Laughing Sherpa by Dr Miriam Korn, MD

Simple Tasty Treats

Mia Korn — Thu, 25 Dec 2014 06:16:00 +0000

SWEET

Banana Ice Cream

Cut two bananas into one inch pieces.

Freeze them for a few hours, until solid.

Take out of freezer and put pieces into food processor.

Blend until banana forms smooth “ice cream”.

Makes 4 servings.

Chocolate Mousse

Put

one peeled medium banana

one peeled /pitted medium avocado

into a food processor.

Add:

1/4 cup cocoa,

1/4 cup maple syrup

1/4 tsp vanilla

2 tbsp strong coffee
1/4 cup almond milk

dash of salt

Blend.

Add sweetener or

cocoa to taste.

Blend again.

Makes 4 servings.

Serve in wine glasses
and sprinkle cacoa nibs on top

Fig n’ Nut

Soak overnight :

1/2 cup almonds

4 figs

Put both in food processor.

Blend in pulses to create

coarse mixture of fig and almond pieces.

Makes 4 servings.

Serve above :

individually

“ice cream” with

“fig n’ nut” then

“mousse” on top

any combo of 2

SAVOURY

Almond Butter Dip

Combine in a small bowl :

2 tbsp smooth almond butter

1 tbsp flax seed oil

1 tsp Braggs or tamari

1 tsp apple cider vinegar

1 tbsp water

Mix with fork until smooth.

Dip for fresh cut vegetables

Veggie Feast

Add another 1 tbsp of water to

Almond Butter Dip

and warm in saucepan.

Drizzle over steamed vegetables,

atop a bowl of tofu and brown rice.

Top with sprouts.

Almond Delight

Soak overnight:

1/2 cup almonds

Put in food processor, without water

Add

1/2 cup fresh dill

1/2 cup fresh parsley

1 tbsp flax seed oil

dash sea salt

Blend to create coarse mixture of almonds and herbs.

Put 2 tbsp on a romaine lettuce leaf.

Top with 2 tsp of Almond Butter Dip.

Makes 4 servings.

The post Simple Tasty Treats appeared first on Laughing Sherpa by Dr Miriam Korn, MD.

ICU story

Mia Korn — Sun, 14 Dec 2014 21:19:00 +0000

Rites of Passage

ID: 50 year old man with hairy cell leukemia
transferred to ICU for treatment of pneumonia.

Lives with wife and two daughters. Works as CEO of bank.

Mr. Goshen is wheeled into the Intensive Care Unit. His skeletal body is encased in thin yellowish skin, draped with white sheets. With him is a balding white-coated man and his bearded colleague, wearing a white shirt, blue tie, jeans and pointy cowboy boots. As the nurse moves the stretcher to a corner, they approach our white-coated entourage during our morning rounds. The resident’s recitation of numbers describing bed number two’s bodily functions is aborted, “We need to talk about Andrew Goshen.”

Our little circle breaks as we turn to exit single file, into a dingy space of pink vinyl sofas. “Family Room” says the sign outside.

So far, working at the ICU has been okay. Each day, I visit my assigned patient, an eighty year old, white haired woman who is having a hard time weaning off a respirator. She still needs a tube down her throat and taped to her lips, to help her breath. I do my head-to-toe medical student exam each day, then record digits in various tables. I ask her questions. She nods her head or blinks her eyes.

Before her, I’ve monitored less interactive patients. A jaundiced man in his fifties, withering away and swelling up due to hepatitis; a twenty year old,
HIV positive, heroine addict rescued from a house fire, his body mottled with
“cherry red” lesions of carbon monoxide poisoning.

Each morning I arrive at the ICU to see what type of cookies the nurses have left in the staff room and which beds are surrounded by a curtain. Soon uniformed men show up, go behind the curtain, emerging to wheel away a gurney transporting a long white zippered plastic bag, like a tarp-covered log.

* *

“How was your day?” asks my father at dinner. My parents are visiting from Toronto this week.

“Okay,” I reply. “Interesting.”

“What did you do?” inquires my mother.

* *

In the Family Room, we take our places around two fatigued-looking women on the sofa. One has her hand on the other’s shoulder, face turned to whisper to her couch-mate’s bowed head. Dr. Lindsey, the balding one, sits in a chair next to her, with a worried frown.

My attending, Dr. Hardy, is next to him, The young “team”, is scattered about the room, standing beside and behind furniture. I am leaning against the doorpost. The bearded cowboy, Dr. Jones, paces across the room, stops and puts a foot on one of the sofa’s chrome arm-rails.

