Chief complaint: arm pain, / Waiting in room 4. / As I enter, he looks me up and down — / What is it he’s looking for?
I have learned that patients seek health care services at free clinics for a myriad of reasons and some are atypical. There were specific populations I expected to see: the uninsured, underinsured, undocumented, and those without access to transportation. Yet there were other populations I was more surprised to see, namely patients who had insurance but preferred their experiences at free clinics.
Each morning, Mr. E had a new concern — too hot, too cold, too dizzy, too stiff. He was admitted for what seemed to be a straightforward heart failure exacerbation, but his echocardiography showed severe hypertrophy in both sides of his heart that the cardiologists described as “concerning for infiltrative cardiomyopathy.” For me, this was intriguing; as a fourth-year medical student with only one year of clinical training under my belt, the autoimmune diseases I’ve come across in actual practice have been few and far between. Mr. E, however, seemed completely uninterested whenever I brought up the amyloidosis they had found on nuclear imaging.
While the professor moved to the next slide, my face visibly blanched. All I could hear was the drowning sound of my own heartbeat thumping in my ears. Is this true? I thought. Nothing we can do? Only five years of survival? Did this apply to my grandpa Baba? But Baba has been sick for six years!
We’re overloaded with so much advice, so many ideas on how to be a better doctor, / how do we decide what to follow and what to ignore?
Until recently, vulnerability meant weakness, allowing oneself to fall behind without a chance for recovery. Courage, on the other hand, had the opposite meaning: betting all my chips on prevailing at any cost.
Allowing natural death gives the elderly and terminally ill the opportunity to control the end of their life, providing empowerment and a sense of peace during their time of uncertainty. This patient and her family’s forethought allowed us to provide medications to ease her pain and discomfort. When she closed her eyes for the last time, her body relaxed into the sheets, and I pulled the blanket up to her shoulders. Her family said goodbye, and then I began to perform post-mortem care.
I commented to the resident how satisfied the attending would be with the efficiency of his work. He just laughed and said “look” as he gestured down to his list of patients. I saw the name, and a sense of dread sank in during the rest of the silent walk down the hall.
The 2015 U.S. Transgender Survey conducted by the National Center for Transgender Equality demonstrates the U.S. transgender community’s need for mental health services and unique barriers to care.
The HIV clinic was one of my favorite rotations in all of third year. It was often emotional for me. Many uninsured, low-income patients came to the clinic not only for their HIV treatment, but also for comprehensive primary care.
Asking someone if they want to kill themselves becomes easier every time. The appalling part is how quickly this and other taboo personal questions became a normal part of my routine.
We shuffled out of the room, but before closing the door, I could hear her bangles ringing as her hands fell with defeat into her lap. Behind the closed office door, Dr. Altman gave us his three-word assessment: “She’s just crazy.”