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David Elpern
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This classic article was handed to me in 1976 when I started my residency in dermatology at Johns Hopkins. It has been helpful many times over the years and is pertinent to survival in academia, medicine and many other situations in life. V. Cousteau is a pseudonym. The author was... Continue reading
Posted Dec 3, 2016 at Medical Keepers
by Sébastien Moine, BMJ 2016; 355 (Published 28 November 2016) Mapping the territory of human suffering with only clinical tools, diagnostic tests, and biomedical concepts is difficult, if not impossible.1 Or to say it differently, it doesn’t seem easy, or reasonable, to answer the questions of how to live a... Continue reading
Posted Dec 3, 2016 at Medical Keepers
by Sébastien Moine, BMJ 2016; 355 (Published 28 November 2016) Mapping the territory of human suffering with only clinical tools, diagnostic tests, and biomedical concepts is difficult, if not impossible.1 Or to say it differently, it doesn’t seem easy, or reasonable, to answer the questions of how to live a... Continue reading
Posted Dec 3, 2016 at Medical Keepers
From Bonnie M. "Dr. Elpern, Just to let you know I had a similar experience when I was at UMass Medical in Worcester for a week. The doctors are very good but have so many patients that they do not have a lot of time to be with you. There was an amazing lady who brought the food and happiness to me. Being from Africa her children are going to high school or college in Africa she smiled all of the time. She talked to them on the phone. She has been working hard to make a better life. She continued to talk to me more and more eventually telling me she had lived on the street for awhile and still smiling. She visited each day for a while showing happiness which helped me through the many days there."
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From Richard Ratzan: alan was a gentle and caring soul but not wishy washy. he was a good friend over the years and we enjoyed talking. he embodied living the spiritually brave life. i liked cecily too
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From Sandra Bertman: Oh my--a dear voice from the long ago past. Thank you David. His gentleness, egoless presence was so obvious --always. I recall meeting Cicely. Wish I could find some of that old correspondence and/or somehow stayed in touch. After Florence Wald died and Morris Wessel (?) I lost touch with that wonderful group. Just read Alan's obit. I'll forward it to Sally Bailey who has moved South.
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from Samuel Abady, Esq: "Such experiments mirrored Nazi medical experimentation on helpless test subjects at Buchenwald, Dachau, Natzweiler, and Ravensbrück; the less well known but equally horrid Japanese Unit 731 medical experiments during World War II; and the Tuskegee syphilis study conducted between 1932 and 1972. These are discussed in Jonathan D. Moreno, Undue Risk: Secret State Experiments on Humans (2000). The government’s report on the infamous Tuskegee study is here: http://biotech.law.lsu.edu/cphl/history/reports/tuskegee/tuskegee.htm [Pub. Health Serv., U.S. Dep't of Health, Educ. & Welfare, Final Report of the Tuskegee Syphilis Study Ad Hoc Advisory Panel (1973)]. In 1966, Article 7 of the International Covenant on Civil and Political Rights stated, “no one shall be subjected without his free consent to medical or scientific experimentation.” [G.A. Res. 2200 (XXI), U.N. Doc. A/6316 (Dec. 16, 1966)]. But is mere “free consent” sufficient? Prof. Jay Katz at Yale Law School thinks not. I bet you’ll appreciate his discussion of the subject in the attached law review article.
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A physician reader wrote: "powerful post, one person who trained around my time and did a laser fellowship recently told me, forget lasers, im starting to speak for psoriasis companies, they pay the big bucks. go figure!"
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This, the last collection of poems by George Bascom, was published in 1993, the year of his death. We have selected those poems of interest to those readers interested in health care and the human condition. Title Page Gloria 3 Operation 6 I With My Death 9 Notice 13 Post... Continue reading
Posted May 22, 2014 at George Bascom - Surgeon/Poet
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I think it was Richard Caplan, an Iowa dermatologist, who introduced me to the writings of George Bascom in 1992 or 1993. I wrote to Dr. Bascom, and received a nice card in reply. He was in the last stages of his struggle with metastatic prostate disease. In the photos,... Continue reading
Posted May 21, 2014 at George Bascom - Surgeon/Poet
The great auditorium was cool and quiet. The speaker, a silver haired surgeon in his sixties, professor and chairman of his department, leaned with one elbow on the podium and with a pointer indicated on the huge projection of his slide the point at which the pancreatic duct entered the... Continue reading
Posted May 20, 2014 at George Bascom - Surgeon/Poet
George S. Bascom, M.D. (1927 – 1993) Dr. Bascom wrote, “I first heard the music in Shakespeare in a dark auditorium in Topeka (Kansas) as a high school student, first wrote a little poem as a grade schooler, but began to work at it more or less seriously as a... Continue reading
Posted May 20, 2014 at George Bascom - Surgeon/Poet
by Dylan Thomas Never until the mankind making Bird beast and flower Fathering and all humbling darkness Tells with silence the last light breaking And the still hour Is come of the sea tumbling in harness And I must enter again the round Zion of the water bead And the... Continue reading
Posted Mar 10, 2014 at Heaven's Door
I just came across this quote: "Perfect does not mean perfect actions in a perfect world, but appropriate actions in an imperfect one. R.H. Blyth. Dilatation and Evacuation can be a necessary and appropriate action for a tragic situation.
