Don’t Shake Hands

Photo: buddawiggi

One of the earliest memories I have is of my father teaching me how to shake hands. He would always comment to me whenever he received what he considered to be the hallmark of a quality handshake, a firm grip. Handshakes, he taught me, were important. The indicated something about the character […]

The Right To Die

Photo: rjhuttondfw

The notion that dying is a right seems nonsensical to argue: death is given to all of us equally without the need of anyone’s sanction. The right to die well, on the other hand—well, that’s another matter entirely. A good death is, in many cases, something our fellow human beings have great […]

One Event, Two Stories

Photo: Kal111

I recently had a patient of mine undergo surgery to remove his gallbladder due to acute cholecystitis. He’d been out to dinner with some friends and had started to feel nauseated, then developed some right upper quadrant abdominal pain that necessitated ending the evening early. After a sleepless night, a morning episode […]

End-Of-Life Discussions

Photo: 28misguidedsouls

When I was a resident working in the intensive care unit (the ICU) at the University of Iowa, one of my responsibilities was to communicate with the family members of my patients. However, an intensive care unit, as its name suggests, is an intensely busy place, and I often observed among my […]

Why We Shouldn’t Decide Ourselves When We Need Medical Attention

Photo: stars alive

Four years ago, I was driving home from work when I began to experience mild chest pain. It was located slightly to the right of my sternum and felt like a muscle strain. My chest was slightly tender when I pressed on it, but so slightly that I felt unsure with […]

Knowing When To Stop

Photo: Nicholas_T

“When do we stop?” my patient’s son asked me.

“That’s really hard to know,” I answered.

We were discussing when to stop making interventions in hopes of trying to save his father’s life. He’d been diagnosed with a severe gastrointestinal bleed from a stomach ulcer.


The Whimsy Of Serendipity

Photo: Audin

Years ago, a longtime patient of mine came to see me with an odd complaint: he’d developed spontaneous bruising on the top of his penis. “I honestly don’t know how this could have happened,” he said. “I certainly didn’t bang it on anything,” he added with a nervous chuckle.

He went on […]

The Problem With Being Too Persuasive

Photo: aspearing

When I was a first-year resident, I admitted a 34-year-old HIV-positive man to my inpatient general medicine service for fevers. On physical exam, I found a large lesion on his right retina near the macula (the retina’s center). I called up an infectious disease specialist, who confirmed what I’d suspected: he had […]

Managing Chronic Pain

Photo: RTP

I have a small cohort of patients who suffer chronic pain so intense and unremitting it prevents them from living normally. They often don’t work, shop, go to restaurants or movies, leave their homes or sometimes even their beds except to visit doctors, or have meaningful relationships outside their immediate family, who […]

The Anatomy Of A Doctor Visit

Photo: Patrick J. Lynch

Working as I do in an academic medical center, I’m frequently called upon to teach medical students. I do most of my teaching now with the third-year medical students when they rotate through our outpatient clinic. Usually, I’ll send them into an exam room on their own to see my […]