Saturday, May 30, 2015

NYTimes: Smuggling a Beer for My Hospital Patient

My pager went off late one afternoon with a message from the oncology service at my hospital, asking me to see a 70-year-old man with metastatic cancer and trouble breathing. I wasn't hopeful. I had chosen to train in pulmonary and critical care medicine because I wanted to be someone who saved lives. But, it turned out, there was so much sickness I couldn't fix.
The patient had worked as a mechanic. Vague pain led to a diagnosis of colon cancer that had traveled to his liver and lungs. Now, he was short of breath and might have pneumonia. His team was asking me to arrange a procedure, called a bronchoscopy, in which we insert a small tube with a camera at the end down the throat in order to look inside the lungs and suck out a deep sample to help find out what's going wrong.
"We'll get him on the schedule for tomorrow," I sighed, suspecting that nothing I did would make him better. "No food or drink after midnight."
In the waiting area outside the procedure suite the next morning, I went through the usual consent forms. He would be asleep for the procedure, thanks to sedative drugs we would run through the intravenous line. We would make him feel pretty good, but he would remember none of it. "Just imagine a really good martini – or two or three," I joked.
It was the first time I had noticed my patient smile. "You know, I'm more of a Guinness man myself," he said.

More ..,

NYTimes: The Secret Sadness of Pregnancy With Depression

At the beginning of spring in 2013, Mary Guest, a lively, accomplished 37-year-old woman, fell in love, became pregnant and married after a short courtship. At the time, Mary taught children with behavioral problems in Portland, Ore., where she grew up. Her supervisor said that he had rarely seen a teacher with Mary's gift for intuiting students' needs. "Mary was a powerful person," he wrote to her mother, Kristin. "Around Mary, one felt compassion, drive, calmness and support."
Mary had struggled with depression for much of her life. Starting in her 20s, she would sometimes say to Kristin that she just wanted to die. "She would always follow up by saying, 'But you don't need to worry, Mama,' " Kristin told me. " 'I don't have a plan, and I don't intend to do anything.' " In recent years, Mary and her mother went for a walk once a week, and Mary would describe the difficulties she was having. She was helped somewhat by therapy and by antidepressant and antianxiety medications, which blunted her symptoms.
Mary's friends appreciated her wacky sense of humor and her engaging wit. Colleagues said that her moods never impinged on her work; in fact, few of them knew what she was dealing with. Yet for years Mary worried that she would never be in a stable relationship and experience love or a family of her own. She said plaintively to Kristin, "I think I would be a really good mother."

More ..,

Sunday, May 24, 2015

Henry Marsh’s “Do No Harm” - The New Yorker

For the schoolteacher, the changes had come slowly. First, his walking had grown unsteady; then his hearing had worsened. He had become stooped, and had begun walking with a cane, even though he was only in his late fifties. Now he sat with his wife and son in the consulting room of Henry Marsh, a London neurosurgeon, looking at a scan of his brain, which showed a tumor growing near the base of his skull. The question was whether it could, or should, be removed. Marsh, who had been practicing neurosurgery for only a few years, was unsure. The tumor was massive—he was startled by its size—and it was situated in the brain stem, a vital area. Left to itself, it would destroy the schoolteacher's hearing, rob him of his ability to walk, and, eventually, kill him. But, Marsh explained, surgery could leave him paralyzed, or worse. The family faced a difficult choice, between the certainty of a slow, predictable decline and the possibility of an immediate cure—or catastrophe.

They decided to seek a second opinion from an older, eminent neurosurgeon. A few days later, the surgeon phoned Marsh. "It's a young man's operation," he said. "I've told them you should do it." Flattered, Marsh agreed to go ahead. The surgery began at nine in the morning and continued late into the night. Brain surgery is slow and dangerous, and removing a tumor can be like defusing a bomb. Often, surgeons look through a microscope and use long-handled, fine-tipped instruments to pull the tumor away from the brain before removing it with a sucker. A quarter of the body's blood courses through the veins and arteries of the brain; if one of them is torn, bleeding and stroke can result. It's also possible to remove important parts of the brain by accident, because brain tissue and tumor tissue look pretty much the same. Unlike the rest of the body, the brain and the spinal cord rarely heal. If a neurosurgeon makes a mistake, the damage is often permanent.

More ...