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Saying Thank You to Patients

The year was 1990. I was in Detroit, Michigan working as a resident physician in Internal Medicine. Detroit was dilapidated, its old structures were crumbling, boarded up unkempt houses in neighborhoods once humming with life were now empty, desolated, overgrown with weeds. Brick walls of the old houses, once rock-solid were now fragile and cracked, in some of which parasitic plant lives had found foothold telling the story of once mighty Motor City. A drive through such neighborhoods evoked an unknown anxiety and fear that was only interrupted by sight of an occasional industrial park, equally gloomy, in disrepair, hauntingly desolate, behemoth brick buildings with broken glass windows and ragged pitched roofs still oozing melted snow, as if only kept alive in this state of coma by some unknown force just to remind people of the old industrial glory of Detroit. Coming from Bangladesh, an overpopulated country of 2000 people per square miles, it was terribly lonely for me not to see any people on the streets and neighborhoods deserted whereas in my home country it was hard to see an inch of empty spot devoid of humans. I was struggling in my conscious and subconscious to reconcile and digest the contrast. Loneliness that I found impossible in Bangladesh, now in Detroit was over abundant and almost overwhelming. Demand of residency training, both physical and mental vigor that is called for from a young trainee doctor, kept me busy and had distracted me somewhat, perhaps even protected me from the malady of loneliness. Working in a large urban medical school training program I needed to rotate through many different hospitals. Allen Park Veterans Administration Hospital and Medical Center was one such a place. Allen Park, twenty minute South and West of Detroit was a small working class community of Downriver area. Houses were small but neat, yards were tiny yet tidy. The imposing structure other than nearby shopping mall was the VA Hospital. As I drove the very first day of internship towards this hospital, the first sight of the sprawling red-brick building stuck right next to the freeway, with its multi-floored structure and hundreds of small panes of glass windows on all sides seemed like I was being watched by a giant alien with hundreds of eyes looking out over the plains. The sight was overpowering. As I approached the building close, the billowing cloud of smoke from the smoking veterans on both sides of the entrance outside greeted me with an aura of Burmese Opium Den. But time is a great healer; distance is the halcyon; work is the opium; my old familiar sights and sounds from the home country of Bangladesh faded gradually, and soon realities and demands of current surroundings took the center stage. Curious part of my brain sprang back into action again, perhaps I subconsciously realized it to be a healthy distraction from the monotonous grueling work of patient care at the VA Hospital. Often in call nights, I would look through the cracks and crannies of the old hospital building noticing the fine color difference of the two buildings put together, the subtle difference of the pinkish bricks, the variation of the poured concrete, the rusted iron rods sticking out as if I was driven by an impulse to find an old skeleton hidden somewhere. There are times at night I would circumnavigate the old buildings as if I were the Columbus on a mission to discover America. The reason behind as to why the Federal government put this huge hospital in such a place outside the city limits of Detroit was simply another Henry Ford story. In the dark days of Great Depression of the 1930s, the Ford family had donated 38 acres of land to the federal government in Allen Park, MI, as an inducement to set up this VA hospital. The construction work began in 1937. At the end of Second World War as the rank of Midwestern veterans swelled, the hospital was expanded in phases to accommodate the increasing demand. The architects in charge of these renovations never wanted to hide this fact perhaps, because any observant set of eyeballs could easily still tell each additions of the hospital separately. This VA Hospital was gem of a place to learn for any aspiring medical student. Veterans and the teaching faculties were always easy going compared with elite private hospitals and sophisticated patients therein. Veterans on the other hand, did not have any special demand upon the trainees. VA Patients were always compliant and unabashed at the request of physical examination and as of yet, neither there was the looming threat of malpractice law suits, nor there was any pressure from the administration to discharge anyone early to save the hospital money. In fact the pressure was opposite: to keep patients in the hospital for any reason as long as one can, medical to social. It was not unusual to keep someone for days even weeks in the inpatient hospital service because the veteran had no taxicab fare or bus ride to go home. Apparently each individual VA Hospitals used to get budgeted money allocation according to the census of the hospital. The more patients each hospital had in its rolls the more money were to be allocated. I remember one day, the chief of the hospital came in our morning round and told us to “keep as many patients in hospital as you can so our census goes up since the budget allocation time is coming up”! Inside the mammoth building it was gloomy dark with old fixtures. The walls were old and bare, as if the building was missing the touch of a woman and truly it was devoid of women at that time. In my whole time of service over several years, I only got to see two or three female veterans in this hospital. The whole hospital building was made for only men by men. The rare female veterans who were to be admitted were

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Age of TeleMedicine

With the Coronavirus Crisis, we are enduring the modern Plaque of our times. Here in the United States, 30 of the 50 States have declared strict social distancing as of this date of writing. This order stopped all work of outpatient surgical facilities and also stopped the regular patient visits to the doctors’ offices making the the nation increasingly dependent on tele-medicine, or remote medicine by using video or other chat technologies. Studies on US patients show that even in normal times a significant percentage of patients are unhappy with the encounter experiences. With the introduction of computer technologies and EHR, some feel increasing impersonal and mechanical atmosphere of the sacred doctor-patient relationship, the basis of which is so personal in nature. This feeling now will accentuate to a higher degree given the providers and the patients are not even in the vicinity of each other. In absence of direct eye contact and touch of physicians or providers, I am afraid the dissatisfaction will sky-rocket. At the same time, we should not discount the advantages of remote medicine and look for ways to mitigate the disadvantages of such remote encounters. Remote medicine is a great way to reduce one of the main complaints of American patients: waiting time. Since patients are in their own environment either at their own homes or offices, doing what they normally do, this is an area we can see immediate improvement. We also have to look at favorably the productivity of the patient by not spending time in the physician offices or hospitals. In addition, exposure to infectious and contagious diseases will be minimized by remote medicine. With respect to mitigation of lack of physical exam and touch and feel of the physician, there is no true replacement and serious patients must still be examined by the provider. But one way to mitigate the disadvantages of remote medicine is physicians have to better story listeners and better storytellers. Each patient is an open storybook. Physicians just have to read it. I am an advocate of replacing the age old medical school slogan of “History and physical” to “Storytelling and Story Listening”. The reason storytelling is important because in my experience I find that physician has his/her own story to tell first to make the patient comfortable. This is a great signal to a vulnerable individual that physician/ provider is a human and it is the best reassurance and encouragement for patients to open up about her/his own story. In my own remote or person to person encounter, after initial introduction, I often start the interview by an open ended question, “Tell me your story……..” And this gives the patient on the other side of the line or sitting on the other chair to start with whatever they want. And often times people will start with something that is important to them or something that is bothering them the most. As the conversation starts, I find something of my personal life to share with them….. thus a patient’s story becomes one with a doctor’s story and it becomes a human story. By the time it ends, we both have an insight to our mutual connections as our doctor-patient relationship solidifies and a satisfactory treatment plan is built upon this solid foundation. In my experience, patient satisfaction and compliance is far superior in this way. But this is also a self-service for the provider. Self-service because as providers we also need to feel content and satisfied about what we do and by doing it better. So this is a way to derive fulfillment about our own job. Most importantly, the intangible benefit a physician derives by connecting with her/his patients is immense, far beyond what money can buy. So in the days of remote medicine and artificial intelligence, provider communities have to be far better storytellers and story listeners. Followings are few examples how my patients told their own stories and at times even gave me away the diagnosis. In 100 percent of times though, they gave me an opening to their lives and a great way to connect: A 48 year old woman; “How anxious I am to learn what is causing my pain. I have been on a liquid diet for more than a week, afraid of having another painful episode and returning to the ER”. This is in the background of upper abdominal pain. A 66 year old woman: “I am getting too many chicken eggs!” This is after successful treatment of blockage of the esophagus. A 59 year old female: “That my mother had a stroke in a catheterization lab and this procedures scares me because of that. But due to my faith, I believe that I’m going to be fine and back at my house eating chicken burgers, BBQ ribs, green beans etc!” This is in the perspective of a colonoscopy exam. A 56 year male: “Get up in the middle of night with panic attacks when I can’t breathe. Using Wal-four Nasal Spray all day long”. This is in the background of an upper abdominal pain. A 65 year old male: “My favorite color is blue, I love my wife more than life itself and my children are my strength. I need to exercise and eat better, I want to live as long as my great grand parents did at 103 and 105 years of age. I love life and believe in Jesus Christ who is with me today as I go through this procedure of life….. This is in the background of bleeding from colon. A 18 year old male: “I like spicy food” This is in the background of reflux and upper abdominal pain.

