novel

Prognosis: Excellent

8 Comments / alcohol, book blog, book publishing, cancer, cirrhosis, doctor, healing and storytelling, healing through storytelling, hospital, liver, liver cancer, novel, patient, publish, short stories, short story, writer's blog / Nizam M. Meah, M.D

She is a 53 year old female. I am a 55 year old gastroenterologist. I was consulted because she had suspicious tumors in her liver on a CAT scan. She has been feeling increasing distress in her upper belly and has not been able to keep anything down in her stomach for last two weeks. The pain was not the severe pain that curls you up, but it is gnawing, that eats you from inside, it is the pesty visitor who visits you at the most uninviting of the moments, it is the conversation that one has to carry on in the most importunate of the situations. I reviewed her labs and scans carefully before I enter her room. I take a pause and a deep breath and tell myself: “Hey you, cheer up, have a smile on face, and make sure your patient does not see you gloomy or anxious”. Having obeyed my own advice, I apply several soft knocks on the door. “Come in” I hear from outside and I enter the room. Laying flat on the bed was a thin lady, ashen looking, covered in white freshly cleaned hospital blanket and the protuberant abdomen sticking out like a sore thumb from under the sheet betrayed her frail physique. Next to her sitting on the rocking chair was her male companion wearing a red bandanna on his head; his white long unkempt beard and cigarette stained handle bar mustache giving out an impression that he would be better fit to the next Duck Dynasty episode casted outdoors in the midst of nature than belonging to this claustrophobic beige colored hospital room with its fours walls closing in on the small space all the times. I have always found hospital rooms to be very interesting. Some rooms seems to be bright, others dim and dark although when I counted they exactly have the same number of flood light fitted on the ceiling and on the sidewalls. The healthcare architects are great in consistency and meticulous in attention. Master of their trade, from faucet to air conditioning vent to a small emergency switches, all of them in exactly placed in the right position, they have an uncanny skill and attention to details, nothing seems to distract them, nothing seems to make them forget even the smallest of the things in pursuit of their job of designing and planning a hospital. I never had much luck in picking their fault as far as hospital patient rooms are concerned. When I cannot explain by science, I always resort to my inner superstition: I concocted the same about the hospital rooms, since architecturally and physically they are all the same and immaculate. I came to believe, the rooms that are bright, or at least appears to be so in my eyes, patients tend to do well and the rooms that are dim and melancholic, they take their occupants into the abyss of dooms. Sometimes I wonder how the admission clerk assigns the room to the patients, is it first come first serve? Or is it at her whims? Or may be she has no choice, the computer assigns it randomly like many things now a days. In my own obsessed physician’s moments, when I get carried away with my own physical symptoms and there are times when I felt calling the EMS to take me to the hospital, not as a doctor, but as a patient. Then in my mind, like an well orchestrated Broadway drama, I go through the rehearsal: As soon as the EMS takes me to the hospital I ask the admission clerk, “I want room number……..” She will be surprised and I will look at her with authority and make sure I have the stethoscope on my shoulder, or my physician ID still displayed somewhere visible and insist, “You have heard what room number I wanted Ma’am!”. Then she might say, “But Dr. Meah, that room is taken, there is already a patient in there!” . Well, my imaginary Admission Clerk certainly got me, after all I cannot ask her to expel the existing patient, I am only a doctor, not a savvy apparatchik national figure who can order around. That’s when I feel like I should develop a secret list of good and bad rooms in the hospital, my own top secret, I will share with no one, although unethical, its use is my nuclear option, only to be used when my own life is at stake, and I come to this hospital and I will tell them give me this room number…..! “Taken”, she will answer, “No problem, give me number……” I will say keeping my smile hidden. “Taken”, she might say again. “No problem, then give me number…..” as I pull out another room number from my secret private list, I know something has to work out, US hospitals have always rooms empty since most of them are made to an excess capacity. Thus I have thought about making a secret inventory of hospital rooms, that is good and bad rooms, although, my laziness had not yet come around doing this in actuality. I introduced myself, interviewed her and after obtaining her consent, examined her confirming all the ominous signs that in medical literature we summarize as, “Stigmata of chronic liver disease” with “signs of hepatic decompensation”. She had a large liver, double the size of normal; it was filled with many marble sized tumors and beneath her wasted skin, these felt as firm as the glass marbles that I used to hide away from my younger brother underneath a cotton blanket in my distant childhood. Normal liver feels slippery, soft, gentle and soothing to palpating finger tips of the examiner, unlike these bold and hard knots, there was something aggressive about them. I noticed her feet were swelling too and one area on the right shin had started oozing clear fluid, a sign that her liver was not able to make enough protein to keep her own fluid inside the body. Her chest was full of dreaded “spider