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The idea is to get a few cognoscenti together to read important (usually new) books about medicine and life. Hopefully, we'll be able to attract a minyan to share insights and points of view from diverse backgrounds - sharing a common interest in what lies between the Cell and the... Continue reading
Posted Jan 20, 2013 at Oslerian Online Book Club
from Marla Lukofsky: "How to Die in Oregon is an amazing documentary David and I thoroughly support the right to die with dignity. I hope it passes in Mass. I wish it would exist here in Canada but it does not. Not even close. To me it is insane to make someone suffer if they don't want to. I never understood why we humans are far more compassionate to animals than humans. There is no reasoning. I can't wait to read this issue of the suicide story. I have had 3 friends now take their own lives and it is a sensitive and complicated topic for me. I even wrote a piece on it called 'No Stone Unturned'. It actually understands and supports the thought and action of suicide but only if every stone has been turned over and examined. I don't believe that people should suffer mentally either. But that is another story and hardly a view that is accepted. As far as Oregon is concerned, I am glad that I have my dual citizenship and if need be, I could move to Oregon, become a resident again, and then have some dignity, should I choose to die due to a hopeless disease. Though I would much rather it be Los Angeles as a place to die. I love LA." Fondly, Marla Lukofsky
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from Marla Lukofsky (Toronto): This is so fantastic and so important. To have yet another doctor who believes in being a real human being with their patients and trusting that it won't be damaging the medical professional but rather more healing to them and the patient. It's time for that old school thought to move over and let empathy and compassion take over, even if it's hard for the doctor to do that. If it's hard for them, just imagine how hard it is for the patient not to receive such warmth and caring care. I would like to think that my one hour speech of my cancer journey does the same thing. I only wish I could speak more often and to medical professionals in particular.
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from Wild Bill, Dr. K: I agree with Rob Norman's musing... Seeing pts often feels like great improv. We can think we can prepare and structure visits to a certain extent but we never really know what the pt is going to say next and what their reaction may be to what we communicate. Keeps it interesting though, eh? Lights, camara...ACTION!!, Dr. Kober(not his real name)
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by David Elpern Feet of woman with Clouston's Disease Abstract: The Orphan Patient (OP) was first described by Walter and Dorinda Shelley in 1988. Herein, we describe a number of categories of OPs and discuss the importance of adopting them in our clinical practices. Download Orphan Patient. Walter and Dorinda... Continue reading
Posted Aug 5, 2012 at OJCPCD Archives
by David Elpern Abstract: A dermatologic visit can be a window of opportunity. We recently saw a 12 year-old girl for an atrophic alopecic area of the scalp. Discoid lupus and excoriation were in the differential diagnosis. It turned out that this child had been the victim of bullying at... Continue reading
Posted Aug 5, 2012 at OJCPCD Archives
from Bill Zeckhausen: "Carolyn Crosby, a brilliant and conscientious sensitive palliative care physician, hospice director, and family practice doc gave the talk to clergy and several other caregivers that is the same theme as Potyk's piece. Another version of: "Caring for the patient means caring for the patient." Her talk was about hearing the patient, getting to know them, and she contrasted that with those physicians committed to keeping the patient from dying, without relating to and getting to know the patient and what they need and want. She added that palliative care proves in some cases help the patient get better and/or live longer then a procedure limited to fixing wth drugs or surgery. Reminds me of the ending of Jane's talk to the pre-meds at Williams college..."Lastly I can remind the medical community that those with disease have faces, voices, families, hopes, joys, fears and a need to be treated with compassion and respect. I am not just a body with disease. I am a spirit about to fly." She was preaching to the choir. I asked her if there was some way to require physicians to listen to talks such as she was giving. She said it didn't seem it would happen. Of 80 plus staff who show up for Schwartz Rounds, there may be 2 or 3 physicians who attend."
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from Michael Symons: "This story had resonance with me. As a Hospice volunteer, I am on the opposite side of this picture. Our job is primarily to get to know the patient as a person - his medical statistics are secondary. What a wonderful teaching story for all those in the medical field."
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from Charles Hardy: "In 1915, the NY Times reported that Charles Hardy had arrived from London and had transferred his business to 50 Church Street, New York. He was a specialist in mining, winning, and using tungsten. In 1918, he received a letter addressed only to "Charles Hardy, Tungsten, USA". Try that today. When I was five years old, a Macy's delivery truck (from next door to Gimbel's, where we also shopped) backed down our driveway and tapped our Model T station wagon, reducing it to a heap of yellow wood that looked like kindling. I haven't forgotten the electric delivery wagons with their solid-rubber tires and hand-operated Klaxon horn to energize the slow horse ahead. Thanks, as Bing used to sing, for the memories." Charles
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from Ned Sahin: "That sky photo bespeaks or instability and stability; chaos and order. The upper atmosphere air is clearly stable enough that the vapor trains remain behind for so long and one can see so many at a time (fully unstable air erases them immediately) and yet they been spread apart, picked apart, and scrambled in odd patterns. Likewise, there are chaotic patterns especially where the trails seem to cross (though the planes that left them likely passed near each other neither in time nor place), yet there is a pleasing order to the ripples and stripes: they couldn't be predicted per se (thus chaos) yet they can be described quite simply (alike ringing in Fourier space) due to their repetition in similar patterns and with similar spatial frequency."
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from Charles Hardy: A minor role I am proud of had me working with Kaiser-Permanente Medical Methods Research Unit in the early 60s when a study of traffic in the Howe Street Clinic suggested that a skilled nurse installed as "gate keeper" could direct clients to appropriate services. The waiting time dropped from a mean near thirty minutes to seven. This led the brilliant Henry J to advocate and support the concept of a "Nurse Practitioner" in K- P's nursing school -- the title hoping for prescribing power, not yet obtained. Charles
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