“We’ve won against the odds. The cancer is licked. He got through the hard part and he’s cured,” he caresses his tie. “Just have to get through this pneumonia.”

“He’s so frail. The chemo took a toll on his defenses,” the older Dr. Lindsey shakes his head.
“He’s still very sick.”

“True, but he’s very young,” says Dr. Jones, the cancer doctor. “He has some fight left in him. I say we push to keep him going. Do whatever we need to do to get him over this last hump. What do you think,
Mrs. Goshen?”

“The woman on the couch looks up, her eyes heavy as she glances at the “players” around her, “I guess you’re right.”

Dr. Hardy, our “team leader”, turns to her, “We’ll do our best to save your husband, ma’am. That’s our job.”

We file out of the room and resume the morning rounds. Back to bed number two’s vital statistics. There are various white-coated doctor people wandering through, asking about Mr. Goshen’s PO2 and BP as they glance a look at his skull-like face. Occasionally, one would go over to his bedside to ask, “How are you doing, Mr. Goshen?”, add “good, good” when he seems to nod in reply, and wander away.

A long piercing shrill shoots through the steady orchestral melody of ICU beeps. Suddenly, the resident is by Mr. Goshen’s bed waving me away to make room for the crash cart being wheeled toward the bedside.

“CODE!”, someone calls out, as nurses load syringes. The resident slaps two orange squares on Mr. Goshen’s chest, grabs paddles from the cart, places them on the bright pads and yells “clear” as Mr. Goshen’s body jolts.

“Sorry Andy!” cries the nurse at the head of his bed.

This scene continues, full of jolts, beeps, injections, apologies to Andy, people pushing down on his bony chest in the bobbing of CPR. Dr. Hardy and I stand in the corner, at Mr. Goshen’s foot – he, watching the heart monitor and barking out names and doses of drugs in response to blood pressure announcements, me, trying to stay out of the way.

Until a nurse points at me, “Take over.”

I am now out of the audience, onto the stage. I push up my sleeves, place two fingers at the junction of his ribs and lay my palm above this, scolding myself for cringing as I feel slime between his chest hairs.

“Get up on the bed!” someone yells. I scramble onto the mattress, straddle the bones under me, and repeat
my landmarking routine.
Looking down, I count, “One and two and three and four and five and. . . “, pushing rhythmically, trying to ignore the crackles of ribs breaking under my efforts and filing away the fear that I will crush the heart below this sternum. Just don’t look at his face. Just count. Just push. Don’t think. Breathe. Don’t screw up. Count. Push. Go. Keep going. Don’t stop. Don’t look.

“Okay, get off,” I comply and stepped away. More jolts. More “Sorry Andy!” ‘s. More blood pressures. More injections. Nothing seems to be helping.

Murmurs about fluid in his lung escalate. A green package is placed in front of the resident. He rips it open, takes out a long plastic tube and pierces Mr. Goshen’s side, triggering a gush of fluid all over the floor.

“Do the other side!” Chest tube number two. (“Sorry, Andy!”) Another geiser.

Blood pressure still dropping.

“Paracentesis!”

The resident responds. A narrow tube stabs the centre of Mr. Goshen’s chest.

   “Get an echo!” yells Dr. Hardy. An echo? “If his left ventricle is still working, we still have a chance!”
       We do? He does? I look at the fried, stabbed body before me and the plastic
protruding from it.  We stare at the motionless blobs on the TV monitor. Dr. Hardy rubs his chin, “Okay, that’s it.”

The Team collects in a narrow room, sitting in a row, side by side along the wall, staring at the floor.
The nurses pull the curtains around Mr. Goshen’s bed and open them once some of the tubes had been removed. The woman and her two teenage daughters huddling next to her are escorted into the room. One of the girls sobs the moment she sees the corpse before her. The threesome shuffle to the bedside.

I look down, like my colleagues. There was no way to hide from their wailing.

“Sometimes things can get emotional,” would be Dr. Hardy’s pep talk the next day.

* *

       I go home. I wish Matt was here, not in New York at his conference.
      I sit down to eat supper.
      My mom comes in and asks about my day.
     “Not so good.”
     “W’hat happened?”
      “A lot”.
      She frowns and points to the worn-down soles of my loafers. “A doctor should wear decent shoes.
Can’t you even buy some shoes? How can you walk in those things? Don’t they throw you out of the hospital with shoes like that?”

