Notes on Morphine by FW Peabody (1927)

Notes on Morphine by F.W. Peabody

Notes on the Effects of Morphine 
For full essay Download Notes on the Effects of Morphine
By Francis W. PeabodyFrom The Caring PhysicianThe Life of Dr. Francis W. PeabodyBy Oglesby Paul
The following unpublished essay is “[a]n example of how FWP, the scientist/physician, used his terminal illness to make clinical observations on himself with his description of his reactions to injections of morphine. This document was completed in October, 1927, five days before his death, and is an unique and vivid record of one patient’s response to the powerful narcotic.” This is an extraordinary essay. Why it was never published is a great mystery; but may lie in the fact that morphine and its derivatives are a much-maligned drugs.. Herein, we see how it allowed FWP to be lucid and function masterfully until the end.

Download Notes on the Effects of Morphine

My Three Livers

My Three Livers: how transplants gave me my life back

Photo from Ms. Walker's Twitter page

Patient Commentary by Erin Walker patient insight and involvement lead UCL Partners, London, UK.  Ms. Walker, now aged 36 has survived > 30 years post her first liver transplant. (BMJ, 3 March, 2019)

By the time Erin Walker turned 20 she was on her third liver, after a second transplant. Seventeen years on she reflects how organ donation has enabled her to experience many of life’s rites of passage.

The Full Article is well-worth reading.

A Mentor's Legacy

Through the Undulations of a Long Career — A Mentor’s Legacy is a moving tribute to her teacher by Ranjana Srivastava, a humanistic oncologist from Melbourne, Australia. 

I heard Ranjana speak a few years ago at a conference and was impressed. Since then, I've read a number of her moving essays in the NEJM. A friend from Australia got me a copy of her book, Dying for a Chat (not available in the U.S.).  This short 75 page volume starts by describing the case of a 90-year-old woman whose care went terribly wrong in a sophisticated Australian medical center. The experience led her to reflect upon medicine, especially about doctor-patient communication. The book is a gem, available only in Australia.

Through the Undulations of a Long Career — A Mentor’s Legacy, in the March 7, 2019 NEJM, will resonate with medical students, trainees, and practitioners at all stages of our careers.  The author visits a retired physician who had mentored her as a student and trainee.  “Students loved him because he wasn’t just erudite but also humane. His concern for and interest in the whole person were plain to see.”

Her declining mentor “was someone who was less interested in pointing out my shortcomings and fixing my defects than in helping me find my way. When I slowed down, he persevered. When I found my feet, he stepped into the background. As a result, I am a better person and a more contented physician.”

For those who don’t have access to the NEJM, I have placed a PDF online.

Pain in Girls is Being Dismissed

It is a common experience for young women. We have long known that women with some conditions are more likely than men to be under-treated for pain, and that doctors are more likely to dismiss reports of illness as psychosomatic when they come from women. Now, a recent study from Yale researchers shows how early this gender bias starts. The study found that when adult participants were asked to rate the perceived pain of a child receiving a finger prick to draw blood, they attributed more pain to the child they thought was a boy than they did to the child they thought was a girl.

This is from “Why Are We Still Dismissing Girls’ Pain?” an Op-Ed piece in the February 18, 2019, NY Times by Laurie Edwards. 

Also see Cell2Soul Statistics of Sexual Violence.

The Informed Patient

by Helen Salisbury, BMJ February 2019

Admittedly, there are risks for patients who use the internet for health information: searches about the most innocuous of symptoms can lead down a terrifying rabbit hole to a terminal diagnosis within minutes However, there are many reliable and balanced sources of information, and people increasingly seem to be able to find them.

Dr. Salisbury feels that “as doctors it’s imperative that we find a way to ask our patients, ‘What have you found out so far?’”  This way we can learn from them and when necessary dispel false, frightening information.

This short piece is pregnant with meaning.  Full Text.

The Luneberg Sign

In 2003, a colleague lamented to me that her daughter had recently gotten a tattoo.  My friend said, “The only thing a tattoo qualifies her for is a job where she asks the customer, ‘Do you want fries with that?’”  I had been interested in tattoos for years and her comments did not resonate with me, so I decided to survey consecutive patients with tattoos and ask them what their ink meant to them.  Over a period of a few months, I collected 50 sequential patients.  With their permission, I photographed their tattoos. (No one declined to have a photograph taken!) In the process, I learned that many (not all) tattoos have special meaning for the patients I saw.  Often, their explanations gave me insight into the person before me.

The images of my patients are on Google Photos.  If you would like to see them, please email DJ Elpern and I’ll send you the link.

Permanent Ink, an recent essay in JAMA's “A Piece of My Mind,” is a reflective piece on patients' tattoos by Paige Lunenberg, an internist from Baltimore.  It resonated with me, and some of you may find it inspirational as well. 

See: Paige Luneburg, MD Permanent Ink

JAMA. 2019;321(6):545-546. Free Full Text.

It begins:

Over the years, I have developed a fascination with patients’ tattoos. I make a habit of asking about them. My team often jokes with me; I imagine them sitting in the conference room before morning rounds, telling each other, “Make sure you mention his tattoo. That’s her thing.” All attendings have quirks, and I guess a fascination with body art has become mine. One intern went so far as to eponymously brand novel information gleaned from a tattoo, “The Luneburg sign.” We all laughed, especially me.

I saw this patient in 2003 with a dragonfly tattoo on her lower back.  When I asked its significance, she told me that a few years earlier her sister had died.  At the funeral, a dragonfly landed on the coffin. She got this tattoo to commemorate her mother and that event. DJE

The Graphic Medical Student

Annals of Internal Medicine: Graphic Medicine     

Annals Graphic Medicine (http://annals.org/graphicmedicine) brings together original graphic narratives, comics, animation, and other creative forms by those who provide or receive health care. They address medically relevant topics—be they poignant, thought-provoking, or just plain entertaining. These are (for the present at least) available from The Annals free and open access.

The popularity of Annals Graphic Medicine has prompted The Editors to include it regular monthly column. 

In the February 5, 2019 Issue, there’s a fine graphic narrative called, “The Medical Student.”

For more about Graphic Medicine. see: the Graphic Medicine website. "Comics are “not just for kids.”  Over the past decade this underrated medium has begun to receive recognition and acclaim from literary critics, academics, and broadsheet reviewers. Thanks in part to the medical humanities movement many medical schools now have students read classic literature or modern novels to gain insight into the human condition. It is high time that graphic fiction is taken as seriously: comics, graphic novels, and graphic narratives are great resource for health professionals, trainees, students and the public.