Every Friday, thousands of readers smile when they see an e-mail from Pulse: voices from the heart of medicine in their in-box. Pulse is a free, online magazine that publishes riveting, often moving, sometimes controversial, and occasionally hilarious first-person stories and poems about medicine. (Click on “hilarious” for a story that will astound you, and, if you share my sense of humor, make you laugh. )
All of these tales are true, and the authenticity of the writers’ voices helps explain their power. Written by patients and doctors, nurses, caregivers, and students, these unblinkingly honest stories and poems bear witness to the suffering that patients endure, and to the compassion of caregivers — as well as their doubts.
Some of My Favorites
Long-time readers may remember poems and stories from Pulse that I have cross-posted in the past.
— “Useless (But Needed), A Doctor’s Constant Companion” — one of my favorites
— “First Do No Harm,” a story about how we train doctors that drew thoughtful and provocative comments from both doctors and nurses;
— “Broken”– a controversial story about what happens when a trauma surgeon overrules an obstetrical resident. The question: should they have tried to save the baby or the mother? Could either be saved?
A Stairwell Conversation, And a Unique Magazine is Born
Pulse founder Paul Gross, practices family medicine at Montefiore hospital in the Bronx, New York. He recalls how Pulse was conceived:
“What would it be like, I wondered, if there were a magazine that told about health care the way it really is? What if patients and health professionals alike got to tell their stories?
“Around the same time, I had a stairwell conversation with a hospital director of nursing. It stopped me short. ‘For the first time in my long career,’ she said, ‘I’m ashamed to be in this business.’
“To me, this sounded like a cry for help; it sounded like a system in crisis,” Gross adds. “And yet, for the most part, popular magazines and medical journals seemed oblivious.
“It occurred to me that if we found a way to share our stories—the difficult moments along with the glorious ones—perhaps we could jump-start a national conversation about health care. Maybe this exchange could lead us toward a better health system.”
Pulse Today–A Second Anthology
Since then Gross (who continues to practice at Montefiore) and co-editor Diane Guernsey (a professional writer, editor and psychoanalyst), have wedded their knowledge and skills.
Together, they and other Pulse editors have done a brilliant job of selecting and editing stories and poems from the many submissions that they receive. I am impressed by the high polish of the finished product.
In 2010, Pulse put together an anthology of the pieces it had published online. Dr. Perri Klass reviewed the anthology for JAMA, and summed up what is special about Pulse: “All of the stories in this book . . . are told with a kind of urgency; these encounters change lives and mark memories. This collection is in some sense about writing for one’s life.”
Now, Pulse has published a second collection, Pulse: More Voices,” and this time former CMS director Donald Berwick, M.D. wrote the copy for the cover: “I don’t just read Pulse, I adore it. The supply of compelling, often poetic accounts is the best around.”
You can buy the anthology ($21.99) here.. If you’re not ready to buy the book, you still should subscribe for free weekly e-mails. You will receive a story or a poem every Friday, be able to comment, and become part of the Pulse community.
A Story from the Second Anthology
The story below that raises a pressing– and as yet unanswered –question about how the Affordable Care Act is going to provide, not just access to health insurance, but access to health care, for the many poor Americans who will suddenly become eligible for Medicaid.
One More Child Left Behind
By Brian T. Maurer
Making the diagnosis might be straightforward, but sometimes getting adequate medical care poses a more formidable challenge.
It was the end of an exhausting afternoon in our busy pediatric practice in Enfield, Connecticut. I had just finished seeing what I thought was the last patient of the day, only to find yet another chart resting in the wall rack, a silent signal that one more patient waited behind an adjacent closed door.
His name was Aaron. Six years old, he sat on the exam table cradling his left arm in his lap. The most striking thing about the arm was the large bluish bulge on the side of his elbow. His mother stood by his side; his grandmother sat in the corner chair.
“What happened?” I asked.
“Another kid pushed him off a table at school. He won’t move his arm.”
I took a step closer. “Let’s have a look.”
Gently, I palpated the borders of the blue bulge. Aaron winced in pain. I felt his wrist to check the circulation to his hand. “Squeeze my fingers,” I said. He tried and winced again.
“It’s likely broken,” I explained. “At this hour all the x-ray facilities in town are closed. Your best bet is to take him to the emergency room,” I said, wrapping Aaron’s arm in a sling.
“When you get to the hospital, they’ll take a special picture of your arm,” I told him. “Give them a big grin so it comes out well, okay?”
Aaron’s grandmother flashed a faint smile as they walked out.
The next morning Aaron’s mother phoned the office to tell me that, although the x-ray showed a fracture of the elbow, no “bone doctor” had come to the hospital to treat the break. [Note: under federal law, ERs do not have to treat the patient. They must evaluate him, and “stabilize” him. That is all. mm]
Instead, she was given the names of some local orthopedic surgeons, with instructions to arrange an appointment with one of them that morning. But none of the surgeons would give her an appointment, so she wanted advice about what to do.
When I flipped through Aaron’s chart, I saw why none of the local orthopedists would see him. It was all too clear: Aaron’s health insurance coverage was through an underfunded state-sponsored Medicaid plan.
I telephoned the client services department of Aaron’s health plan. A cordial representative proceeded to give me the names of several participating orthopedic doctors in the area.
“Hold on,” I interrupted her when I heard the first name. “The mother already called that practice and was told they were no longer participating.”
“’Sometimes that happens,’ the representative told me. ‘The doctor opts out, but doesn’t inform us directly, so we still have the name on our list.’ She gave me three other names and telephone numbers. ‘Call me if you’re still having a problem,’ she said cheerfully. ‘Have a nice day.’”
Feeling frustrated and irritable, I delegated the task of locating a participating provider to Laura, one of our medical assistants. ‘When you find someone, schedule the appointment and call the mother to let her know,’ I told her then turned my attention to my morning patients.
I returned from lunch to find Laura still on the phone. “None of the practices you gave me would accept this kid’s insurance,” she said. “I called client services again and got six more names. Each office was happy to schedule an appointment until I told them the insurance carrier. I can’t believe that no one will see a six-year-old boy with a broken arm!”
To find out what happened to Aaron, you can read the rest of hte story here. http://www.pulsemagazine.org/Archive_Index.cfm?content_id=89 Come back to HealthBeat to comment.
Postscript: Ads on HealthBeat
Often, I am asked whether I sell ad-space on HealthBeat. Normally, I say “No,” because I can’t vouch for the product or service advertised.
But recently, I decided to post ads for organizations that I know well. Scroll down on the right hand side of this page, and under “RECOMMENDED” you will find links to healthinsurance.org, (for information about family health insurance); the Empowered Patient Coalition (Information and resources for patients, caregivers, and advocates) and Pulse: voices from the heart of Medicine.
In the future, I will be posting more ads for books and publications that I admire and non-profit groups that I know and trust. They are inexpensive–I see these as “public service” ads. (If interested in advertising please, click on “Contact Maggie” at the top of this page.)