Prognosis: Excellent Read More »

Inner Orchestra

2 Comments / book blog, book publishing, bowel movement, constipation, doctor, healing and storytelling, healing through storytelling, healthy eating, novel, patient, publish, short stories, writer's blog / Nizam M. Meah, M.D

Your whole life you have lived healthy. You have eaten healthy and patronized good habits. Your good health and sense of good well being therefore, is not an accident, rather the result of your diligence and calculated choices of life. You are active, fully functional and enjoy the finer things in life, friends and family. Then comes the sudden betrayal of life. You have the urge; you have the sense of immediacy that you always depended on. Except you sit, first for few minutes thinking just taking time would help, then fifteen minutes goes by and then thirty minutes! You strain, perhaps by now with some feeling of nausea, you have looked at the favorite magazine flipping through all of its pages, or surveyed all the pages of the old newspaper that had been left in restroom in forgotten past, you had re-examined every component of the potpourri you had stacked away on the vanity table of the rest room, you even had the second and the third look at the little painting of the flower you had hung on the wall of your intimate restroom only now discovering the little imperfections all the while sitting patiently on the commode sit. But it won’t come. Not that it doesn’t want to come out, but you have the feeling that something is blocking it, something is not letting it out in the open. Your colon betrays your wish, your body’s wish, defying the signals of your brain and the spinal cord. You come out of the experience frustrated, sweaty, and fearful; but hope for the best and hope that it would solve itself next time around. You redouble your good diet, increasing fiber, and then you visit your neighborhood’s friendly pharmacy buying some remedies, a probiotic perhaps in addition to laxaitives. But next day is the same and more of the same is the following day. You wonder what’s happening and why is it you? The very thought not only makes you scared but even angry. You have all the terrible thoughts: “Do I have colon cancer?” “What did I do wrong” or “Perhaps I am not still eating right”! You second guess, begin to doubt yourself and your mind goes crazy. This is exactly what happened to my patient Mrs. X. She grew up in Boston. Following New English Irish tradition her early education was completed in Catholic Schools. She grew up in a single parent home and lived in government housing for a time. Those are the days in Boston’s Catholic bastion, children of single matriarchal family were frowned upon, not that anyone told anything openly, but the unexpressed “there’s something wrong with your family or mother” was evident in their expression and refined New England accent. When I saw her in the office her complaint was constipation. But not the “normal” constipation that people suffer from! It is the constipation that has urgency of bowel movement but as if her colon is betraying her by not relaxing, an act that is essential for a successful and satisfying bowel movement. In her interview, I could realize right away that she was a born artist; she was born to sing as she claims. Her sentences with New England accent were rich in inflections, her eyebrows and facial muscles danced together like a performing singer on a stage. Her face bore the aura of a Prima Donna, her lips and eyes moved in an inner drama of conflict reminiscent of Tchaikovsky’s Tatiana. In her adult life she had moved from bustling metropolis of Boston to an obscure Texas town in the somnolent shores of the Gulf of Mexico never singing, never been in stage and thus never fulfilling her dream. I know her for years. She considers herself a failed artist. Her heart wanted to be an artist and mind wanted to sing. But realities of life had never fulfilled her dream. Instead, her heart and mind became the ground of an internecine warfare, a war that is eternal, and a war that has no ceasefire. Quite a few years ago, she visited my office for the first time with a nagging pain on the right upper side of her abdomen, which was worse with eating and at times radiating to the upper back. Extensive investigations including CT scans and MRIs showed a swollen bile duct, but no stone in the gallbladder or no tumor or cancer in liver or pancreas. I finally diagnosed her to be having dysfunction of her bile duct sphincter or guarding valve of the bile duct, known medically as Sphincter of Oddi dysfunction. In this condition the valve of the bile duct fails to open or relax in response to a meal when our food content reaches the upper part of small intestine. Bile carries important enzymes for digestion of fat and protein, so the action had to be very rhythmic, precise and timely, like that of a well functioning orchestra. It is a fine sophisticated action, accomplished by interaction of nerve signals, hormone signals and the influence of the food itself. To give her a relief, I treated her by cutting the valve of bile duct medically known as ERCP with Sphincterotomy which resolved the problem. Few years had gone by and she again presented to me with the problem of intractable constipation. Upon careful history taking she was the example of good life and good habits. Her physical examination was naturally quite normal. She is the picture of health, externally. Having ruled out any other new problem by ultrasound and having ruled out Colon cancer by Colonoscopy, my diagnosis was Pelvic dyssynergia. This is another condition where the complex coordination of our brain, spinal cord and action of muscles of colon, rectum and pelvis fails. This results in failure of relaxation of the muscles and therefore the feces or stool cannot come out. Human colon is a tube made up of specialized muscles and with a length of four to six feet, it is easily the second

