Jen Baker-Porazinski's story “Dying at Home” (Spring 2024 Intima) drew a vivid picture of a patient and her family, and the rhythm of her last few weeks. The love and dedication of her husband was especially moving.
I was also struck by the narration of Baker-Porazinski’s journey, as a doctor. Reflexively, at each visit, she listened to her patient's heart and took her blood pressure. Baker-Porazinski felt this showed that she hadn’t given up on her patient .
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Big moments are surrounded by little moments. That’s what I was trying to pull out in my story “There’s a Special On Car Washes,” published in the latest issue of Intima. That bewildering sensation, common in life and especially in healthcare, that extraordinary things happen but that time marches on without sentimentality. You win the big game but when you get home you still have to take out the garbage. You receive a life-changing diagnosis and then you have to figure out the machine to get out of the hospital parking lot.
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Grief walks in many forms, and its footsteps are padded and quiet, imperceptible even, except to those who lay awake at night, counting its tip taps on the upper floor.
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It is the great privilege of medicine that we are asked to show up, constantly, albeit in a different role than a family member would be. To not look away is in the fabric of what we do. It is partly why the practice of medicine can be exhausting, electronic charting and reimbursement quibbles aside. We are asked as caregivers not to dispense always but to receive, to hear questions that we don’t want to reflect upon. It is our privilege to be present.
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My first-ever clerkship rotation as a medical student immersed me in the realm of inpatient psychiatry. This profound and eye-opening experience blurred the boundaries between sickness and health. It challenged my preconceived notions and deepened my understanding of mental illness.
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My short story “The Waiting Room” (Spring 2024 Intima) was inspired by recent legislation that threatens women’s rights and health. In the story, a young couple is troubled by a decision they made to terminate a pregnancy – they are scared of persecution and legal action, but they are also emotionally and spiritually haunted by their choice.
The story ends as they drive away from the reproductive clinic, but it is evident they will think about that afternoon for months, and years, to come.
Can one miss something that was barely there?
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Being sick takes work. There is the pain and exhaustion, the adaptation, the cognitive load required to keep moving forward when my body holds me back. There’s also the business of being a patient: sitting in waiting rooms, standing in line at the pharmacy, being on hold with the insurance company.
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I came across two Intima pieces in conversation with my recently published poem, “Mercury, A Public Service Announcement” When I was younger, I took my body for granted. I thought medical science or pharmaceuticals would patch all my future ills. Wanting to live life to the fullest made it difficult in my busy life to do more than what was needed at that moment and then move on ... but as I age, I find my body has kept score and is less resilient.
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I’m writing in response to Danielle Snyderman’s Field Notes essay “Not Yet, The Epilogue” (Spring 2021 Intima). I wrote the poem “The Trail to Ahous Bay” to read aloud to my friend Joan Bodger. She was in the palliative care unit of Tofino Hospital on Vancouver Island. I had come from Toronto to visit with her, and to say goodbye. I was staying on Vargas Island, a short boat ride from Tofino, and had taken the cross-island hike that became the poem.
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I think about time a lot now. My days are ruled by schedules and cases and meetings, and I spend much of my day reacting to the pressures of the unrelenting sweep of the second hand as it moves around turning into minutes and hours, never slow enough for me to accomplish everything I need to do.
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An internist reflects on his short story as well as a fellow physician’s personal essay and explores the complex issue of crossing implicit social boundaries in the clinician-patient relationship.
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A retired gynecologic oncologist reflects on her own career and realizes how watercolor artwork can allow for even healthcare providers to be seen.
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I work at a community clinic with patients who are homeless–there is the stigma of homelessness, and then there is the stigma of looking homeless.
Some patients of mine do not–or do not yet– appear unhoused. It is usually those who still have family that support them, who live in a car, who hold a job—running food for Doordash, picking for Amazon, sitting security—or who have not been homeless for so very long. But many of my patients do appear frankly homeless: a shuffling gait, a blanket draped around their shoulders, belongings pushed in a stroller, blackened teeth, leg wounds.
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In this reflection, a retired surgeon examines the research findings of evidence-based medicine to uncover whether empathy, in addition to the principles and practice of narrative medicine, can facilitate deeper healing.
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Recently, I read Adam Conner’s short story “How to Write about Your Cancer” (Fall 2022 Intima) with amusement and recognition. And if I transform the rules in it to a scorecard, my poem, “Minds Go Where Bodies Can't” ends in the red.
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“I like Beethoven the best!” is a declaration made by a patient of Mitali Chaudhary, as she readies to leave his hospital room. A busy senior medical resident at the University of Toronto, Chaudhary juggles many demanding responsibilities with her desire to get to know this elderly patient. In her Field Notes essay titled “Beethoven’s Symphony No. 5,” published in Intima’s Fall 2023 issue, she recalls how she’d tried to get her patient to respond to questions about symptomatology, all the while aware that twenty-three other patients – along with a group of junior residents and medical students – were awaiting her time and attention. In that moment, she finds herself turning away from an opportunity for a personal interaction with him in order to ensure she manages her tasks appropriately.
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While returning to the U.S. on an international flight not long ago, I sat next to a young African woman. As we approached our destination, she sheepishly passed me her passport and a customs form. Since I was in the aisle seat, I assumed she wanted me to pass it along to the flight attendant, until I realized the form was blank. She was asking me to fill it out.
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Great books can guide us in every day life, and I found it fitting that Dean Schillinger, MD and I both invoke works of literature to describe the experience of realigning our values with those of our patients. In his essay, “The Quixotic Pursuit of Quality,” (Spring 2015 Intima) Dr. Schillinger compares himself and his patient, Mr. Q, to Quixote and Sancho Panzo from Miguel de Cervantes Saavedra’s Don Quixote. With only misplaced medication lists, no-show appointments, and a stubbornly elevated hemoglobin A1c to show for his repeated efforts to help Mr. Q better manage his many comorbidities, Dr. Schillinger’s frustration melts away when Mr. Q unexpectedly gives him a massage. From then on, “the duel was over.” There would be no more tilting at windmills.
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In theory, whenever we go to the doctor, most of us want to hear “good news.” The test is negative. You don’t have ___. Your results are inconsistent with ___. There are times where we take that in and walk away with an emotional weight removed. Other times, we are left with a void. The diagnosis we thought we could hang a hat on is taken away. Now where do we put our hat?
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I recognized right away a kinship with Bessie Liu’s “Variations on the Negative Space Before Healing” (Fall 2023) and its use of subtraction to create new meaning; The poem by Liu, a third-year medical student at Johns Hopkins School of Medicine. very much feels like a sister to my poem, At the Doctor’s Office, I Check, Yes, I Have Experienced the Following: Sudden Weight Loss (Fall 2023).
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