Monthly Archives: March 2012

Spring Planting

—Richard M. Berlin
                 For Julianna A. Luntz Van Raan, 1950–1998
A morning call wakes me:
something hard and fibrous in her leg
growing fast and uncontrolled
that can’t be weeded out.
Through my bedroom window
I study winter rye in April
swinging on strong stems.
I wish I could plant Julie’s leg
in a warm tangle of earth,
turn her face toward the sun,
and let her nurse on spring rain
like the dandelions waiting
to fill the meadow with stars.

Reprinted from The Country Doctor Revisited (KSU, 2010) with permission.

Dr. Berlin celebrates Spring and reflects on his wishes for his patient who is dying of cancer.  We grow attached to our patients. Their losses can become our losses. Although we need to maintain a certain professional distance so that we can contiue to care for them, we can still feel sad and should make the time and space to feel our own grief.

When you grieved the loss of a patient for whom you cared, did you talk with someone about it? Did you cry? Write a poem or story? Go for a run or a walk? We may be scientists, but we have hearts and we are human.

Learning to Walk the Healer’s Path

–Erik Brodt

Three minutes and thirty seconds remained in the fourth quarter of the Minnesota Section 6A boys’ basketball final. Showcasing a fake plant step, our All-State point guard sends his opponent to the floor again. Dribbling around the flopping contender, number 5 pulls up and sinks a fifteen-foot jumper to put Cass-Lake up by four. But there is a turn of fate. Floating down from his jump shot, our point guard landed on the foot of another player, twisting his ankle inward and sending him to the floor in agony. Hearts dropped with the crowd’s deep gasp. Silence. I gulped nervously as my time was at hand. I composed myself and strolled onto the court to help our star as thousands looked on.

“Three minutes and thirty seconds!” she shouted as I threw myself into my disaster gown. “Estimated time of arrival, three minutes and thirty seconds!”

My hands quivered cold with sweat as my fingerprints formed though my  latex gloves. Confusion rested on my shoulder. I didn’t know what, but I could feel something horrible happening. That day, now eternally etched into my mind, had begun as a splendid day. Each step was light, walking between medicine clinic and the women’s health wardto visit a laboring mother and evaluate a baby I had delivered in the morning.

Wearing a wide grin of connection and accomplishment, I fought to contain the giddy chuckles of becoming a doctor. When all is well, being a doctor is bliss. Pulling the hospital door, it didn’t budge. Puzzling. Why was our rural hospital locked in the middle of the day? My pager sounded, I was needed in the ER immediately. March 21 will never be another day to me. No day will.

As a third-year medical student I performed a nine-month rural clerkship at North Country Regional Hospital in Bemidji, Minnesota. I chose Bemidji to be close to my family and the three largest Minnesota Chippewa Reservations. I am Anishinaabe (Chippewa) and it was the perfect opportunity for me to invest in the Native community during medical school. Little did I know how profound an impact the experience would have on me, especially on the afternoon when a young man entered Red Lake High School, shooting thirteen people and killing eight, including himself.

Reprinted from The Country Doctor Revisited (Kent State University Press, 2010) with permission from the author.

As a medical student completing a 9-month clerkship in a hospital near the Red Lake reservation, Dr. Brodt cared for the victims of a tragic shooting. It was particularly challenging because he had spent summers with his grandparents on the reservation and knew many of the victims and their families. Triaging and treating the patients injured in this kind of disaster is difficult for any health care provider. Because Dr. Brodt knew the families, it added another layer to the calamity. Because the community had just celebrated the men’s basketball team competing in the state finals, the community’s elation quickly crashed with the tragedy.

In earlier posts we have talked about the blurring of boundaries that occur in small communities. Our patients are often our friends. This is both positive and negative. Together the community mourned, but as a nurse or doctor that day, Dr. Brodt and his colleagues had to put their feelings aside and do what needed to be done. I often think of it as pushing a hold button on my feelings so that I can do the A,B, Cs–airway, breathing, cardiac . . . Once the work is done, I release the hold button.  In his essay in The Country Doctor Revisited, Dr. Brodt reflects on how he and the community struggled to heal from that tragic day.

As physicians we witness the best and worst of times in the lives of our patients and the communities we care for. In order to stay healthy ourselves, so we do not become jaded and cynical, it is important that each of us figures out how to care for ourselves. We may see some colleagues turn to alcohol, drugs, too much work or other behaviors that keep them from facing the real issues. Life is filled with good times and bad times and ultimately we have very little control.

Spring and All, Revisited

—after William Carlos Williams

–Richard M. Berlin

By the road home from the general hospital
under the surge of the pink
towering clouds drifted from the
southwest—a warm wind. Beyond, the
edge of a mountain pond, redwings
on bulrush calling out their claims,
circle of black water
the veil of thin ice, receding
All along the road, the same reddish
purplish, forked, upstanding twiggy
stuff of bushes you saw years ago
Damp and buzzing, spirited
spring awakens—
Pickerel feed in the shallows,
skunk cabbage on the shore emerges
brownish-purple and mottled-green,
shell-like and hot
around the knob of tiny flowers,
above them, a great blue
heron, alert, waiting
And I think of you, Doc Williams
stopping by the road to the contagious
hospital that morning, standing in a
cold Jersey wind
before the rush of nurses in starched
uniforms and white-winged
caps, your patients with diseases
I’ll never see, like the ferocious
little girl with diphtheria in “The Use of Force”
Right now I’m a hundred and fifty
miles from the waste of your broad
muddy fields, the end
of a day with dementia and AIDS,
headed home to redefine
the objects in my world—
raw knuckles of red
rhubarb breaking the earth’s clay crust,
sawed-off apple limbs expecting fire,
sticky-swollen horse chestnut buds,
tips sharpened to stingers aimed at the sky,
all around, the grass a rumor of green.

Dr. Berlin, a psychiatrist in western Massachusetts, is a wonderful poet. He is a careful observer of nature and life, as was Dr. William Carlos Williams who Dr. Berlin paraphrases here.

Avoid medical-speak

From Good Will

–Donald Kollisch

“Like a sponge,” Elwin was thinking, sitting in his father’s old chair. “The doctor said my lungs are filled up like a sponge that they need to wring out.”

He pictured a large sponge—the kind his father used to use to wipe down the horses after a full day’s work, knobby and heavy and dripping in his hands. Elwin held the image in his mind as he tried to clear his laboring lungs. Some sections were softer and more supple; others were stiff and scarred. Water was stuck in the stiffer cavities so he wasn’t able to squeeze it out. That was what made his breathing fast and shallow—the way it had been ever since he’d come in from moving the John Deere into the barn.

(Excerpted from Good Will and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

Elwin was a retired farmer. His doctor gave him a concrete image to understand his congestive heart failure. Avoiding medical-speak is important. Sometimes when we are new to medicine we like to use the big words to impress or friends and colleagues. When presenting to attendings and preceptors we are supposed to use the proper medial terms. But when explaining illness to patients medical-speak doesn’t work.  Translate medical lingo into concepts and images your patients will understand. That may vary depending on a patient’s culture and experience. In the above story, Dr. Kollisch was talking to an old farmer –he understood sponges and water and washing his draft horses. One of the magical moments in talking with patients is when your patient helps you identify the image that makes sense to him or her.  Share one of those moments with us if you can. . .