Inner Orchestra Read More »

Medical Detective: Anemia, Dr. Denton Cooley Busted!

14 Comments / book blog, book publishing, doctor, healing and storytelling, healing through storytelling, hidden cause of anemia, novel, patient, publish, short stories, short story, writer's blog / Darrell

Medical detective: Anemia, Dr. Denton Cooley Busted! It’s real, just listen to the story: Don is 85 year old man, who visited me for finding out the reason for Iron Deficiency Anemia. Anemia means low blood, Anemia is not one disease but many diseases. His specific type was Iron Deficiency Anemia, meaning that he is chronically losing iron from his blood. This means he had to have a mystery bleeding somewhere internally in his body, most common being in the GI or Gastrointestinal Tract. He had had this anemia for a good while and his primary care physicians had tried with iron as a band aid but he continued to be anemic and that is why he was sent to me so we could unmask his hidden bleeding. The cause could be hidden anywhere in this GI tract, from stomach to small intestine to colon and each of these being vast organs, the story could be complicated and challenging. It could be from Peptic ulcer in the stomach to small bleeding vessels deep in the crevices of small intestine which is a twenty two feet long organ to colon cancer Don was born and brought up in Texas. Don had a serene look in his face, he is a man who is lean and thin still muscular even in this age, his dressing was clean cut, face was clean shaved and his gait had no hint of hesitancy totally unburdened by age.

Medical Detective: Anemia, Dr. Denton Cooley Busted! Read More »

An Orphan’s Mother’s Day

11 Comments / book blog, book publishing, celebrate dead mother, dead mother, doctor, healing and storytelling, healing through storytelling, how do orphans celebrate mother's day, memory of mother, Mother died long ago, Mother's Day, Mother's Day for dead mother, novel, orphan's mother's day, publish, short stories, short story, writer's blog / Nizam M. Meah, M.D

