Scott is sitting in the corner of the kitchen, feeding baby Antonina freshly pumped breastmilk since I am busy cooking. His voice is a little raspy and his hands are clumsy because he is on day 2 of Folfox cycle #6.

More about an unexpected juxtaposition here.

The Ten Commandments of Sensible Health

My mother was a domestic worker. My father worked for Bethl’m Steel. Neither of them had any insurance. He died and they got insurance. Three thousand dollars. Eighty eight dollars a month for her and the kids. She didn’t get any Social Security because of who she worked for. Three kids! Imagine if they had gotten sick. They never got sick. We never got sick! I think everyone should get health insurance. Why don’t they want them to get health insurance?”Bethlehem Steel Mill

“They don’t like poor people.”

“It’s not their fault! I think everyone should have it.”

“I saw Selma. It was a great movie. I had four kids then. I couldn’t get up and go to protests. I saw Obama when he spoke to our church group. I didn’t think he was going to be president. I never thought a black man could be president.”

Uncertainty is a common experience in health care. For an upcoming book and ongoing research project, I want to be in contact with patients, families, and caregivers to learn their strategies for approaching, dealing with, and understanding such uncertainty.L0074969 All in search of health should wear Harness'

For example, Ms. A. has back pain unaccompanied by underlying serious disease. She has no way of knowing whether it will go away in weeks, months, or not at all. She wants an MRI, which accepted evidence indicates will neither aid in treating her pain nor reassure her.

On the one hand, both she and the healthcare provider would like to do “something” as a sign of care; on the other hand, we want to harm neither Ms. A (with tests/procedures that won’t work), nor society (afflicted by a health care system which costs too much, delivers poor care in comparison to other systems, and treats people unequally).

There are many scenarios in which treatment is pursued despite evidence showing it does not work more than placebo. For example, hormone treatment in the patient with local (not metastatic) prostate cancer; repeated CT scans for thyroid nodules without symptoms; treatment of ductal carcinoma in situ (DCIS), mammograms in a patient without significant family history more often than every two years.

How do you as a patient, family member, or caregiver seek the best care in such a situation, where things are uncertain and more tests/procedures might not work? What strategies do you use? What should healthcare providers do? Please be in touch with me to help guide this work. zberger1 at jhmi dot edu

See the presentation below for another depiction of the problem.

How Do You Deal With Uncertainty In Healthcare? from Zackary Berger


This week, I covered for one of the chief residents. I was the attending physician for about 25 patients in the hospital during the space of a few days. On one of those days, I still had scheduled my regular outpatient clinic; the entire day became a way to experience the contradictions inherent in the practice of medicine, crossing the street again and again between the hospital and my clinic like a shuttle on a loom.

How many contradictions, or rather, pairings that we see as contradictions, confronted me with each patient I saw, comparing in my mind the medicine I practice every day in clinic with the kind of health care delivered in our hospitals!images

  • Providing each person the care that works for her uniquely, while uniformly assuring best practices for safety to hundreds of patients at a time.
    Getting the tests and treatments that are needed as fast as possible, while deliberating appropriately on the evidence base of every intervention.
    Treating pain — but acknowledging the dangers of opiate addiction.
    Enabling the patient to make decisions, while recognizing they need the support of a treatment team in an alienating and scary environment.
    Discharging as soon as medically possible, while aiding the patient in their convalescence.
    Hewing to principles of safety and organizational efficiency, while being unafraid to venture out of the box when changed situations demand it.

How can we treat patients while on the very knife-edge of these contradictions? Treating both inpatients and outpatients makes me more sensitive to the edge, but I’m not sure I can dance any better….yet.

Here’s another poem I am reading this Saturday at Beth Am Synagogue, but this one is a translation from the Yiddish (original here).2879762-2-lotus-throne-mandala-om-mani-padme-hum

by Yermiye Hesheles

You glimpse once
among time’s leaves:
a pressed flower
Its kind long ago
its perfume
bilions of years distant.

If you sense the flower’s
deeper avatar —
it’s no longer silent.
It’s an avatar
of God’s.

And you call out:
Om mani padme Hum!

Here is a poem I will be reading aloud this Saturday at Beth Am Synagogue in Baltimore, prompted by our rabbi to think about the topic of return.index

The Ingathereds

Even mistakes do what they can
bringing the most of themselves
to the failure fair.

A sweet grimace of misunderstanding
slips from error to error.

An unexploded sun fumbles at the earth with thick rays.

Under a millstone, a mud-swaddled mushroom
ponders its toxin, deeply felt legacy.
Turning, a moon faces its mother
with the homey side, its poxy jewels.

“The title of the book, One Nation Taken Out of Another, really comes in the form of a question, and this highlights a significant stylistic aspect of Berger’s poems. The question mark gets a heavy workout in these pages. Whether it’s in dialogue (“Vos iz mitn goyish? I say. What’s with the goyish? Speak Yiddish like we do at home.”), the poet speaking to one of his characters (“Nachshon, need a shower?/Nachshon, foxy fish down there, huh?/Nachshon, one small step for man?” – “Hagode shel Peysekh”), a riddle asked of himself or the reader (“How do you English a Yiddish nation?”), the effect is to put the reader on the spot, get him/her involved.”

A nice review, by Charles Rammelkamp, here.

Check out the new issue of Happiness Poetry, the best free one-page broadsheet in Worcester, Mass. My poem about Noah is on the upper right. To see the poem in its natural habitat, check out the Kindle version of One Nation Taken Out of Another – for only $3.99!

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