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UC San Diego med school grad tackles the world
Dr. Jim Eichel on childbirth, suicide, neurotic patients, code blue, managed care frustrations, schizophrenia, overeating, sweet people at life's end, and med school itself
Instead of answering, she hung up. She felt, I’m sure, that I was not getting it.
Show Me Your Saphenous Vein, James!
I wish I could say I reveled in having brought a fresh new life into the world, but a new baby is slippery, and I was scared she would fall to the floor, perhaps ending my career. I don’t remember what she looked like, who clamped and cut the cord. One thing impressed me: the sturdy umbilical cord, with its rubbery, tough, gray-white braided ropelike appearance and the three life-sustaining umbilical blood vessels twisting their course toward the baby.
March 20, 1997 | Read full article
He did not have a pulse at one minute of age. At five minutes of age, he had a slow pulse but no other signs of life.
Deliverance
This all took about 90 seconds, barely enough time to allow the ICN team to arrive with the “crash cart” to attend to critically ill newborns. We usually have a warning when something terrible is happening to a baby during birth; this was an instance where everyone was caught off guard. I passed the baby to Tamara, who gave it to the ICN team, then I turned back toward Cheryl.
March 27, 1997 | Read full article
“Can’t we get that [intravenous] fluid to run any faster?” I asked.
The Night God Used Binoculars
Larry spoke up, to which a supervising resident responded, “What are you?” conveying that Larry didn't have the right to say anything during a code. Larry countered, “Anytime someone’s life is in danger, you have to be willing to listen to helpful suggestions.” The comment later earned him a firm personal reprimand from the chief of surgery, who told him he had to be willing to watch people die so residents could learn.
April 10, 1997 | Read full article
Most of what we do goes unnoticed.
The Bad News Wasn’t the Seizures
I don't lie to patients. Ever. But when a physician gives terrible news to a patient, within a few minutes the patient wants to know what'll happen next and what his chances of survival are, and neither Todd nor I could give reliable answers to those questions. This is the one situation I can recall in my career that I did lie.
May 1, 1997 | Read full article
I check the rectum of every patient over age 50 every year. During my second year of medical school at UCSD ten years ago, Bill, a fourth-year medical student, taught me how to finish the rectal examination.
Tell Her the Old Lady Hasn't Got Much Time Left
Women after menopause get iron deficient when they're losing blood from an unknown source, usually the gastrointestinal tract. I referred her to a gastroenterologist, who found a small cancer in her “hepatic flexure,” where the ascending colon turns 90 degrees in the right upper abdomen to become the transverse colon. Two days later, I assisted Charles, the general surgeon, as he performed a right hemicolectomy, the removal of the right colon.
June 12, 1997 | Read full article
“You must have really thought I was in bad shape to put me in here with these people."
It’s None of Your Business Whether I Kill Myself
Were her problems new or old? For about 30 seconds, she only looked at me. “Both,” she finally offered. What did her husband and 12-year-old daughter think of them? “They don’t know; I won’t tell them.” Had she ever been this depressed before? “Many times.” Was she thinking of killing herself? She replied with an affirmative nod. How would she do it? She didn’t answer. Had she ever tried it before? “No.”
Aug. 21, 1996 | Read full article
Haba (standing), the author, Tanti, baby Terry at two months, and Hatouma. I have fantasized about moving my practice to Mali.
This Must Mean Fatouma Really Loves Me
Tanti summoned me to her house to evaluate her stomach troubles. As I stooped to lower my head through the curtained entrance, I felt a bit ill-at-ease: A white man, just getting to know this family, in a Muslim woman’s bedroom ready to discuss details of her bodily functions and to touch her body. She'd be exposed in a way that her religion does not allow.
Sept. 18, 1997 | Read full article
I will do what I can for as long as I can withstand her relentless attacks.
Queen of the Button Pushers
When she calls the office I know I’m in for a rough evening. Her calls always take a long time, usually 30 minutes or more. They start with her saying in a beleaguered tone, “Yeah, well, I just wanted to ask a question..." and then she asks the question. One of her frequent concerns is, “Can years and years of stress and anxiety cause me to have hypertension and heart disease?”
Oct. 30, 1997 | Read full article
You may have noticed that your doctor seems to have less time for you, to look more stressed than before, and to have less competent staff at the office.
