Patient by Patient : Lessons in Love, Loss, Hope, and Healing from a Doctor's Practice

by Transue

• ISBN13: 9780312372781
• ISBN10: 0312372787
• Edition: 1st
• Format: Hardcover
• Copyright: 2008-04-01
• Publisher: St. Martin's Press

Summary

Patient by Patientis the memoir of a young doctor, fresh from residency, as she explores the joys and frustrations of beginning her medical practice. As she strives to help her patients face a range of challenges from the humorous to the profoundly devastating she learns that while medical school gave her an M.D., treating patients has made her a doctor. At the same time she is working with her patients she is also struggling with illness in her own family. Through her shifting perspectives of doctor, daughter, and granddaughter, she contents with the process of dying, the experience of grief, and the buoyancy of the human spirit. Dr. Transue began chronicling her experiences in her memoir of residency,On Call, and she continues her education here but the source of her knowledge about love, loss, hope and healing are not medical texts or professors but the patients she treats and gets to know those she helps to wellness and those she must let go. Emily R. Transue, MD,author ofOn Call,is a native of Toledo, Ohio, and a graduate of Yale College and Dartmouth Medical School. She did her residency and chief residency in Internal Medicine at the University of Washington, Seattle. She works as a general internist at a multispecialty group in Seattle, and is a clinical Assistant Professor at the University of Washington. She received the Providence-Seattle Medical Center Outstanding Educator of the Year award in 2003, and is a Fellow of the American College of Physicians. She has also published stories and poems inJAMA,Dartmouth Medicine, and elsewhere.

Author Biography

Emily R. Transue, MD, author of On Call, is a native of Toledo, Ohio, and a graduate of Yale College and Dartmouth Medical School.  She did her residency and chief residency in Internal Medicine at the University of Washington, Seattle.  She works as a general internist at a multispecialty group in Seattle, and is a clinical Assistant Professor at the University of Washington.  She received the Providence-Seattle Medical Center Outstanding Educator of the Year award in 2003, and is a Fellow of the American College of Physicians.  She has also published stories and poems in JAMA, Dartmouth Medicine, and elsewhere.

Table of Contents

Beginnings
Another Beginning	p. 3
First Days	p. 6
Coding and Compliance	p. 10
Advice	p. 16
Hematospermia	p. 19
Family History
Living Long Enough	p. 25
Loss	p. 35
Godiva Diabetic	p. 44
Lost and Found	p. 49
Family	p. 61
Laughter and Loss
The Peggy Afternoon	p. 77
Margaret	p. 82
Afternoon Off	p. 91
California Poppies and Bleeding Hearts	p. 94
Being Doctor Transue	p. 103
Musings on Death from a Day in January	p. 109
Interruptions	p. 116
Valley of the Shadow	p. 124
The Medical History of Julia Evelyn (Wilson) Hanson	p. 129
Dolly Parton	p. 132
Words
Normal	p. 137
Lucky	p. 140
Grief	p. 156
Words	p. 162
A Doctor or an Architect	p. 169
Self-Consciousness	p. 172
Time	p. 174
One-Liners	p. 180
Endings and Beginnings
Letting Go	p. 189
Simple	p. 199
October	p. 200
Pills	p. 220
Embodiment	p. 223
On the Airplane	p. 228
A Reading	p. 234
Lonely	p. 236
Margaret, Part Two	p. 242
Bridge	p. 249
January	p. 252
Epilogue: Kaleidocycles	p. 256
Table of Contents provided by Blackwell. All Rights Reserved.

Excerpts

Chapter 1

As I pressed my new parking sticker carefully onto my windshield, I paused to consider the enormity of what the small sliver of plastic represented. At the age of twenty-nine, with twenty-four continuous years of education under my belt, I was about to begin what could be called my first real job. My new business card burned in my pocket: “Emily R. Transue, MD, General Internal Medicine.” I was starting practice as a primary care physician.

