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Before I Sleep describes a day in the life of a fictional physician, John Galen, who not surprisingly resembles its author. Through encounters with diverse patients in Galen’s practice, the book makes apparent that a doctor’s care demands not only knowledge of anatomy, biochemistry, physiology, and pathology but also compassion, commitment, and love. The book captures how demanding the profession of medicine is on physicians and their families while showing the many daily special treasures they receive from patients.
     Through multiple patient vignettes, the reader discovers the tremendous cultural, ethnic, and socioeconomic diversity Dr. Galen must understand if he is to be able to treat patients effectively. Wit and humor are needed to help this doctor, his colleagues, and patients get through the day. Indeed, those traits are needed for all doctors.
     I believe this book will serve to remind future generations of physicians of the life of a superb internist and the way care was given during the last half of the 20th century. It depicts the life of excellence, commitment, discipline, and management of time for the patient, the profession, and one’s own family and self.
     This book shows medicine like it really is, and it recognizes the delicate interplay of the science and art of medicine. In the current era of managed care, less time for comprehensive patient care, and increasing paperwork, physicians like Dr. Galen may no longer exist. It is the responsibility of the profession, the public, third-party payers, and the government to work out new ways to ensure that the patients of the future will be as fortunate as those who were cared for by the fictional Dr. Galen and his author, Dr. William Waters.

By Jack Shulman, senior adviser, curriculum, Emory School of Medicine
"Maybe the elephants handle it a little better. They have a certain place they go when it’s time to die. All the elephants seem to know about this place. When one goes there nobody bothers him. Certainly nobody resuscitates him, presses on his chest, shocks him, sticks needles into him, gets blood gas determinations on him. He can die in serene, if elephantine splendor.... The elephant burial ground is the only place where one can die—guaranteed
—undisturbed; the hospital is the only place where—guaranteed—you can’t."
"It is characteristic of teaching that the receiving end is 90% of the process. You can convey the same ideas, say the same words, use the same inflections, keep the same gestures—and the results will vary 1:10 depending on the condition of the listening apparatus. The finest grass seed, broadcast widely over a parched plain, will expire without further biologic ceremony. Water the ground first, till it, make sure all the critical minerals and nitrogen are present, and the cheapest brand of fescue will germinate lasciviously.
     So with learning. Give a monotonous lecture, crammed with facts, and count the glazed eyes."
"The physician prescribes restoratives for the patient; the patient himself is the restorative for the physician. The grateful smile is addicting.... If, like the cocaine freak, you have a small empty place in your spiritual anatomy; if you are not quite whole but must fill the vacuum daily—who knows, you may become a doctor, my son.... You will do your work with secret rapture. You will complain about your hours, to be sure, but with tongue firmly embedded in cheek. You will groan loudly about inadequate reimbursement for cognitive services and government intervention and DRGs and HMOs. But you will carefully never admit to the authorities what every true physician-addict knows so well: you would pay to do this."


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