Resident Physician Contributing Writer
Melissa Palma is an Iowa-raised daughter of Filipino immigrants and aesculapian advocate. She trained in family medicine at safety-net community health centers and is a board-certified Preventive Medicine and Public Health physician in Chicago, IL. Her writing reflects on the privileges and responsibilities we have as physicians to advance health equity for our patients and our communities. When not in clinic, you can find her reading non-fiction while nursing a taro boba tea.
Ana sits on the exam table in front of me explaining how, in three short weeks, her mother will evict her from her childhood home. She is eight months pregnant and is studying night courses to become a paralegal. As her prenatal provider and primary care physician, I have been sending referrals to numerous community agencies in hopes of securing housing at the local YWCA.
Health and wellness are more than a simple product of access and initiative, as such a simplified formula is only enjoyed by a very small minority. The equation becomes more complicated as new factors enter, such as unemployment or housing insecurity. Despite their importance as determinants of health, such elements are seldom addressed in the medical interaction between patient and physician, and are thus discarded in the interest of a perceived efficiency.
As a child of immigrant parents, I had limited exposure to the American military. Ironically, my sole memory of the American military exists outside of America — in Japan. I spent part of my childhood in Tokyo and fondly recall the excitement that came from visiting the American Naval Base in Yokosuka to buy “American groceries,” specifically Eggo waffles.
“Direct Admit: bounceback 72M recurrent pleural effusion, new diplopia,” my pager beeped with our new admission. As a “bounceback” admission, this 72-year-old male would be returning to our service after recently discharging from the hospital. This type of admission often indicates that a problem recurred or an issue was not fully addressed during the most recent hospitalization.
As I contemplate the future of our country, the future of medicine and the future of reproductive health and justice, I am truly frightened of what is to come. Since our president appears to base his desires on what makes him popular, I fear that he will gut Planned Parenthood, turn over Roe v Wade, and make it even more difficult for women to afford and access care, all in the name of ego.
We are in the thick of winter and URI season is upon us. Since a few of the older providers have been out for the holidays, I have been seeing their patients for same-day sick visits. It can get tedious after a morning of telling patients why I’m not giving them antibiotics. And very easily, one can fall into a “well bias” trap where you assume everyone is fine.
I remember ranting to a friend one night about the terminology, lingo and semantics that run through medicine. When I started studying medicine, I found the language fascinating. Most physicians seem to appreciate the language of medicine because truly understanding it is proof that after years of studying, working, and putting nose to grindstone, you made it in to the exclusive club that utilizes this jargon.
The novelty of becoming an intern has worn off, the fresh sheen of excitement on each shift, the crampy belly pain as I walk into a critical patient’s room, the rush of adrenaline as I try to intervene on a patient slowly or rapidly dying in front of me. Get up, go work, and sleep. And not much more.
The first time I performed CPR — that is, literally kept a human alive by the very force of my hands — I was a third-year medical student. In other words, I was a book-smart twenty-something with two years of multiple-choice medical knowledge and a single four-hour course on ACLS under my belt.
You’ve seen Mr. H before. He comes in occasionally, usually at the end of the month, when his Social Security money runs out. He’s homeless, has no family to speak of, and his success in the community is tenuous, effectively measured by how many dollars of disability money he has saved.
The message, like all earth-shattering pronouncements, came with the softest of dings. As I was walking out from my house into the cold December air for a morning shift in the emergency department, my parents messaged me about the passing of my grandfather.
Double-booking. Concurrent surgery. Procedural overlap. However it is named, the once clandestine practice is now under public scrutiny.
Resident Physician Contributing Writer
Columbia University
Dr. Laratta is currently one of the chief residents at the Columbia University Department of Orthopaedic Surgery in New York City. He completed his undergraduate education at the University of Michigan - Ann Arbor, where he graduated with highest distinction. He continued onto medical school in his home state of New Jersey at Rutgers University New Jersey Medical School, where he finished in the top 5% of his class. In the upcoming year, Dr. Laratta will begin his fellowship training in Neurosurgical and Orthopaedic Spine Surgery at the Norton Leatherman Spine Center in Louisville, KY.
