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There
are some advantages to being an M-50.
1. You can impress the house staff (temporarily) by making some
instant diagnoses. After a half-century, knowing that the abdominal
pain is merely early shingles is just recognizing an old, old friend.
2. You have finally stumbled upon the magic shortcut to clinical
evaluation: Forget the MRI and take another history from the patient.
3. You can ski free at many Colorado resorts.
4. But the most fun about having a half-century of memories is just
that: You can project them around in your brain at will, no admission
charge.
Take for example, the euphoria of senior medical students. First
of all, they know everything. And when they've gotten their match
for a graduate program around March of the year, they can hardly
bring themselves to speak to ordinary mortals. If you're so unfortunate
as to have a member of this species in your office for a month (as
I did for some 30 years), you'll get no work out of them—if
you can even find them. I found one, Larry, in March, asleep in
the library. I found another, William, in April, asleep in our receptionist's
office. They had not been studying late. They had been celebrating.
When I was one of these creatures myself, I had boldly asked my
dad, a physician since 1924, if he knew anything about hypoglycemia.
Without a word, he dug out a yellowing reprint of an article in
the Annals of Internal Medicine, vintage 1931. It was the
first report in treatment of low blood sugar with a high-protein
diet. There was a single author. It was my father.
Fortunately, this psychotic exhilaration of seniorship has its own
built-in cure. It's the instant effect of the first day on the ward
as an intern. I remember it well. I had eight patients on the Grady
medical unit, all my own, and I was suddenly responsible for all
of them. As I made rounds, the gut-wrenching realization descended
like a shroud:
I didn't know diddly-squat.
I devised endless clever maneuvers to pry advice out of residents
and attending physicians: "Suppose you had a patient who keeps
running a fever but the white count is normal . . ." |
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By
far the worst was Minnie. Some 65 years old and living alone, she
had come in very sick indeed. I knew she had sever sepsis, probably
from an infected kidney. I knew she was in shock. I figured I had
her on the right treatment. But why this heavy breathing? This severe
acidosis? Despite all our efforts, including staying up all night,
she died. I carried Minnie around from then on, part of my permanent
edcational baggage. And then, during my fellowship in Boston three
years later, my brilliant mentor discovered lactic acidosis, previously
unknown. Helping him write a couple of papers on this strange condition,
I had a double realization: First, we were breaking new ground;
second, I was beginning to understand Minnie.
As I surf the memory bank, the images roll. Riding the ambulance
as an intern . . . Diving into icy Piedmont Lake vainly trying to
save the man trapped in a submerged car, then learning that he had
left a suicide note . . . Prying the man out of a car wrapped hopelessly
around a telephone pole some 20 feet in the air (the estimated 115
miles per hour), and being amazed that he only had a few bruises.
What is that about sparrows? And what is that about spiritu frumenti?
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The
rewards keep coming back . . . storming into the administrator's
office at Grady complaining about the nurses and orderlies. He,
between puffs on his cigar, told me: "You know my hardest problem,
Waters? Getting orderlies and nurses. You know my easiest problem?
Getting interns." But then on the ward the next day, I noted
a vast change in the attitude of the staff. I learned that the whole
crowd had been called on the carpet the night before—by the
administrator.
As a faculty member at Emory, being referred a man with a weird
array of recurring abdominal pains and nerve damage. Then noting
to my horror the horizontal bands ("Mee's lines") in his
fingernail beds, indicating multiple doses of arsenic. (No arrest
followed, but a divorce did.) Or the student rushing up to tell
me that my new patient had Wilson's disease (!) a rare disorder
causing copper to deposit throughout tissues of the body and producing
liver trouble and mental disorders. "Fist of all," sayeth
the experienced clinician, "compose yourself, son, and tell
me what Wilson's disease is all about." He did, it was, the
patient was treated, he responded, and I've followed him for 40
years. The student, who acquired instant fame in internal medicine
circles, went into psychiatry.
The pictures keep streaming. Telling the family, in 1965, that we
couldn't do much for Tom, sick in the nearby hospital room, because
he had end-stage kidney failure. Then turning and seeing who? Tom
himself standing there? No—his identical twin! Then arranging
the trip to Boston, the only place where kidney transplants were
then being done—and only between identical twins.
Having the young new ICU nurse ask if I was Dr. Water's father (Dr.
Water IV(my son)—on hospital staff 2 days; Dr. Waters III
(me)—on staff 25 years. "Yes, my dear."
Despite all the hassles of modern medicine, I still tell the new
medical students about my fantasy: I could step down from the podium,
walk up the aisle, find an empty seat . . .
And start all over again.
Sincerely,
P.S. All the names have been changed to protect the quilty.
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