Blog | Wednesday, March 21, 2012

Two things to read today

The first comes from Portland internist Devan Kansagara, MD, MCR, in an eloquent piece for Annals (usually "medical humanities" is not dignified by an actual human style). (This comes on the heels of a first-author systematic review in JAMA.)

Dr. Kansagara writes: "I have cared for several patients over the years whose palpable loneliness still shocks me. And this is not loneliness that 5 minutes of handholding or a visit from the volunteer dog can fix. This is institutionalized loneliness, refractory loneliness, the end stage of a life that has somehow not gone as planned. It is mixed with the memory of poor choices and their residual regret. I am sometimes witness to tragedy that I cannot define, diagnose, manage, or cure. I am increasingly aware of the tragedy of social isolation, but I have a hard time understanding it. The mechanism of disease--if one can call it that--is too overwhelming, too multifaceted. Social isolation is not a medical illness in the way that I was taught to think about illness, but it is often the ubiquitous fact that envelops every medical decision and even haunts the way I think about a patient's terminal illness.

"I have never asked a patient why he or she and society had parted ways, but in quiet moments, I occasionally think about it. Sometimes clues present themselves: an offhand remark about an accident, a history of incarceration or drug abuse, or a financial dispute with a family member. Roman, however, did not offer many clues. The next-of-kin information in his chart was blank. He had a daughter, but they had not spoken in years. I don't know why. Sometimes it's better not to know--sometimes too much history can corrupt empathy."

The second comes from "The Oracle of East Baltimore," an article from Urbanite:

"Weaver holds an endowed chair as alumnae professor of English at Simmons College, editing and translating poetry and prose both into and from modern Mandarin. In 2004 and 2008, he organized international conferences of Chinese poets at Simmons, the first held outside China.

"In a telling anecdote on the mindset of the average Baltimorean, he recalls family members refusing to believe that he could speak the language of Yao Ming. To which he replied: 'How would you know that anything I said wasn't Chinese?'"

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.