Feel My Pulse

As I’m bidding farewell to my second to last patient, I hear two female voices yelling at each other in the waiting room.

Turns out, it’s my last patient, screaming racial slurs at another patient. 

The nurse calls security, who help my attending and I pry the two women apart.

I get my patient into the clinic room. “Ma’am, that kind of behavior is not appropriate here. You will be respectful and behave yourself.”

My patient squints at me. “I don’t understand your English, are you from here?”

Mind you, I was born in the US, raised in the US, I get teased for using SAT words and enunciating like I’m performing theatre. You know why she asked me this question? Because I “don’t look like an American”. Her words, not mine.

Okay. We gonna do this racist shit?

I can play this game. Let’s go.

So as she begins to ramble, I begin to squint. 

And cock my head. 

And every one or two sentences, I interrupt her and say “can you say that…more slowly?” or “wait wait one more time. Enunciate, if you wouldn’t mind.” “Oh I’m so sorry I didn’t understand that.” She’s just here for her med refills. I already filled them out before she came in. I draw out this torture for the entire twenty minutes. By the end of the visit, I’m smiling serenely and her face is the color of a tomato.

My medical assistant sits outside my clinic door and hears this all go down. When I’m done with the patient, he picks up where I left off.

“Ma’am, I’m going to need you to speak clearly, I’m having a hard time understanding your English,” he says, as he provides her discharge paperwork and final instructions. I’m choking down my laughter in my clinic room. 

Excerpt:

Below is a time-lapse video, using images captured by [photographer James] Balog and the Extreme Ice Survey team, documenting changes at Mendenhall Glacier in Alaska. Between 2007 and 2015, the glacier retreated by 550 meters, or more than 1,800 feet.

For Balog, the location that’s had the greatest personal impact is Sólheimajökull Glacier in Iceland, which he described as his “first love.” “It’s where I kind of first realized how quickly the ice is changing,” he said. “And it’s because of what the local scientists were able to show me by way of the change in the glacier in a shockingly short period of time.” Reports suggest that the glacier has shrunk by more than 2,000 feet since 2007. Below is a time-lapse of its retreat between 2007 and 2015.

(PS, whoever snatched this video from Extreme Ice Survey added a lousy music track. The video is disturbing. Don’t need the music.)

Below are before-and-after images of Switzerland’s Stein Glacier, which also retreated by 550 meters between 2006 and 2015.

Stein Glacier, in part of the Swiss Alps, on Sept. 17, 2011. (James Balog and the Extreme Ice Survey/GSA Today/Geological Society of America)

Stein Glacier on Aug. 20, 2015. (James Balog and the Extreme Ice Survey/GSA Today/The Geological Society of America)

Below is Trift Glacier, which retreated by more than 3,700 feet between 2006 and 2016.

Trift Glacier in the Swiss Alps in 2006. (James Balog and the Extreme Ice Survey/GSA Today/The Geological Society of America)

Nursing is messy. Nursing is chaotic. Nursing is twelve and half hours in a shift. Nursing is never enough time to get everything accomplished. Nursing is charting. Endless charting. Nursing is waking up in a panic about something you did/said/didn’t chart. Nursing is hard. Nursing is breaking my body. Nursing is glorious. Nursing is beautiful. Nursing is the awe-inspiring moments you get to witness. Nursing is being present for the gut-wrenching moments you wish you could walk away from. Nursing is fighting for your patient. Nursing is a good bit of skill and a lot of luck. Nursing is listening. Nursing is educating. Nursing is a profession. Nursing is a gift. Nursing is a curse. Nursing is being afraid I’m going to get sued no matter what I do. Nursing is lying awake at night wondering about patients you took care of and where they are.

The First Climate Model Turns 50, And Predicted Global Warming Almost Perfectly

“The big advance of Manabe and Wetherald’s work was to model not just the feedbacks but the interrelationships between the different components that contribute to the Earth’s temperature. As the atmospheric contents change, so do both the absolute and relative humidity, which impacts cloud cover, water vapor content and cycling/convection of the atmosphere. What they found is that if you start with a stable initial state – roughly what Earth experienced for thousands of years prior to the start of the industrial revolution – you can tinker with one component (like CO2) and model how everything else evolves.”

In 1967, a groundbreaking paper in climate science was published, detailing the inputs and feedbacks for the first accurate climate model. You don’t have to look far to find contentions that climate models are wrong, inaccurate and unreliable: 8 of the first 10 results on google state it. Yet if you look at the science, the original model, even at age 50, does a remarkable job of getting things right. The biggest success? Understanding how large-scale processes work, including the thermodynamic effects of adding additional greenhouse gases to Earth’s atmosphere. The increase of temperature – approximately 2 degrees C for a doubling of CO2 – was well known then, and continues to be well known today. There are uncertainties and difficulties in modern models, but that doesn’t mean there’s uncertainty surrounding global warming. Quite to the contrary, the evidence has never been better.

“Physicians should regard autonomy as an immutable pillar of beneficence that cannot be compromised.” 

One of my medbesties wrote that line in an essay about medical ethics and it runs through my mind often. Today I had to piss off an attending in defense of that principle. I’ll do it again tomorrow if I have to. 

My patient doesn’t speak English, and was diagnosed with tuberculosis while visiting the US. He was held at the hospital against his will for treatment, and he has really been very pleasant about it. Now he’s not contagious, but he has other serious illnesses going on, and we think it’s very unsafe for him to leave. He wanted to go anyway. I feel like my attendings have been manipulating him into staying by implying that he is still not actually free to leave. I called my attending out on that during rounds, which felt terrible. Later I went in to see the patient without them and explained the procedure for leaving AMA while still getting his meds and staying in compliance with the public health laws. I was afraid he would die if he left, and I told him that very pointedly, but I also told him it was his choice. 

Just as he was about to do head out the door, he hesitated. I got a page from his nurse. He turned to the only doc he trusts, the only person who he believes is on his side, and he asked me what he should do. I told him that I thought he should stay, so he did. It could have gone the other way. He could have left, and died. But it would have been him making that choice. The choice that he did make, the safer choice, he made of his own free will because I treated him with respect, and he is now engaged in his own care in a way that he wasn’t when he felt as though he had no choice. 

Just like in any good (or “so bad it’s good”) kung fu flick, one of the most important moments of being a student is the day you challenge your master.