Practicing Medicine by Ear

December 15, 2015

My grandmother was an aspiring mezzo-soprano opera singer in Italy before World War II. After the German Army was driven out of Naples, she met and later married an American GI, settling down in central Maine, where they started a family. Like many of the immigrants in the area, my grandparents worked in the local mills making everything from shoes to blankets. My grandmother never gave up singing and was renowned for stunning her coworkers with renditions of classic arias that rose above the rhythmic chatter of sewing machines and looms. I have rich memories from my childhood of Sundays with my Nonna. We would make fresh pasta and sauce together and her booming voice would saturate the kitchen with the melodies of her youth.

By comparison, my own musical career got off to a less impressive start. At times I “played” the piano, violin and even the recorder, all with little success. Then, quite by accident, I discovered vocal music. I had always liked theater, and when they needed singers for the school musical, I was cast in the show. From then on I was a singer, eventually landing a coveted spot in a summer supergroup of some of the best college a cappella singers in country. I accomplished all of this without formal vocal training or expertise in music theory. A childhood surrounded by musicians resulted in my learning to sing by ear. Without being able to read music, I could tell you what the next note would be because I knew which note “fit” the chord.

Looking back, my approach to clinical medicine in the emergency department, mirrored my early days in music: I practiced medicine by Read the rest of this entry »

2 Comments | Creating Dialogue, Decision-making | Permalink
Posted by Nadine T Himelfarb

A Journey to Kale and Quinoa

December 7, 2015

Michael, a man in his late fifties, presented to my emergency department with left-sided arm and leg weakness suggesting a stroke. The symptoms began the night before, but he was still able to walk. He got himself to bed, neglecting to mention anything to his wife Dana. The next morning, he woke with a headache and his weakness had worsened. He was no longer able to escape his wife’s attention. On presentation, his blood pressure was markedly elevated at 207/112. His exam demonstrated mild left arm and leg weakness and subtle sensory changes. His workup was normal except a head and neck CT angiogram with scattered atherosclerotic disease, with no stenosis or brain ischemia. An aspirin was given and his blood pressure managed.

Michael had only visited with a physician twice in twelve years. His misconception of health as the absence of a named disease led him to avoid doctors. He, like so many of our patients, had central obesity, the result of a typical American diet and lack of exercise. He admitted to stress related to work. I learned weeks later that the source of much of his stress ran layers deep.

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Posted by Nadine T Himelfarb