An Orphan’s Mother’s Day, that is my Mother’s Day with my mother is silent, somnolent, serene and solemn. I never take her out to dinner, not even to lunch. Bouquet of fresh flower? Even that’s out of question! May be a physician son like me would like to buy something expensive, something exotic for my mother! Well dead wrong again! Then what do I do for my mother on a Mother’s Day? Nothing, and nothing, and yes, nothing. Plain and simple. Paraphrasing Mark Twain, there are only two kinds of people in the world: the ones who have mother and the ones who don’t, I mean a mother who is living in flesh and blood. I belong to the latter kind. We are Orphans. For us, Mother’s Day is not a celebration in traditional means, for us it is a mixed emotion; a strange state of mind where celebration and mourning happen together. Have you ever known people without mother or people who lost their mother early in life? If you didn’t yet or if you had not have the occasion of conversation with one of them on this then let me let you know that we walk, talk, laugh and live our life with a strange subconscious burden every day, but as the Mother’s Day rolls around, that burden becomes heavier, more conscious, more real. I know exactly when the Mother’s Day is coming: the UPS guy in the neighborhood gets busier delivering packages form Amazon, malls and restaurants are busier; when I open my browser, blinding colorful Pop Ups announce: Send Your Mother Something Memorable; beautifully animated flashy announcement from 1-800-Flowers: Send Your Mother Flowers, let her know you love her. Oh! Yes, let your mother know you love her. My mother is far beyond this flower or dinner business, beyond the reaches of UPS or FedEx, beyond the blinding internet Pop-Ups. I still remember the day: it was a sunny Midwestern day in Detroit, September 17th, 1989 to be exact. I was in first year of my internship; this was post–call day for me. Although tired, sleeping is not for me, I ate breakfast and showered and got on new pair of hospital scrubs, which were my usual 24 hour attires at that time, and I was trying to get some studies done in internal medicine. A friend called and wanted to visit, I sensed something wrong, but kept the feeling inside and welcomed him with his wife. “How’s the family back at home?” they asked, “Fine, okay I think”, I answered, investigating their facial reaction and knowing subconsciously that it was not the real question or answer they were interested in. “How’s your mom?” the friend’s wife asked as her second sentence. “She’s always weak, she works so hard…..” my heart stopped for a moment as I caught myself talking and my words dropped off, “Wait a second are you saying that something is wrong with my mother? Are you saying that? Are you saying that? “, I became frantic and couldn’t help screaming. I just picked up the phone right in the living room, in a reflexive response and started dialing the phone line. 1989! This was not yet the time of cell phone and internet! Back in the old country, the town of Chittagong, 8000 miles away from Detroit, Michigan, my family did not even have a phone, I mean land phone. If you could bribe the government owned telephone monopoly, you could get one in 10 years and if you didn’t have the money or means to bribe, the wait could be forever. So I used to dial a neighbor’s house and they were always gracious to call my family to talk to me and this used to be the way to communicate. As I kept on frantically dialing, the only message I got from AT&T was, “All international lines are busy in the country you are dialing, please call later”. I frantically called the AT&T operator, call could not go through even with her help; no one could help. This was the state of communication in those days in the poor 3rd world countries. Even emergencies had to wait! I did the only thing I could do, sob and kept on trying, finally reaching one time after five hours of trial! Just think about it: getting phone line after five hours of continuous dialing. Strangely, in the worst of grief and loneliness, the human benevolence takes over: I only wanted to know how my mother died, what she said as her last words and my main worry was my family, especially my younger siblings, how helpless they were feeling without a mother, how they will be taken care of. I totally forgot of myself. By the time I could make arrangement calling the med school and airplane ticketing and other formalities, and then finally reached the old hometown after 3 days of grueling journey, my mother’s body was only represented by a freshly turned pile of red dirt lying in her ancestral graveyard on a hilltop next to a 16th century mosque that was founded by a revered Saint of Chittagong, my ancestral home town. There is always a strange silence in the graveyards, even in an overpopulated country. After the eight thousand miles journey that was my first stop over, I fell on my knees, I cried but my eyes were dry from the dehydration of three days of journey over the oceans, mountain ranges and continents. As I prayed, I felt my mother would come alive at any moment, a strange, lunatic sense of denial conquered me over, I prayed and prayed but the miracle never happened, my mother never rose up, she never talked to me, I never saw her in flesh and blood, never again. Who knew that two years ago on my way to the United States, when I said goodbye to my mother in the dusty Second World War era airport of Chittagong that was going to

An Orphan’s Mother’s Day Read More »

Prescription for Doctors, from Patient

1 Comment / book blog, book publishing, doctor, healing and storytelling, healing through storytelling, novel, patient, publish, short stories, short story, Uncategorized, writer's blog / Darrell