Ten Guys and $7 Billion
We have a choice between Allegra, Claritin, Hismanal, and Zyrtec. When deciding between drugs, the patient and I opt for the cheapest and/or the one with the most convenient dosing schedule. But the choice is not ours to make anymore. Each insurance company has its own formulary, and we doctors must prescribe drugs on the formulary, or the insurance company won’t pay for it.
Dec. 11, 1997 | Read full article
The nursing staff gave her the last room in the back of the hallway.
Miriam’s Demise
D and E's are tricky. The bigger the fetus, the tougher it is to get out through the dilated cervix. That’s the reason most obstetricians won't do abortions more than 12 weeks after the first day of the patient’s last menstrual period. Getting a larger fetus out involves breaking and extracting the fetus in parts, and most obstetricians don’t do enough of these procedures to feel comfortable or confident doing them.
May 28, 1998 | Read full article
"If he asks where she is, please say she’s in the hospital.”
Piece by Piece
After two months of rehabilitation, Myrna could walk short distances with her walker, but it became apparent by this time that she'd spend most of the rest of her life in a wheelchair. Meanwhile, her husband Ty, once a brilliant technical writer, had lost much of his memory. He had no idea what day or even what year it was. He did, however, take wonderful care of his wife, on whom he doted every minute.
June 25, 1998 | Read full article
Terry and Jim Eichel with baby. "I decided not to use gloves."
The First Human to Touch My Daughter’s Head
I exhorted Terry to push hard, pulled straight down on the baby’s head, avoiding the use of too much force and thereby coaxed out the anterior shoulder. I then pulled straight up to get the posterior shoulder out. Usually, the baby slides out without much effort once the shoulders are out, but mine didn’t. I had to grab under the armpits and pull, as though someone was holding my child in from the other side.
July 23, 1998 | Read full article
When I told him he had a four-centimeter-diameter cancer in his right lung, his immediate reaction was, “I’m worried about my parents.”
You Will Not Believe This Guy’s X-Ray
In most cases, symptoms start at about age 18, a time when society expects us to become independent. Performance in school and/or work declines as unrelenting thoughts ruin the schizophrenic’s ability to concentrate and distract him from his basic needs, particularly self-care. One of the reasons most of us do not have many schizophrenic friends is because when they are ill, they do not conform to our grooming standards. They do not bathe.
Sept. 10, 1998 | Read full article
A returned Peace Corps volunteer who spent her two Peace Corps years in Mali, Lisa was one of the best M.A.s we’ve ever had, but now she’s a second-year medical student at U.C. San Francisco.
The Bad Ones Get Fired
When she told me that she was working her last day, I felt so used and misunderstood that I struck my office’s wall with my open palm. I had seen her as a spiritual ally within the office who could see the big picture and use her youthful vision to help us fight to change it, and instead she left because “You all only care about money.” I felt terrible for hours and bad for weeks.
Oct. 15, 1998 | Read full article
“I’ve decided I don’t want to keep losing weight,” she told me.
Appetite Everywhere
Every week I work on her self-esteem. The fact that I, a man who she knows is busy, agree to see her every week helps. She has said to me many times that she expects me to give up on her, usually during visits where she has gained weight from the previous week. I can’t imagine giving up, but I do get frustrated, despite having learned not to depend on patients’ improvements for my own happiness and satisfaction.
May 13, 1999 | Read full article
She went home with that thrombus ready to break loose. Some time Christmas morning, her left ventricle pumped it into her aorta.
Was This My Fault?
“What happened?”
“She’s had a big stroke." I made a small effort to hide my hurt, but I could feel my body’s emotional gates gape open so that anyone could see inside.
Terry allowed me a few quiet seconds, then gave me an affectionate squeeze behind my shoulders. “Are you okay?"
My response, couched in quiet, hitter, adult tones, was childlike. “Not really. It’s not fair. It’s Christmas. She’s a really nice lady."
Aug. 12, 1999 | Read full article
“Please discuss this with your pastor,” I pleaded.
What Is the Name for This Collection of Events?
“God spoke to me last week and told me I was cured” was how she opened our conversation. “So I stopped taking all of my pills,” including the steroids she needed to keep her lupus quiet. My attempts to convince her to think of her medicines as God’s tools failed, so I did what I always do when I can’t help someone: I referred her. “Please discuss this with your pastor,” I pleaded.