With a laugh, I thought back to the day I’d decided to go to medical school. It was early in my senior year in college; I’d been a biology major, scrambling for a new career path after realizing I didn’t want to spend my life at a lab bench. I’d done Parkinson’s research with primates, and reasoned that if monkeys were interesting, people must be even more so. I called my grandparents to announce my momentous decision.

“But we hate doctors,” my grandmother protested.

Through all my years of medical training, whenever a physician amputated the wrong leg, administered the wrong medication, or made some other terrible mistake, my grandmother would send me a news clipping. I was never sure if these were warnings about what might occur if I applied myself inadequately, or simply further evidence for the argument that physicians were an untrustworthy lot. During my second year of medical school, she called to tell me that my grandfather had developed atrial fibrillation, an irregular heart rhythm. It’s usually treated with blood thinners, to reduce the risk of a clot forming in the heart and traveling to the brain, and cardioversion, a brief electrical shock to restore the heart rhythm. “They’re giving your grandfather rat poison,” my grandmother declared. Rat poison is made from warfarin, the same compound used medicinally to thin blood. “Then they’re going to electrocute him.”

I had to admit that these were precisely the kinds of barbaric things that people in my chosen profession did.

 

 

 

Still, here I was. Absurdly, the parking sticker brought home what my contract, my application for hospital privileges, the ordering of office letterhead and exam room supplies, and all the other events of the past weeks had not. In the eight years since I had started medical school, everything I had done had been temporary. Student clerkships lasted four to eight weeks, residency rotations a month. My year as a chief resident, teaching and helping run the program I had finished the year before, was the longest I had spent in any single role, and even that was clearly defined as transient; my successor was chosen before I’d even started. In all that time I had hung temporary parking placards from my rearview mirror. The sticky teal rectangle on my front window seemed to symbolize the end to transience and the unfamiliar permanence I was entering. After eight years of working toward this role, I had arrived.

A few weeks before, the ink barely dry on my employment contract, I had signed another sheaf of papers, buying a house with my sweetheart, also a doctor starting his first job. Our possessions were still in boxes, the wonder of owning a piece of land and the home that sat on it still fresh. As I finished affixing the parking sticker and walked into the angular brick and glass building of the clinic, I was bursting with the richness and strangeness of my new life. I had a house, a job, a piano, two cats, a life partner. I was a long way from Ohio, where I grew up, and from New Hampshire, where I went to medical school. I was far from my family. My brother was doing computer work in Boston; my mother had left her college professor position in Ohio to go to law school in Washington, D.C. Most acutely, I felt my distance from the ones who weren’t well: my father, who recently had moved into a nursing home in California, and his parents—the ones who hated doctors—who were close to ninety but still living independently in Pennsylvania in the house where my grandfather grew up.

Nonetheless, I had laid down my roots here, in Seattle. I could feel them in the earth under the maple tree in my new front yard, and even in the glue of the parking sticker. I was about to walk into the clinic and begin to grow roots of another kind, putting on my white coat and meeting strangers who would become my patients, as I grew into my role as their doctor.

I felt the joint tug of responsibility to the people I loved and to the patients I would begin caring for today. I had finished the hard years of residency, the hundred-hour weeks and thirty-six-hour shifts, the drama of the hospital and the emergency room. I had seen a lot of people die or nearly die in those years, and I thought I knew plenty about grief and loss and healing. I little imagined how much more and how differently I would learn in the coming years. Much of this would come from the patients I would care for, not just in the episodic crises of the hospital but in the slower, richer arc of sickness and health that a primary care doctor sees. In parallel, my first years in practice would be tumultuous ones for the people in the world I loved most, and I would see more than I ever had of medicine from the other side.

I could only begin to glimpse all this, as the sliding doors opened to admit me to the cool, quiet air of the clinic. My heart sped with a mix of anxiety and excitement as I stepped inside, savoring the newness, and looking forward to a time when I could savor familiarity instead.

 

Copyright © 2008 by Emily R. Transue. All rights reserved.

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Excerpted from Patient by Patient: Lessons in Love, Loss, Hope, and Healing from a Doctor's Practice by Emily R. Transue
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.