The patient is a 61 yo M with a Hx of NIDDM, ASCAD, HBP, COPD and CHF who presents with chest pain radiating to his jaw and both arms for thirty minutes, accompanied by diaphoresis, SOB and nausea. PE shows bibasilar rales, generally regular rhythm with frequent ectopy, an S3 gallop, 2+ JVD, liver edge 10 cm below RCM, 2+ edema. EKG shows Q's V 1-4, STE V 3-6; CXR shows cardiomegaly and basilar congestion. Initial CPK and troponins are elevated…
and his wife is in the waiting roomterrified
and his children are on the wayworried
and his dog is at homeconfused
and his flowers are in their bedsgrowing
and, yes, he has a Living Will
and, yes, he would like a tissue
to wipe away his tears
About the poet:
Bill Toms was medical director at Dartmouth-Hitchcock Keene, a large group practice, for nine years, retiring in 2005. He now practices part-time, seeing homebound patients for his colleagues, and leads discussions regarding listening to patients at Dartmouth Medical School. "I have been fortunate to have been a family physician in New Hampshire for over thirty-five years. During this time I have tried to listen for the stories my patients tell, frequently without words. I have recorded some of these stories, primarily to honor the importance of their lives. It is probably the magic and the moment of their stories that allows them to be retold more easily in verse than prose."
About the poem:
"This is about a patient who enters our cold, sterile, abbreviated and deflated medical world and finds his warm, vital and sensate self left outside the ER. This story, like many, asks why. In recognizing a tear, the real history yearns to focus; if only 'tear' could be found in the Electronic Medical Record drop-down."
Judy Schaefer and Johanna Shapiro