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The Boy Who Stole His Mom’s Money

The school house was high up on a flattened mountain top clearing of Chittagong Hill Tracts, a district in the farthest corner of Indian subcontinent and called appropriately so due to its hilly terrain and forbidding landscape of impenetrable jungle infested with year-round malaria and dengue causing mosquitoes. Its open spaces were carpeted with tall shimmering green grasses undulating languidly like a ballet dancer with the passing of humid breeze where blood sucking leeches lurked on every blade. Although surrounded by lush green rain forest, in the dog days of summer, the tormenting brew of high humidity, heat of the tropics and bright sunshine used to raise the temperature to 110 to 120 degrees Fahrenheit in the tiny tin roofed school building where four class rooms for nine to ten year old school children were housed. Currently on lease from the government of Pakistan by a giant private paper company that exploited the natural resources of the surrounding forest to make paper, no one actually knew how this building came into being. But elders say it was an abandoned hill-top Second World War era military station which in its hay days served as surveillance outpost in the Anglo-Japanese war front when the Japanese Imperial Army occupied Burma rather quickly and was knocking at Chittagong, located in the farthest South Eastern corner of British India. The building was in disrepair and dilapidated; passage of time was evident on some of its corrugated tin sheets that had curled up and rusted long ago; in some others, rusting had given way to small holes through which sunlight poured in the midday like a thin slicing sword down from the heaven.  The building base was a square of cement slab with brick walls on all sides; the cement was peeling away in many areas exposing the carnelian red bricks in places. Each of the classrooms could perhaps accommodate twenty children at the most, but now due to rapid population boom of this jungle town, fifty to sixty children were crammed in the same tiny space. Only some of the students could sit on the stools with a desk and the rest either stood on foot or sat on the floor during the class time. Children used to come on foot traversing the dusty winding road cut in between the mountains from dense settlements sprawled at the foot hills of the hilly tracts, from far and near. Then they had to climb hundreds of steps of thin stairways, curved on the steep side of the mountain to get to the class room. This was the most dangerous part of their journey to school everyday and children did it with remarkable patience and care, because they knew just one slip of stairs meant their young body will swirl down several hundred feet down below. Climbing the steep stairs by the time they had reached the top of the hill, they were already drenched in sweat. The class rooms had no running water, but there was piped water that ran near the outhouse little further away. The water was pumped through the exposed on-the-surface metal pipes, and it was as hot as boiling water in the summer. Being so hot both inside and outside the class room, the children needed a constant supply of cool water. The school had no air conditioning and in those days, children in the remote corner of East Pakistan, current Bangladesh, had never heard of refrigerator yet, let alone having one in the class room to keep the water cool. The only way they could keep the water cool is by storing water in an earthen pitcher, locally called “kolshi”. This large earthen vessel of the size of a giant turkey fryer used to be kept on the corner of the class room and students and teachers alike could pour in a little drink of cool water in their ceramic glass they all shared to keep them hydrated especially in the long hot summer days. Earthen pitcher cools down water by capillary action, a basic law of physics. One day early in the summer time the old earthen pitcher of the class broke into pieces as it grew old and could not contain the pressure of the water inside it any longer. Children had no more supply of cold water, and in their tender mind, they knew that it was essential for their life. They decided to raise money and buy a new kolshi soon. Although just few pennies in American currency, it was expensive for the children in this corner of the world, where some of them used to come to school without any breakfast and some of them could only afford to eat one meager meal a day. So raising money was difficult and yet they all pitched in with an urgency and they raised about five “takas”, equivalent of six US pennies. A boy, son of a teacher, who was voted as the “Class Captain,” was given the responsibility to safe guard the money the class had raised and it was his job to buy a new kolshi from the bazaar, one hour on foot journey from the neighborhood.  The class decided for him to accomplish this on the weekend so they have cool water from next Monday. As the Sunday came, he was ready to go to the market with the raised money to buy the kolshi. He took out the only pair of pants he had, which he always wore to school and as he put his hand in the pocket, he felt no coin! He was surprised; a shiver crossed through his spine. He put his hands on both the side pockets and then to the back pocket, but his fingers felt no money, no jingle of coins. He was at a loss and he now started sweating profusely. What had happened to the money? Did he lose it or did some one play a trick on him or had someone picked his pocket? What should

