps clinic on 12 February 1934. On 19 May 1934, Zelda was transferred to Sheppard-Pratt Hospital outside of Baltimore.


In September 1935, Fitzgerald rented an apartment at the Cambridge Arms on Charles Street. This is now Wolman Hall, a residence hall at the Johns Hopkins University Homewood Campus. In 1937, Fitzgerald left Baltimore for good and went to Hollywood.


And that concludes the tour. Apparently there's a book on Fitzgerald and Baltimore out there, so I'm going to see if I can get my hands on it. And of course, if you come to Baltimore, I'll show you around myself.

Since Beth linked here...

...I ought to have something new to say. So I'm doing two months of rural medicine in Williamsport, Maryland, and every afternoon my preceptor and I go to the county jail to see inmates. Let me just say: when you're missing half of an ear, there is something wrong with your life.