Tuesday, May 6, 2008

A different approach to assessment: poetry

I had the good fortune to meet Paul Liebow, MD last May at an EMS week dinner. He is a passionate and committed physician and a very interesting man. He gives much to EMS.

In one of our subsequent conversations on books, photos and writing he offered to send me some poetry he has written. I'd like to share some of his work with you.

Just Listen to the Patient

In five minutes you will either know
What’s probably wrong or you may
Later that day, or you won’t.

Listen to Death whispering as it
Tiptoes in behind the woman
Who pushes the huge, protesting
[Too much!] man through
The hissing ED doors.

“I’ve got chest pain but its not my heart!”
So we coded him for two hours-
Every drug by every route
Know to medical science-,
Shocked him over and over.
He walked out of the hospital
Two weeks later.

“I’ve go the same thing my brother had”-
And eight other brothers-
All pipefitters in The Great War
Who chain-smoked Camels
The Army gave out as “rations”.

“You can do anything you want to me-
Treat me with anything you like-
Just don’t tell me I have cancer!”
She did and we did just as she said-
She died at Peace- her family beside her.
Of course they all knew.

“He was fine last week”
The whole re-united family agreed-
Though the poor shriveled up man
Had laid mumbling and contracted
For years in the fetal position.

“I know she just has a headache,
A little fever, and a beautiful smile-
But her sister had meningitis
When she was little”

If you see a mile long list of symptoms,
Tests, and specialists, and they’re now
“Here to find out what’s really wrong”-
You won’t ever know
Unless you immediately do.
And if you let them know they’re O.K.
Be ready for the complaint-
“The Dr. didn’t care about me-
The Dr. wouldn’t listen to me”

But if they are “never sick”-
With even the strangest complaint-
You had better be
Very, very sure it’s nothing-
Before you just write a prescription.
“I feel like my head is going to fall off!!”-
Because the rheumatoid arthritis has
Eaten away their odontoid process-
The last little bone between the
Cervical spine and the base of the skull”

“I’ve been on the Internet-
And I know I have “---”
Take them very seriously-
Get the best scientific article you can.
Give it to them, and they’ll be happy
Whether they do or don’t have it-
With a good referral
And a few simple tests.

In five minutes you should know:
“Live or die”
“Sick or well??”
“Admit or send home??”
“STAT tests or refer now??”
“Will I know before they leave the ED?”

It will still take an hour
To ask all the other questions,
Look and listen, feel and smell-
Answer all the phone calls,
Do all the paperwork,
See all the results.
But you won’t be disappointed-
And neither will they.

Thank you, Dr. Liebow

No comments: