The Accidental Victims of the War on Opioids

Even before the Washington Post profiled chronic-pain sufferers for whom the war on opioids is having unintended consequences, a student in my narrative medicine class drew on the experiences of his own mother to explain how the crackdown on the opioid abuse has failed to take into account the very people the drugs were intended to help. 

Every day that I have known my mother, Michelle, is a day that she has had to deal with excruciating pain. For years, she has suffered from Tarlov Cysts, also known as sacral nerve root cysts. These cysts are expansions of the nerve sheath, which ultimately causes a sac filled with cerebral spinal fluid to form. Because they are normally found lower on the vertebrae, they can eventually affect bladder and bowel control, and without proper medication, the unceasing pain they cause can eventually become incapacitating. Chronic pain is, by definition, frequently incessant, and leaves sufferers with very few treatment options, one of those being opioids. These few treatment options are what makes the pain bearable enough to go about daily activities. The public hears far more about the negative impact of opioids on our society than the life-changing relief they offer to those without other options. For such sufferers, the current attempt to curb opioid abuse by strictly monitoring and limiting the quantity at which they are prescribed has severe consequences for their quality of life. Continue reading →

Coming Attractions: Featured Student Writing on Illness and (sometimes) Healing

My hope, Gentle Reader, is that you associate June’s approach with nothing more taxing than breaking out the ol’ backyard slip-n-slide. It’s a somewhat odd time of year, though, for those of us whose peculiar profession it is to haunt the halls of so-called higher learning. Despite the fact that final grades have been posted—a signal to students that their labors are definitively and blessedly finished—I don’t find it nearly so easy, as their professor, to declare mission accomplished. Instead, I continue to ruminate over each of my classes, tallying successes and fretting about ways to improve things that didn’t go as well as I’d intended. Continue reading →

Ben dreams of deadly sushi.

Ben Utter, one of the founders of Vital, reflects on how we–doctors, scholars, parents, everyone–can improve each other’s health by listening.


The lark sings loud and glad,
Yet I am not loth
That silence should take the song and the bird
And lose them both.
               —D.H. Lawrence, “Listening”

The doorbell rang in my dream the other night, and I opened our front door to find a food deliveryman. Without a word, he handed me a cooler and walked back toward his car. Inside the Styrofoam container were several slices of fugu, the infamous, highly toxic pufferfish, the kind prepared only by highly-skilled Japanese chefs, lest a residual trace of poison kill a diner. In the dream, I handed these morsels to my young daughter and son and watched—passively, but, as is often the case in dreams, with a suffocating sense of imminent danger—as they slurped them down. I awoke with a gasp, disoriented, still wondering whether or not this dangerous dinner was going to send my children into renal failure (turns out that on this count, at least, I needn’t have worried, since tetrodotoxin kills by paralyzing the lungs—an unsurprising error on the part of my mind’s dream production company, which had no more data to draw on than what I knew about fugu from watching that episode of The Simpsons). Continue reading →

Bicycle Advocacy Improves Public Health

If you’re an avid reader of Vital, you probably know that we like bikes a lot around here. First and foremost, it’s fun to ride a bike. And also, it’s good for your health and the health of the planet. With this in mind, I interviewed Randy LoBasso and Ashley Vogel of the Bicycle Coalition of Greater Philadelphia about what it means to advocate for bikes and their riders. Here’s what I learned. Continue reading →

Dr. P.K. and Vulnerable Me

With the power that inevitably accompanies a professional role like that of physician or teacher comes the responsibility not to take advantage of others’ relative vulnerability.

Infertility problems are not something my life partner and I have had to worry about in our marital and procreative relationship. After giving birth to four of the most wonderful, near perfect children on God’s good earth, we decide that it could only go downhill from here.

So one of us has to do something about it. I draw the short straw and find myself in a family practice doc’s office a few weeks later. I don’t know this physician, nor does he know me. My regular primary care physician has referred me to this man because of a Chinese surgical procedure for vasectomy that his partner has just studied. He has not mastered it, however (I will discover rather too late), and will be trying out his new skills on me. Continue reading →