Leaning Close: "No more interventions. No more transfusions." A reflection on mortality and morbidity rounds by pediatrician-writer Laura Johnsrude

When I read “All Tuned Up” by Albert Howard Carter III (Spring 2021 Intima), I remembered a pediatric intensive care unit patient from my own 1980’s residency experience. In Carter’s poem, a medical resident presents a case during mortality and morbidity rounds. The resident is moved to tears as he tells the gathered audience about the death of a patient he knew well. A senior doctor “gently” offers context and says, “Maybe he was just tired.”

Mercifully, I’ve muffled memories from some of the deaths during my residency training in the pediatric intensive care unit. But I remember a slight girl of about sixteen with silky, wavy hair, lying in a metal-frame bed parallel to the wall against the window, in silhouette.

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Scripting Death: When Words Fail – In Conversation with Liana Meffert’s “Death is Usually an Easy Diagnosis” by Paula Holmes-Rodman

“A medically assisted death, such as I recount in my essay “Mercies, Or, the Mostly True Tale of a Narratively Assisted Death” (Intima Spring 2023), is the antithesis of a traumatic ending in an ER. It is highly anticipated, fully orchestrated and well rehearsed – on everyone’s part but my own.”

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Beyond Acronyms: Contemplating what 'OLD CARTS' really stands for by Tulsi Patel

“OLD CARTS” is an acronym we’re taught in medical school to guide us on questions to ask to elicit a history of the patient’s illness: Onset, Location, Duration, Characteristics, Aggravating or Alleviating factors, Radiation (of pain), Treatment, and Significance. Although OLD CARTS is a helpful checklist initially, over time it begins to feel perfunctory, done to check off a requirement on the rubric. We ask many questions, and I am keenly aware I’m asking because I want something from the patient—I want telltale signs, any clues on the diagnosis, any information that the care team can act upon and use— I feel greedy.

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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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Attunement: Reflecting on the Art of Making a Difference by Catherine Klatzker

Empathy and compassion arise from sensitizing events, often many. Sometimes it’s easier than others to track those events to their origins. Patient Jane provided student-doctor Brian Sou with one such activating event. (Field Notes “A Student’s Moment in NYC’s Most Famous Hospital”) In their first encounter, Sou writes “I did not manage to comfort Jane in her moment of vulnerability, when she needed someone to do so the most. I was so interested in the medical aspect of curing that I completely neglected the compassionate side of healing.”

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