Jan. 20, 2000 | Read full article
I mentioned my family’s intestinal woes, and Linda volunteered to give us her loperamide, a generic Canadian version of the medicine known as Imodium in the United States.
Travel Bug
The worker, a short Dominican fellow who looked to be about 45, came back with me from the gift shop into the room. He had an older relative with diabetes and believed this gave him the right to be our medical expert. “You should rub her feet,” he instructed in Spanish and began to demonstrate. Knowing that my mother-in-law was still alert enough to fear this level of courtesy, I repositioned myself between him and her toes.
Feb. 10, 2000 | Read full article
Should he sue me and, if not, should he continue to see me as a patient?
I Was Worried that Fred Might Never Wake Up
Given all of this, sleep was out of the question, so I went downstairs to let Terry go to bed. I turned on the TV and observed the talking heads reading me the 11 o’clock news, but of course I wasn’t interested. Some time passed, and I called the hospital. Fred had not awakened, but he had tolerated the procedure without complications and had stable vital signs. I took my dry mouth and aching abdomen upstairs and conked out.
Dec. 21, 2000 | Read full article
Environment of Mistrust
Most people in the United States believe that specialists are smarter than primary-care doctors, even though objective measurements such as standardized tests (e.g., SATs) and grade point averages) suggest the opposite. Most do not know that board-certified family physicians do a three-year residency to become specialists in common problems. When something appears serious, treatment from a family practitioner does not seem to be enough. I was prepared to go through this again over the phone with Veronica.
April 12, 2001 | Read full article
“For as long as he is here, we are his parents.”
I’m Not God
Exhausted, I turned my attention to Greta, who I remembered had much more right to be tired than I did. I pointed out to her what a remarkable effort she had just put forth to get a vaginal delivery, and she thanked me. I had nothing to do now but go home, so I said good night. Laurel intercepted me on the way out and gave me the warmest professional-to-professional hug I’ve ever had.
Aug. 30, 2001 | Read full article
Here's something you might be interested in.
UC San Diego med school grad tackles the world
Dr. Jim Eichel on childbirth, suicide, neurotic patients, code blue, managed care frustrations, schizophrenia, overeating, sweet people at life's end, and med school itself
UC San Diego med school grad tackles the world
Dr. Jim Eichel on childbirth, suicide, neurotic patients, code blue, managed care frustrations, schizophrenia, overeating, sweet people at life's end, and med school itself
Instead of answering, she hung up. She felt, I’m sure, that I was not getting it.
Show Me Your Saphenous Vein, James!
I wish I could say I reveled in having brought a fresh new life into the world, but a new baby is slippery, and I was scared she would fall to the floor, perhaps ending my career. I don’t remember what she looked like, who clamped and cut the cord. One thing impressed me: the sturdy umbilical cord, with its rubbery, tough, gray-white braided ropelike appearance and the three life-sustaining umbilical blood vessels twisting their course toward the baby.
March 20, 1997 | Read full article
He did not have a pulse at one minute of age. At five minutes of age, he had a slow pulse but no other signs of life.
Deliverance
This all took about 90 seconds, barely enough time to allow the ICN team to arrive with the “crash cart” to attend to critically ill newborns. We usually have a warning when something terrible is happening to a baby during birth; this was an instance where everyone was caught off guard. I passed the baby to Tamara, who gave it to the ICN team, then I turned back toward Cheryl.
March 27, 1997 | Read full article
“Can’t we get that [intravenous] fluid to run any faster?” I asked.
The Night God Used Binoculars
Larry spoke up, to which a supervising resident responded, “What are you?” conveying that Larry didn't have the right to say anything during a code. Larry countered, “Anytime someone’s life is in danger, you have to be willing to listen to helpful suggestions.” The comment later earned him a firm personal reprimand from the chief of surgery, who told him he had to be willing to watch people die so residents could learn.
April 10, 1997 | Read full article
Most of what we do goes unnoticed.
The Bad News Wasn’t the Seizures
I don't lie to patients. Ever. But when a physician gives terrible news to a patient, within a few minutes the patient wants to know what'll happen next and what his chances of survival are, and neither Todd nor I could give reliable answers to those questions. This is the one situation I can recall in my career that I did lie.