I don’t reply. I look down at my plate, picking at my spinach, shredding it
into green strips.
She leaves the kitchen.

I slide off the chair and crumple up on the kitchen floor. The coolness of the tile against my cheek soothes me as I bring my knees to my chest and hide my head into the curve I have created.

The next day, Mom insists she drive me to work. She rants about my shoes and my irresponsiblity for not picking up my reading glasses from the optometrist’s office. She is interrupted by my explosion.
“WHAT do you want from my life? You’re nagging me about shoes and glasses while
I go to work everyday and watch people die!”, I sob.

We arrive at our destination. My mother is silent. I fumble for the door-handle, climb out and slam the car door. Dizzy and disoriented by a curtain of tears dripping from my eyes, I stumble toward the nearest hospital door. “Stupid shoes,” I mutter, angered by the accuracy of my mother’s appraisal of them.
My coat clutched in one hand, knapsack slung over my shoulder, I rush down the stark pale-yellow walled, linoleum tiled hallway.

Don’t want to be late for my first autopsy.

The post ICU story appeared first on Laughing Sherpa by Dr Miriam Korn, MD.

World’s Best Cookies

Mia Korn — Tue, 25 Nov 2014 06:08:00 +0000

Folks say these are not mere cookies, they are a meal.

1/2 cup quick rolled oats

1/2 cup whole rolled oats

2 tbsp hot water

1/4 cup brown sugar

1/4 cup almond butter

1 medjool date – pitted, diced

1/4 tsp salt

50 g chocolate ** – cut into 1cm chunks.

Preheat oven to 425 degrees.

Put quick oats in bowl. Add hot water.

Add whole oats, brown sugar, almond butter, date, salt.

Stir with wooden spoon.

Batter will be sticky and thick.

Fold in chocolate.

Drop by tablespoonfuls onto greased cookie sheet.

Bake for 7 minutes.

Turn off heat. Leave in oven for another minute.

Take out of oven and let cool enough to remove with a spatula.

Serve warm.***

** My favorite is a combination of

70% dark Green and Black’s, MacaSure and Extra Creamy Lindt milk chocolate.

*** I generally like to make batter, put it in a jar, refrigerate it and

make a few cookies at a time in a toaster oven so they can be

served / eaten warm with the chocolate still melted.

****WARNING: batter is mighty addictive, too.

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Triumph Cake

Mia Korn — Sat, 22 Nov 2014 06:19:00 +0000

A few days ago, I made a birthday cake.

I modified a recipe from Baby Cakes, a well-known vegan, gluten-free bakery in New York City.

It contains yam and applesauce, which are sweet and moist so less sugar and oil are needed.

Three layers were each topped with chocolate icing (my own recipe).

My masterpiece was decorated with

a marzipan rose from a local patisserie and

surrounded by purple flowers.

Guests raved about this unique concoction: ” a triumph! ”

In response to a zillion requests, here is the recipe

Preheat oven to 325 degrees F

Combine:

1 + 3/4 cup brown rice flour

1/2 cup potato starch

1/4 cup arrowroot

1 1/2 cup brown sugar

1 1/2 tbsp baking powder

1/2 tsp baking soda

1 tsp xanthan gum

2 tsp salt

1 1/2 cup unsweetened cocoa

Add:

3/4 cup pureed yam

3/4 cup applesauce

1 tbsp pure vanilla extract

3/4 cup canola oil

1 cup hot water or strong coffee

Stir with wooden spoon, until smooth.

Lightly oil three 7 x 4 x 3 pans

Divide batter among three pans.

Put pans in 325 degree F oven.

Rotate pans 180 degrees after 8 minutes.

Take out pans after a total of 15 minutes.

Allow to stand for 20 minutes.

Gently run knife along edges.

Turn cake onto wire rack and cool completely.

Put one cake on plate. Cover cake with icing.***

Put another cake on top. Cover cake with icing.

Put third cake on top. Cover all three with icing.

Refrigerate or freeze.

Let cake stand until it has reach room temperature,

before decorating and serving.

*** Chocolate Icing

Combine in small saucepan:

3/4 cup cocoa

1/2 cup brown sugar

1/3 cup soya milk

3 tbsp strong coffee

Whisk as it simmers on stove

until slightly thickened.

Cool for five minutes.

Add:

3/4 cup icing sugar

1/4 tsp vanilla

dash salt

Stir until smooth.

The post Triumph Cake appeared first on Laughing Sherpa by Dr Miriam Korn, MD.