“Look at the patient, to listen to the patient, and not be so hastened to write out that prescription and get them out the door”. This was the starting commentary of a long term patient of mine whom I was interviewing recently. She is an intelligent and articulate person and can express herself very well and this is why I always loved and respected her as a person and as patient. In our many years of relationship I have been with her in the ups and downs her life and so as her families’. Several of her family members are also my patient. So, when I requested her this interview, she easily agreed with a smile and a confident composure. Although I told her that the story could be about anything that had impacted her life, she decided that her story should be about doctors and office visits since it had great impact in her and in her family’s life. It was not until the end of the story that I realized this was a great Prescription for Doctors, from Patient. She went on saying, “Patients like in my case could have more than one issue when I visit a doctor’s office, so which one do we need to talk first this time? In my case I write down a list because I forget often and then I talk one by one and my Primary Care Physician who has the patience of listening through it. I get so aggravated that I have to wait so long just to see him, but its worth it because when I am seeing him, he spends the time, just like you do. I am not just a number, I am not a money-pocket, not just the insurance, it is me, you are concerned about me. That’s important. Sometimes I wait for hours because once I get to see him (my primary care doc) he makes me feel like I am the only patient!” I know her sister and brother in law, two years ago the brother in law was diagnosed to have pancreatic cancer by me. He is still living as of the date of this interview but he is on his way down. When she went to his topic, she started crying and sobbing, and then her gaze deepened at me, “It started with you, it started with you caring, being sensitive to him as well as to my sister, I appreciate that, the family comes to you more, because you are tenderhearted and you showed that you care, I have faith in you totally, I know when you say I have an ulcer or a polyp, I know that you gonna fix it, it is as simple as it.” as she stated. I was filled with a great grief about her brother in law as well as a tremendous happiness as a physician to hear this from her. She went on saying, “My wish for myself is that people will see God in me, that I lived, I walked and I talked with God in me. I stopped smoking about a month ago, I smoked a pack and half a day for over four decades, because both you and Dr. PCP (Primary Care Physician) was getting on by behind hiney..I did cold turkey! For you physicians, Listen, just listen, don’t say wow, I can get her insurance,insurance will pay, its not a money thing, it shouldn’t be, it should not be cattle running through a track for slaughterhouse. It should be truly one to one. When patients and physicians start taking each other seriously, then people will get more healed, not to get God out of the picture. Listen physicians, you guys are very smart, God had given you the wisdom to learn, he put you on this earth for a reason, that is to help us, that is your purpose on earth. by doing this means is to listen to us whole-hardheartedly to figure out what’s wrong with us.” Then I asked her about Life changing event in her life and this is what she told me, “A year and half ago my grandson was born. He was born with a collapsed lung and lung deformity. He was in local Children’s Hospital for two and a half months. He was on a heart-lung machine, and on an artificial kidney machine. they told us he would probably not live through the first surgery, they told us he will live “one hour by one hour”. We all put our faith in God and our trust in the doctors, they were always there, they would give us the worst scenario and the best scenario. they always said, “he could live one more hour, one more hour”! And today he celebrates his first birthday! I am so moved, he is a blessing, just like my brother in law. I have learnt from it to put my trust and faith in God, and to treat people the way you want to be treated. Be kind, be generous, don’t be having negativity, even in the most difficult of circumstances. Like even when my grandson was in the most critical moment, they told us “There’s a chance!”. And he did have a chance, he did make it! And it changed me, made me humble to see the fragility of life.” Then I asked her, “What do you want people to know about you?” Without much deliberation or pause she went on spontaneously looking at the walls of the exam rooms she went on, “That I smiled all the times, happy and that I had positive attitudes, that I did not walk about being mad about the world, expressing negativity. I am a retired hair dresser, I taught this trade too, I loved it when people came to me and said, “You’re just a great hair dresser, I learnt so much from you!”, it’s nice, it isn’t for the praise or boasting but it is nice to know

Prescription for Doctors, from Patient Read More »

I Love You Son!: A Kid in the Candy Store

4 Comments / book blog, book publishing, broken family relation, healing and storytelling, healing through storytelling, novel, publish, short stories, short story, writer's blog / Nizam M. Meah, M.D

“I just cannot wait to hear from my Dad every Sunday, we talk for hours and hours and the surprising thing is that I always wait to hear from him a sentence with four words, he tells me always at the end of our conversation “Son I love you!”. I love to hear this, every time, all the time, this is for me a little boy in a candy store moment”, his face glowing and his eyes popping as he told me his story in my office. This was a well-built, tall handsome man in his early 50s whom I am seeing for the first time in my office because he needed a screening colonoscopy for prevention only, he is otherwise healthy. “But our relation was not always healthy like this, in fact for a period of ten years we had cut off our relationship with each other, oblivious to each other’s plight, I did not know where my father was!”, Jim told me. Jim grew up in a beautiful East Coast town of USA, the area was draped with sunshine, beaches and green tree lines. Jim was in his early teenage years when his parents got divorced. He wanted to stay with his dad in the East Coast while his mother had decided to move across the country to the West Coast with her two children. But Jim wanted to stay with his dad. He pleaded with him but his dad was a distant dad, who never heeded the crying heart of his son. Feeling the hurt from dejection, Jim always wondered why his father never cared for him. After six months of trying to stay with his father, and getting no reciprocity, he eventually gave up, accepting in mind that as much as it seems unreal, his dad had quit on him. So he moved with his mother and took on the challenge of forming a new life in the West Coast.

I Love You Son!: A Kid in the Candy Store Read More »