May 1, 1997 | Read full article
I check the rectum of every patient over age 50 every year. During my second year of medical school at UCSD ten years ago, Bill, a fourth-year medical student, taught me how to finish the rectal examination.
Tell Her the Old Lady Hasn't Got Much Time Left
Women after menopause get iron deficient when they're losing blood from an unknown source, usually the gastrointestinal tract. I referred her to a gastroenterologist, who found a small cancer in her “hepatic flexure,” where the ascending colon turns 90 degrees in the right upper abdomen to become the transverse colon. Two days later, I assisted Charles, the general surgeon, as he performed a right hemicolectomy, the removal of the right colon.
June 12, 1997 | Read full article
“You must have really thought I was in bad shape to put me in here with these people."
It’s None of Your Business Whether I Kill Myself
Were her problems new or old? For about 30 seconds, she only looked at me. “Both,” she finally offered. What did her husband and 12-year-old daughter think of them? “They don’t know; I won’t tell them.” Had she ever been this depressed before? “Many times.” Was she thinking of killing herself? She replied with an affirmative nod. How would she do it? She didn’t answer. Had she ever tried it before? “No.”
Aug. 21, 1996 | Read full article
Haba (standing), the author, Tanti, baby Terry at two months, and Hatouma. I have fantasized about moving my practice to Mali.
This Must Mean Fatouma Really Loves Me
Tanti summoned me to her house to evaluate her stomach troubles. As I stooped to lower my head through the curtained entrance, I felt a bit ill-at-ease: A white man, just getting to know this family, in a Muslim woman’s bedroom ready to discuss details of her bodily functions and to touch her body. She'd be exposed in a way that her religion does not allow.
Sept. 18, 1997 | Read full article
I will do what I can for as long as I can withstand her relentless attacks.
Queen of the Button Pushers
When she calls the office I know I’m in for a rough evening. Her calls always take a long time, usually 30 minutes or more. They start with her saying in a beleaguered tone, “Yeah, well, I just wanted to ask a question..." and then she asks the question. One of her frequent concerns is, “Can years and years of stress and anxiety cause me to have hypertension and heart disease?”
Oct. 30, 1997 | Read full article
You may have noticed that your doctor seems to have less time for you, to look more stressed than before, and to have less competent staff at the office.
Ten Guys and $7 Billion
We have a choice between Allegra, Claritin, Hismanal, and Zyrtec. When deciding between drugs, the patient and I opt for the cheapest and/or the one with the most convenient dosing schedule. But the choice is not ours to make anymore. Each insurance company has its own formulary, and we doctors must prescribe drugs on the formulary, or the insurance company won’t pay for it.
Dec. 11, 1997 | Read full article
The nursing staff gave her the last room in the back of the hallway.
Miriam’s Demise
D and E's are tricky. The bigger the fetus, the tougher it is to get out through the dilated cervix. That’s the reason most obstetricians won't do abortions more than 12 weeks after the first day of the patient’s last menstrual period. Getting a larger fetus out involves breaking and extracting the fetus in parts, and most obstetricians don’t do enough of these procedures to feel comfortable or confident doing them.
May 28, 1998 | Read full article
"If he asks where she is, please say she’s in the hospital.”
Piece by Piece
After two months of rehabilitation, Myrna could walk short distances with her walker, but it became apparent by this time that she'd spend most of the rest of her life in a wheelchair. Meanwhile, her husband Ty, once a brilliant technical writer, had lost much of his memory. He had no idea what day or even what year it was. He did, however, take wonderful care of his wife, on whom he doted every minute.
June 25, 1998 | Read full article
Terry and Jim Eichel with baby. "I decided not to use gloves."
The First Human to Touch My Daughter’s Head
I exhorted Terry to push hard, pulled straight down on the baby’s head, avoiding the use of too much force and thereby coaxed out the anterior shoulder. I then pulled straight up to get the posterior shoulder out. Usually, the baby slides out without much effort once the shoulders are out, but mine didn’t. I had to grab under the armpits and pull, as though someone was holding my child in from the other side.
July 23, 1998 | Read full article
When I told him he had a four-centimeter-diameter cancer in his right lung, his immediate reaction was, “I’m worried about my parents.”