Spicy Salad

Mia Korn — Fri, 21 Nov 2014 06:36:00 +0000

Asian Coleslaw

3 Tbsp lime juice

2 Tbsp rice wine vinegar

1 Tbsp sugar

½ tsp salt

2 dried red chilies, crumbled

4 cups thinly sliced green cabbage

1 small carrot, cut into small matchsticks or grated

2 shallots, thinly sliced

1 Tbsp fresh ginger, cut into matchsticks, or

2 tsp minced fresh ginger

1 Tbsp coarsely chopped fresh cilantro leaves

¼ cup unsalted peanuts, roasted and chopped

Whole cilantro leaves for garnish

Whisk the lime juice, vinegar, sugar, salt, and chilies
in a 2-quart mixing bowl.

Add the cabbage, carrot, shallots, ginger, and chopped cilantro.

Mix all ingredients thoroughly.

Let the coleslaw stand for 15 minutes to
allow the flavors to develop.

Divide the salad among 4 plates.
Sprinkle generously with chopped peanuts
and garnish with whole cilantro leaves.

Makes 4 servings.

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Vegi Miso Soup

Mia Korn — Fri, 21 Nov 2014 00:48:00 +0000

2 tbsp. organic sesame oil
¼ cup shallots, finely chopped
¼ cup green onion, finely chopped
1 heaping tbsp. chopped ginger
1 tbsp. finely chopped garlic
1 celery stalk, chopped
3 medium carrots, thinly sliced
6 cups vegetable broth
2 cups purified water
1 bok choy, chopped
6 tbsp miso, light yellow or white
8 oz tofu, diced
16 shiitake mushrooms, thinly sliced

In large pot, heat oil over medium heat.

Add shallots, green onion, ginger, garlic, celery and carrots and sauté for 5 minutes.

Add broth, water, bok choy and miso.

Stir and bring to a boil. Reduce heat to simmer.

Add tofu and mushrooms and simmer for 10 minutes, stirring occasionally.

Serves 8.

From: Dr. Patricia Fitzgerald December 2011.

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Economics of Happiness

Mia Korn — Sun, 26 Oct 2014 07:56:00 +0000

Historically, economists have said that well-being is a simple function of income. However, it has been found that once wealth reaches a subsistence level, its effectiveness as a generator of well-being is greatly diminished.^[11] This paradox has been referred to as the Easterlin paradox.^[1] Happiness economists hope to change the way governments view well-being and how to most effectively govern and allocate resources given this paradox.^[12]

In 2010, Daniel Kahneman and Angus Deaton found that higher earners generally reported better life satisfaction, but people’s day-to-day emotional well-being only rose with earnings until a threshold annual income of $75,000.^[13]

Gregg Easterbrook claims that even though wealth, or economic surplus, is more common today than in 1950, people are still as happy as they were 60 years ago.^{[citation needed]} In polls taken by the National Opinion Research Center, about 1/3 Americans said they were really happy in 1950, since then the polls have been taken periodically, and the results have stayed about the same since then.

Other factors have been suggested as making people happier than money.^[6] A short term course of psychological therapy is 32 times more cost effective at increasing happiness than simply increasing income.^[14]^[15]

Scholars at the University of Virginia, University of British Columbia and Harvard University released a study in 2011 after examining numerous academic paper in response to an apparent contradiction: “When asked to take stock of their lives, people with more money report being a good deal more satisfied. But when asked how happy they are at the moment, people with more money are barely different than those with less.”

Published in the Journal of Consumer Psychology, the study is entitled

“If Money Doesn’t Make You Happy, Then You Probably Aren’t Spending It Right”:

Spend money on “experiences” rather than goods.
Donate money to others, including charities, rather than spending it solely on oneself.
Spend small amounts of money on many small, temporary pleasures rather than less often on larger ones.
Don’t spend money on “extended warranties and other forms of overpriced insurance.”
Adjust one’s mindset to “pay now, consume later,” instead of “consume now, pay later.”
Exercise circumspection about the day-to-day consequences of a purchase beforehand.
Rather than buying products that provide the “best deal,” make purchases based on what will facilitate well-being.
Seek out the opinions of other people who have prior experience of a product before purchasing it.^[16]

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10 Habits of Happy People

Mia Korn — Sun, 26 Oct 2014 07:39:00 +0000

10 Signs Of Happiness

Though it may come in different forms for different people, most human beings are in pursuit of the same thing: happiness. It may be closer than you imagined.

