Does the Patient Know the Prognosis is Terminal? A reflection by Julie Freedman

Does he know?’

The prognosis is terminal. No treatment will change that fact. His doctors know, but the patient, he seemingly does not.

In Phillip Berry’s essay, “Black Tango,” the narrator wonders if his patient knows his cancer will soon kill him (Please go read it, it’s beautiful, before I spoil it). He worries the patient is living “on fumes” of hope and resents the doctors who previously, falsely, pronounced him cured. He dreads telling him the truth. Finally, he sits down to talk with the patient and his wife. They already knew. In a sudden reversal, it is the patient who was protecting the doctor: “He saw me dancing with words, he read my evasions, and he waited. Waited until I was ready.”

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Shakespeare, Stanzas and How We Think About Death by Albert Howard Carter, III, PhD

When my sonnet “All Tuned Up” appeared (Spring 2021 Intima), I was asked to write about another piece published in the journal. I chose “I Picture You Here, But You’re There” (Spring 2020 Intima) by Delilah Leibowitz. Her poem and mine both explore how we think and feel about death.

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How a Doctor Learns to Act: A Reflection by Claire Unis, MD

“Am I becoming / something unfamiliar?” asks Lauren Fields in her poem My First Mask Was a White Coat” and in that simple question she brings back for me the struggle of becoming. With our first medical school clerkships we don white coats and mimic our preceptors: some false confidence here, a prayer for invisibility there. Silent reassurances never spoken aloud: It’s okay to pretend at doctoring. That’s how you learn.

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How Touch Affects Healing, a reflection by Wendy Tong

In her Field Notes essay “Hand Holding” (Fall 2019 Intima), Dr. Amanda Swain describes the experience of beginning her surgery rotation as a third year medical student. In the early days of the rotation, she feels an intense sense of being out of place within the “intricately choreographed dance” of the operating room. But when the next patient is wheeled in, Dr. Swain is reminded of how a nurse once took her hand before she underwent surgery, the touch conveying an unforgettable message of comfort during a time of deep vulnerability.

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On Fathers, Love and “Exit Wounds” by psychiatrist and essayist Greg Mahr

I regularly attend a poetry critique group in Ann Arbor, MI called the Crazy Wisdom Poetry Circle, named after the bookstore and tea shop where we used to meet before the pandemic. The experienced poets there have come to accept the sad and overly personal poems and flash pieces I write and help me craft them into something that sometimes almost sounds like real writing. One of them once told me, “You always write from a place of longing. That’s a good place to write from.” I realized he was right. I find it hard to share what I write with the people I love. When I am in a good relationship, I write about bad ones; when I love someone, I write about missing them.

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Doctoring and Disobedience: Speaking an Important Truth, a reflection by Kelly Elterman

Sometimes, the truth can be uncomfortable. It can be difficult to hear and often, even more difficult to say. In her Field Notes piece entitled “Doctoring and Disobedience” (Spring 2020 Intima) Dr. Lisa Jacobs recalls her struggle with being told to hide the truth of a prognosis from an elderly patient with metastatic disease. Despite the instruction of her attending physician, and the decision of the patient’s family and ethics team to not speak of death to the patient, Dr. Jacobs feels compelled to let her cognitively-intact patient learn the truth. So strong is her conviction that she takes on considerable risk to her own career for the sake of bringing the truth to her patient.

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Healing and Trauma: Recontextualizing Suffering by Sundara Raj Sreenath

Suffering due to trauma or illness often brings with it feelings of disconnect from the world as we knew it when we were healthy. The healthcare provider-healer, therefore, has an important opportunity to intervene in this unique setting and respond to the patient’s cry for help by offering a personal, humanistic touch and guiding them through trauma in addition to clinical management.

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The Cost of Efficiency and the Price of Empathy, a Reflection by Jordana Kritzer MD

After the long hours and intense learning curve of my Emergency Medicine residency, I had become one of those efficient robots who could solve medical puzzles and save lives, but I felt empty, disconnected—the classic symptoms of burn-out. I was once a wide-eyed, empathetic intern constantly criticized for trying to solve their patient’s chronic issues. I remember one attending saying, “Figure out the least amount of things you need to do to rule out an emergency.” I see now that he was trying to teach me efficiency.

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Life in the Gaps: How Illness Transforms Our Sense of Time by Renata Louwers

It was in those gaps, between our lived experience—the crushing uncertainty about how long my husband would live, the daily reality of his intolerable pain, and the abrupt shift from a life of joyful ease to one spent contemplating death—and the oncology profession’s standards of care, first-line treatments, and numeric pain scales that my frustration festered.

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Growth is Not Linear: A Reflection on Recovery and Healing by Sujal Manohar

I skimmed through “Eight Months after a Suicide Attempt” (Spring 2015 Intima) once as I perused articles in past issues of Intima. But I came back to it, read it again, and again. Andrea Rosenhaft’s non-fictional and personal narrative speaks to the nonlinear recovery process after mental illness. It is also a deeply vulnerable account of the realities of suicidal depression.

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Becoming the Superheroes Our Parents Need: The Journey from Child to Worthy Caretaker by Usman Hameedi

Our parents are often our first examples of superheroes. They make gourmet meals from minimum wage, give hugs that vanquish our demons, and provide limitless love. They are impervious to damage or decay and are always ready to save our days. So, seeing the human in them, the mortality in their breath is unsettling. When they come to need us, we feel so grossly unprepared.

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Caring for Our Caregivers: A short reflection by poet and hematology-oncology nurse Nina Solis

Caregivers deserve patience, gratitude and comfort just as much as those they support. As healthcare providers, we all could use a reminder to advocate for these irreplaceable members of a patient’s team.

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Anatomy Lesson: See the Face of Those Before You by Rodolfo Villarreal-Calderon, MD

For those with the privilege of having participated in a longitudinal cadaver dissection, the connection you build with the donor’s body is known to be a truly unique experience. That bond is part of what I attempted to capture in my poem “Through Damp Muslin.” Especially reflecting on how to express gratitude to the person who once was—and now who is, or at least whose body is—lying before you.

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Lady Psychiatrist Queen: Compassion in Caregiving, a reflection by Eileen Vorbach Collins

Lisa Jacobs, in her nonfiction piece, March Manic (Intima Spring 2019) describes a long shift on a psychiatric unit. She is “beyond exhausted” to the point of having questioned her own grasp on reality.

As a case manager in a Baltimore City hospital, I once spent hours attempting to find placement for a homeless 19-year-old addicted to heroin who needed long term IV antibiotics. When I asked if I might call her mother she replied “I don’t give a fuck” but retracted her permission as I was leaving the room. I pretended not to hear. The next day I was told she had signed out AMA (Against Medical Advice). a colleague said, “Get over it. She was a waste of time and resources.”

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