You Will Not Believe This Guy’s X-Ray
In most cases, symptoms start at about age 18, a time when society expects us to become independent. Performance in school and/or work declines as unrelenting thoughts ruin the schizophrenic’s ability to concentrate and distract him from his basic needs, particularly self-care. One of the reasons most of us do not have many schizophrenic friends is because when they are ill, they do not conform to our grooming standards. They do not bathe.
Sept. 10, 1998 | Read full article
A returned Peace Corps volunteer who spent her two Peace Corps years in Mali, Lisa was one of the best M.A.s we’ve ever had, but now she’s a second-year medical student at U.C. San Francisco.
The Bad Ones Get Fired
When she told me that she was working her last day, I felt so used and misunderstood that I struck my office’s wall with my open palm. I had seen her as a spiritual ally within the office who could see the big picture and use her youthful vision to help us fight to change it, and instead she left because “You all only care about money.” I felt terrible for hours and bad for weeks.
Oct. 15, 1998 | Read full article
“I’ve decided I don’t want to keep losing weight,” she told me.
Appetite Everywhere
Every week I work on her self-esteem. The fact that I, a man who she knows is busy, agree to see her every week helps. She has said to me many times that she expects me to give up on her, usually during visits where she has gained weight from the previous week. I can’t imagine giving up, but I do get frustrated, despite having learned not to depend on patients’ improvements for my own happiness and satisfaction.
May 13, 1999 | Read full article
She went home with that thrombus ready to break loose. Some time Christmas morning, her left ventricle pumped it into her aorta.
Was This My Fault?
“What happened?”
“She’s had a big stroke." I made a small effort to hide my hurt, but I could feel my body’s emotional gates gape open so that anyone could see inside.
Terry allowed me a few quiet seconds, then gave me an affectionate squeeze behind my shoulders. “Are you okay?"
My response, couched in quiet, hitter, adult tones, was childlike. “Not really. It’s not fair. It’s Christmas. She’s a really nice lady."
Aug. 12, 1999 | Read full article
“Please discuss this with your pastor,” I pleaded.
What Is the Name for This Collection of Events?
“God spoke to me last week and told me I was cured” was how she opened our conversation. “So I stopped taking all of my pills,” including the steroids she needed to keep her lupus quiet. My attempts to convince her to think of her medicines as God’s tools failed, so I did what I always do when I can’t help someone: I referred her. “Please discuss this with your pastor,” I pleaded.
Jan. 20, 2000 | Read full article
I mentioned my family’s intestinal woes, and Linda volunteered to give us her loperamide, a generic Canadian version of the medicine known as Imodium in the United States.
Travel Bug
The worker, a short Dominican fellow who looked to be about 45, came back with me from the gift shop into the room. He had an older relative with diabetes and believed this gave him the right to be our medical expert. “You should rub her feet,” he instructed in Spanish and began to demonstrate. Knowing that my mother-in-law was still alert enough to fear this level of courtesy, I repositioned myself between him and her toes.
Feb. 10, 2000 | Read full article
Should he sue me and, if not, should he continue to see me as a patient?
I Was Worried that Fred Might Never Wake Up
Given all of this, sleep was out of the question, so I went downstairs to let Terry go to bed. I turned on the TV and observed the talking heads reading me the 11 o’clock news, but of course I wasn’t interested. Some time passed, and I called the hospital. Fred had not awakened, but he had tolerated the procedure without complications and had stable vital signs. I took my dry mouth and aching abdomen upstairs and conked out.
Dec. 21, 2000 | Read full article
Environment of Mistrust
Most people in the United States believe that specialists are smarter than primary-care doctors, even though objective measurements such as standardized tests (e.g., SATs) and grade point averages) suggest the opposite. Most do not know that board-certified family physicians do a three-year residency to become specialists in common problems. When something appears serious, treatment from a family practitioner does not seem to be enough. I was prepared to go through this again over the phone with Veronica.
April 12, 2001 | Read full article
“For as long as he is here, we are his parents.”
I’m Not God
Exhausted, I turned my attention to Greta, who I remembered had much more right to be tired than I did. I pointed out to her what a remarkable effort she had just put forth to get a vaginal delivery, and she thanked me. I had nothing to do now but go home, so I said good night. Laurel intercepted me on the way out and gave me the warmest professional-to-professional hug I’ve ever had.
Aug. 30, 2001 | Read full article
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