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Prognosis: Excellent

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

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Inner Orchestra

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

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Muhammad Ali and Bangladesh

Muhammad Ali And Bangladesh: Story of Love

The year was 1978. In the month of February, still a mild chill persisted in the sunny mornings. This is the time Muhammad Ali visited Bangladesh. I was in the 12th grade at that time, that will be local 2nd year of Junior College. I remember Muhammad Ali to be a great healer of souls if not permanent but a temporary one. Bangladesh was liberated in December of 1971. The country’s adored son Sheikh Mujib who was “Father of the nation” lead the nation till his assassination in August of 1975. In the last years of his rule, he had declared a one party state, assuming all powers in his hand and the country was left with only four daily newspapers, all of which were government owned. In the hills of halted economic activities, 1974 saw a famine where scores of people had died of hunger and malnutrition. With the killing of Mujib in 1975, the country witnessed a series of military coups and counter coups.  Then army General Zia came to power in April of 1977 through a backdoor coup. Whole Bangladesh and its institutions were shaken by BKSAL, the one and the only legal political party, the military coups and the counter coups that followed each other. The country and its people were all wounded and scarred internally if not externally. Muhammad Ali’s visit to Bangladesh in such a time was timely and soothing to the nation, a nation in need for such consolation and redemption so badly. I remember Muhammad Ali going from town to town and wherever he and his wife Belinda went, a huge crowd waited for them singing and chanting. For days the radio played Ali songs, “Muhammad, Muhammad Ali, He is a black mountain, He says to all I am A-l-i…..” One such morning of his visit we got to know in the college that he will be visiting port city of Chittagong. He was supposed to take the road near our college. Several of my friends and I immediately left the college campus abandoning the classes and joining the crowd. After few hours of waiting and chanting finally we saw the motorcade of the champion coming down the winding road. Muhammad Ali and his family were in the second car just after the lead car and they kept their windows rolled down and waving at all the people crazy for them alternately looking right and left. The motorcade was slow and my plan worked out perfectly: I had an old English book on Islam and Prophet Muhammad, quoting and analyzing extensively on the various comments and opinions of Western intellectuals on Islam and Prophet Muhammad. I had written up a letter addressing Muhammad Ali and one letter addressing his son inviting him to be my pen pal. As the motorcade moved slowly, I slipped in the book with the letters inside and noticed it falling on the floor of the moving car. Whether they picked it up or not or even looked at it or not were not known to me. But I returned to the college dorm with a satisfied mind that I had delivered what I wanted to in whatever way I could.  With the glimpse that I had on Muhammad Ali and his family and the way they traveled keeping the window rolled down in a dusty pot-holed road of a poor third world country, I realized the love we Bangladeshis had  was not just one sided, Ali loved us back immensely in return. This is the day I realized Muhammad Ali was not just the ferocious fighter he was, he was just not the dramatic emotional exploiter of boxing; he was a great lover too. He was lover of the poor, the downtrodden, and the destitute. Our country and people whose souls were shredded into pieces by this time with the poor governance, nepotism, dictatorship, famine, coups, counter coups and the legacy of blood that haunted us since the independence were in great need for such an unconditional love. We needed the love; our souls were crying for it. Muhammad Ali did this for us. Ali was great in deed.

