Mr. K had been admitted with dehydration and malnutrition secondary to diarrhea in the setting of HIV. During his stay, he developed refeeding syndrome. When the resulting electrolyte imbalances paved the way for cardiac arrhythmias, he coded twice in the ICU. The care team managed to bring him back each time, but not without consequence; the brutality of numerous cycles of CPR left him with multiple rib fractures, inflicting him with sharp pain every breath.
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.
A scalpel, a corpse — / His beard is neat, his eyes are / Empty. Gloves hide clammy hands / Afraid of what awaits beneath
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.”
Unmotivated to study, I dedicated myself to researching the virus as well as its epidemiological, social and economical impact on our communities. Adjusting to life in quarantine was frustrating, and I felt like I was watching the world turn upside down. However, researching the pandemic felt much more relevant than trying to use all these anatomy apps to fill in gaps created by a lack of practical hands-on learning.
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.
Mrs. H’s story is just one of millions of Americans who have become victims of structural violence and suffered from the social determinants of health. With a clearer understanding of the complex factors that contribute to patients’ health outcomes, I now aim to reunite the erroneously separated domains of medicine and social sciences.
High potassium? / How did this happen so fast? / Secret burrito.
Sameera was an Iraqi refugee who had recently arrived from Tijuana, Mexico. She fled violence from what seemed like every corner of the globe, starting with Iraq, then to Yemen, Brazil, Mexico, and now to a small, bare and cold cell somewhere in southern California.
Today, my grandparents are older than Saul was when distanced from his family. Now during the coronavirus pandemic, they too are isolated. This time it’s not because they are the fomites, but because I might be. Those big enveloping hugs that grandma lives for and kisses from grandpa will likely become a thing of the past.
Our patients deserve to have their battles acknowledged. That means believing your patients when they implore, “I am trying” and appreciating that we may encounter people at different phases of recovery.