By Meredith Dault for readersdigestca

For some, happiness can be a pesky, fair-weathered friend, forever on the loose. The fact is that you have everything you need for happy living right now! Seeing it may simply be a matter of tweaking your own thinking so that you can appreciate what you’ve already got. Look for these signs and say hello to happiness!

1. You Live Your Life With Integrity

Living a life that’s in line with your own values and belief is important for happiness. “That means that the things you say you believe in are the things you do,” says “Happy Guy” David Leonhardt, the author of Climb Your Stairway to Heaven: the Nine Habits of Maximum Happiness. For example, if you value the environment, do you mind your carbon footprint? Or if family is important, do you make time for them? Figure out what’s important and live your life accordingly.

2. You’ve Embraced Living In The Moment

You’re fully awake and aware, and concentrate your energies on enjoying the present, rather than worrying about the past or the future. “All we have is right now,” says Michelle Keeley, an executive leadership coach with Fruition Strategies, “and life is just made up of a series of moments.” Enjoy them.

3. You Express Gratitude Regularly

Being grateful for the things you have—and sharing that gratitude—will lead to feelings of satisfaction and happiness. “When you’re performing an act of kindness or giving someone a compliment, you can actually feel an energy shift in your body,” says Todd Keeley, Michelle’s brother and business partner. Seek that feeling out more often.

4. Your Work Satisfies You

If you find satisfaction in the things you do, then you’re well on your way to living a happy life. “The more meaningfully we’re engaged and the more we believe that what we’re doing is meaningful, the more happy we are,” says David Mensink, a psychologist with the student counseling centre at Dalhousie University. And it doesn’t necessarily have to be linked to a career. “For example,” says Mensink, “you can be meaningfully engaged in caring for children,”

5. You Enjoy Harmonious Relationships

Whether it’s at work or at play, being at peace with yourself and the world around is a surefire way to find happiness. Practice respect and patience as you go about your day, whether you’re interacting with family, co-workers or with your partner.

6. You Keep Your Inner Critic On ‘Mute’

If you’ve got a little voice in your head telling you you’re never good enough and you’re never satisfied, then odds are good you won’t find happiness either. “Choose to let go of negative feelings and thoughts,” says Todd Keeley, “You won’t find happiness until you do.”

7. You Aren’t Afraid Of Change

Recognize that change is constant and you’ll be more ready to embrace happiness. “Then choose to respond to life, rather than react to it,” says Michelle Keeley. You’ll feel more in control and will be better able to adapt. Stay open to the opportunities change can bring.

8. You Enjoy The Simple Things

Taking pleasure in small things will help you build a big picture of happiness. Take time to enjoy a well-cooked meal, a beautiful painting or a spring bulb poking up through the earth.

9. You Give Back

Happiness is contagious, so make sure you spread it around. “Giving back to others and sharing is the ultimate way to inspire happiness in your life,” says Michelle Keeley. “Because what you give out will come back to you ten-fold.” Whether you volunteer in your community or share your smiles—it all counts.

10. You Don’t Take Life Too Seriously

Having a sense of humour can help you keep things in perspective. Make sure your life is filled with plenty of laughter!

Reader’s Digest

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Serotonin Dopaimine : Physiological Indicators of Mood

Mia Korn — Sun, 26 Oct 2014 07:38:00 +0000

Higher levels of serotonin are correlated with increased happiness and decreased anxiety.
Dopamine also contributes to good mood, and in addition causes an increase in
activity and willpower.

Both serotonin and dopamine show decreased levels in depression.
However, it is important not just to look at general levels of the neurotransmitter,
but to also consider which parts of the brain show decreased neurotransmitter levels.
Depression correlates with decreased serotonin and dopamine levels in the
amygdala, thalamus, and hyppocampus.

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GI ward

Mia Korn — Tue, 14 Oct 2014 20:06:00 +0000

A Golden Haze

ID : 63 year-old female. Retired pediatric rheumatologist.

Chronic hepatic cirrhosis associated with long history of alcoholism.

Presents with ascites. Lives alone.

Dr. Reddy is here because her belly is full of fluid. Her liver, fatigued by the wear and tear of decades of whiskey sours, can no longer produce enough albumin, the blood protein which usually keeps water where it belongs. When I first meet her, I see she looks just like she is supposed to look, according to our textbooks : yellow skin and eyes, bloated abdomen.

“Hello, Dr. Reddy. My name is Miriam Korn,” I say as I approach her bedside. “I’m a third-year medical student.” I look down at the geography of her face: wrinkles, pale withered lips, folds of grey skin. “How are you?”