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Medical Detective: Anemia, Dr. Denton Cooley Busted!

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.

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Story on the Road: If You’re Rude, I Will Kill You with Kindness

Story on the Road: I just got back from a brief visit to Pennsylvania to bring my son home from his college. My flight was at 6 AM, so we got on the taxi cab at 4:30 AM. Cory was waiting right on the front door of hotel with his taxi cab at the exact time. He is a tall, medium built, in his 30s with scruffy beard and the baseball cap he wore readily declared his loyalty to the Pittsburgh Pirates. A kind and active man he was, helping my family and I with the luggage. Once on the road and he started driving through the early morning desolate mountain roads half blanketed in a thin layer of fog we start chatting. He was actually a machinist got hurt in a motor vehicle accident that injured his back. With multiple surgeries, and protracted pain he had a long rehab time. During this time he refused to take any narcotic drugs except in the period immediately after the surgeries. His youth, determination and strength of mind got him healed physically sooner than many other people but little did he knew that his main struggle of life would just about to begin. After the back injury, no one would hire him as a machinist any more. By now he had a wife and a newborn son. He badly needed a job which will keep his family afloat and also pay for the recently mortgaged house payments. A friend of him encouraged him to drive taxi and this was his start. He drives taxi seven nights a week and rapidly rose to be one of the highest paid cab drivers in his area. He maintains a tight schedule with his regulars and keeps them happy. Some of them tried Uber thinking this would be cheaper, but quickly came back to him. There is no alternative to good service. Within one year of starting on taxi, he also found a three day a week job as a machinist to make screws for eye glasses and as quality control officer. When I asked him why he works so hard, his answer was straight, spontaneous and very American, “Now I have another son and I need to take care of my family. Besides if you’re lazy, you’re broke!” he proclaimed smilingly, a smile that shined through his scruffy beard. With his hard work he now has acquired another home enjoying the rental income from it. He had opened education accounts for his children. I asked him besides the constant risk of traffic accident what other work hazards he comes across regularly in his night time taxi driving. “Sometimes it is the rudeness of people that is more hazardous than chance of traffic accidents” he answered. “What do you do if people are rude?” I asked him. “I generally kill them with my kindness, it is rare that I have to ask them to get out” he put forward again with a broad reassuring smile keeping his eyes on the rear view mirror of the moving vehicle. He grew up with eight other brothers in a Pennsylvania Catholic family. Few years ago, his grandfather died in a head on collision with a drunk driver. Since then seven of the nine brothers promised themselves not to drink and only remaining two brothers of him drink alcohol. By this time the short drive of the airport came to an end. Cory helped again with the unloading and after taking the money he disappeared in the light early morning traffic of the airport. He already had another client waiting to be picked up. Magic Bullhorn Moment:  1. If You are Lazy, You are Broke! 2. Kill Rudeness by Kindness! Doctor’s Commentary: I love to interview common people of our beautiful country and enjoy exploring treasured story every human hides within himself.  So refreshing and inspiring they are! It reminds me of the blessed country we live in and our people are the best assets we have. We have the most hardworking people of the whole world and their work ethics are second to none. This is why America is second to none. I had learned and gained knowledge on something by talking to this young man that I never knew. By the time the ride was finished, I was reassured of the indomitable entrepreneurial spirit of common men and women in our country. God Bless America.

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my mother

An Orphan’s Mother’s Day

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

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Prescription for Doctors, from Patient

“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

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