Cases and Stories

The narratives in medicine

by Suzanne Koven, M.D.

A New Year's Resolution: One Year Later

New Year's Resolutions, like bridesmaids' dresses, fruitcake, and mothers-in-law, get a bad rap. Okay, they often don't work out (though, come to think of it, I adored my mother-in-law and she made a dynamite fruitcake) but sometimes they do. Read More

Politics in the Exam Room

I had always liked my patient Gertrude. A woman in her 60s who had been widowed young, she ran her own business and traveled the world. She seemed to me a model of how to age well: independent, engaged, active, feisty. We always enjoyed good conversation-about books, art, and life--when she visited my office. Read More

Two Kinds of Depression?

I'm no psychiatrist, but it was pretty clear to me that Jack was depressed. Over the past few months the sixty five year-old man had become withdrawn, irritable, had lost his appetite and had dropped fifteen pounds. I got this information from his wife, Connie, because at his first visit to my internal medicine practice Jack barely spoke and sat staring down at his hands. Read More

The Un-Nesting Instinct

Celia's story started out sounding pretty familiar-a cliché almost. She was fiftyish and going through menopause and, in addition to the weight gain and hot flashes, she found herself irritable and sad. Her children, she told me, were a particular source of sadness. "You mean because they're growing up, moving away?" I asked. Read More

A Death by Any Other Name

Is language important in medicine? Read More

Do People Decide When to Die?

No, I am not talking about people who commit suicide or wish to be euthanized. I'm talking about people like my patient. Joe (as usual I've changed the names and identifying details). Joe was eighty-five and suffering from Alzheimer's Disease. Read More

Post Illness Stress Syndrome?

When I walked into the exam room it was clear that Cindy, a usually cheerful and easygoing patient of mine in her forties, was very upset. She'd had some vague lower abdominal pains that came and went and her menstrual periods were irregular. These aren't uncommon symptoms in a perimenopausal woman and nothing in Cindy's description of how she felt physically explained her tears and trembling. Read More

What an Effective New Year's Resolution Looks Like

I'd like to introduce you to "Bill," a patient of mine who has the distinction of being one of the only people I know who has used New Year's resolutions successfully to transform his health and life. His secret? Read More

I'm Getting Bossy About Flu Shots

My patients will tell you that I am pretty laissez faire as doctors go. I have enough respect for people's ability to make good decisions about their own lives and enough humility about the limits of medical certainty to support my patients' choices- even when they choose not to follow my recommendations. Read More

Is It Ever Okay to Be Unhappy?

My patient Jim, as I’ll call him, fears that he’s about to lose his job, though he actually hates his job and dreads keeping it almost as much as losing it. Thirty five years old with a pregnant wife and two year old son at home, Jim feels anxious, sleeps poorly, suffers from stomach pains and frequent headaches. Plus, his two-year old is an obstinate terror and Jim had not been nearly as eager as his wife to have another child. Jim comes to my office not so much to discuss these problems but to ask me whether I can prescribe something to calm him down. Read More

A Victim of Swine Flu: A Doctor's Sense of Invulnerability

My medical colleagues are very busy people, too busy to bother with italics (or even much punctuation) in e-mails, so I knew something was seriously wrong when a physician who happens to be my patient wrote to tell me that "something bad...something really, really bad" had happened to him. Read More

Hypochondriacs Get Sick,Too

Jerry insisted his eyes were yellow, but they didn't appear yellow to me. I moved in for a closer look. Fluorescent lights like those in the office where I practice internal medicine can make subtle jaundice, a sign of liver disease, difficult to detect. No, his sclerae were as white as mine and, as usual, Jerry seemed to have absolutely wrong with him. Read More

My Mother, My Weight

My patient--I'll call her Amy--was heavy. Her mother, Sybil, also my patient, was thin. At Amy's visits to my office we always discussed her weight. At Sybil's visits Amy's weight also came up frequently. Read More

He Said/She Didn't

I was new in practice. They were young - even younger than I. Yet they seemed as attached to one another as a much older couple. Read More

Mrs. O'Malley Isn't Dying Just Yet

New patients usually come to my internal medicine practice for one of three reasons: they’re unhappy with their previous doctor, they’ve outgrown their pediatrician, or they’re new in town. Of these three, only the last gives me no trepidation. Unhappy patients may become unhappy with me, after all, and eighteen year olds frequently arrive attached to anxious parents. Read More

A Case... and a Story

My first "patient" was a big and kindly man named Ronald Blake. I put "patient" in quotation marks because I met Mr. Blake when I was a first year medical student, with neither the skills nor experience to offer him any medical help whatsoever. In fact, Mr. Blake was enlisted to help me. Read More