Her eyes look up, squint and smile through a golden haze. “I’m okay,” she replies, glancing at her bulging belly. She knows she is textbook material.

We chat for a while. She worked for 33 years as a pediatric rheumatologist in New York City. She loved it. “Medicine is a great profession,” she says. “You are so lucky.” She answers all of my questions: four to six drinks a night for over forty years. Didn’t “get in the way” until the past five years, after she retired.

She tells me about her travels throughout the United States and Europe. There isn’t much to say about her family, she says. Her only living relative is her sister, who has been her sole visitor during her hospital stay. On the night table between us, there is a photo of two collies surrounding a robust-looking woman, atop a mountain. “That’s Chloe and Sasha, with my sister,” she comments, after noticing my interest, “We were in Yellowstone Park.” Her eyes shut for a moment. The corners of her shriveled mouth turn upward.

* *

Later, I reenter with the team. Dr. Hashem, the liver specialist, clad in a pinstripe suit and silk tie, leads us into the room. I like him. He is proud of the framed Hippocratic Oath that adorns his office wall. “Good morning, Dr. Reddy,” he says as he reaches towards her. “How are you feeling today?” He touches her shoulder. “I’m Dr. Hashem. I think you’ve met Dr. Korn.” Doctor Korn?

The Gastroenterology fellow, Dr. Usala, steps forward with his stethoscope and listens to, taps then pokes her abdomen “We’ll probably have to take some fluid off. It’ll help you breathe more easily,” he says. He steps away from the bedside. “We still need the biopsy results,” he adds. Dr. Reddy nods as our team exits.

We huddle together outside her doorway. I report that the liver biopsy results have not yet returned. This is not acceptable, says Dr. Usala.

Suddenly we are all dashing out of the ward, then racing through secret passageways, with our coats flying behind us, like capes. We slow down as we approach a sign marked “Pathology”, marking our destination. We follow the arrow pointing left, through the glass doors, and proceed towards an open doorway.

As we gather just inside the threshold, a man sitting at his desk swings around and welcomes us. He invites us to sit down. We each find a seat, except Dr. Usala, who remains standing.

There is some chatting about vacation plans until Dr. Usala asks The Question. “Have you taken a look at Reddy’s biopsy?”

“Oh yes!” replies the pathologist, as he motions us toward the microscopes. I look through the eyepiece at some purple blobs. “See the white cells?” he asks. No. “Acute on chronic hepatitis. Doesn’t look good.”

Dr. Hashem leans away from his microscope to allow Dr. Usala to take a look. They nod in unison and look up. Then back we go, through the labyrinth, to Unit Six.

* *

Dr. Reddy is discharged after a week of lactulose, which soaked up the ammonia in her blood, and a peritoneal tap, that sucked out some fluid from her abdomen. I’m glad she is better, for her sake and mine. I’m tired of her talk about the glory of the medical profession, and I feel guilty that I pity her. I wish I liked her.

* *

A month later, during my next rotation, I’m back on Six West to meet a patient who is being transferred to my ward. On the board behind the nurse’s station, I notice Dr. Reddy’s name. “What happened?” I ask one of the nurses.

Her explanation is not unexpected. Dr. Reddy had returned home, started drinking again, and was brought back to the ER in an ambulance a few days ago. Liver failure.

I walk into her room, planning to say hello and bring good wishes, and find a blanket-covered mound of flesh on her bed. Her bloated face has sealed her eyes shut. The rhythmic rise and fall of her giant girth is the only sign of life. A long breath escapes me as I absorb the scene. Was she inside this sleeping elephant? I turn and exit.

“What’s going on?” I ask the intern at the door. “Her ammonia and LFT’s are really high,” she replies. “Pretty bad. Might not make it to the end of the week. Her sister agreed to DNR . ”

Over the next few days, I glance into Dr. Reddy’s room every now and then as my team works on a case nearby. There never seems to be a change in her condition. She looks like a beached whale on a gurney, in a lonely, stark, hospital chamber.

One day, my peek reveals an empty, freshly-made bed. I pause. Had her sister come to hold her hand? Who would take care of her dogs?

I recall Mr. Goshen’s * family sobbing by his bedside and remember the flow of physicians inquiring about his condition both before, and after, his death. And I think about the newspaper article that celebrating his life and lamenting his demise…

Had anyone noticed this soul slip away?

* see ” ICU Story : Rites of Passage ”

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