The Soul of Medicine: Tales from the Bedside

Looking at three doctors who recount their most interesting case/patient

In The Soul of Medicine: Tales from the Bedside, Dr. Sherwin Nuland takes tales from doctors of various different specialties and puts them together in a medical anthology. Within it are tales of grief, perseverance, and nobleness that pull the reader in. Specifically, there are few tales of some remarkable doctors that I must share because of the admirable qualities they possess.

The first tale is the ophthalmologist’s (eye doctor’s) tale; however, it is about this doctor’s experience when he had to be like an obstetrician (doctor specializing in childbirth). Dr. Rosenzweig served as a doctor in the US military as a part of the Berry Plan, which allowed specialists to delay being drafted by the government in exchange for enlisting in the military and working as a doctor. He was stationed in Montgomery, Alabama under Colonel Ransom, a racist person who took every opportunity to insult African Americans and Jews. Dr. Rosenzweig was a Jew and was unfortunately subjected to torment by the general who actually forced him to stay longer at the Air Force Base in Montgomery in order to torment him even though he should have been assigned to a European base. One day, while Dr. Rosenzweig was moonlighting in a rural hospital to supplement his salary, Colonel Ransom’s wife and daughter came in. The teenage daughter complained about abdominal discomfort and had a swollen belly. Dr. Rosenzweig realized that she was pregnant and helped deliver the mixed race baby, which ended up sadly being stillborn (an infant born dead). He could have spread this story around to get back at Colonel Ransom for every Jew and African American that Colonel Ransom had berated and discriminated against; however, Dr. Rosenzweig was not that kind of character. He believed in strict patient confidentiality and was a man of integrity, so he did the right thing by keeping the story to himself no matter what. I think that for Dr. Rosenzweig to be able to do that despite his intense personal feelings to the patient’s family is utterly remarkable and demonstrates that he is a top class person as well as a top class doctor.

Footling-breech

Delivery of a Baby – Footling Breech

The next tale is the cardiologist’s (heart doctor’s) tale while he was dealing with a patient of his who was slowly dying of congestive heart failure. Dr. Kronberg was very close to the Joe, the patient, taking care of him for few decades. Joe was the director of a rare book library, and he had countless fascinating stories of how he acquired certain texts that made that university’s collection one of the best in the world. However, Joe eventually had to retire because his case was getting worse and worse. He had a heart attack at age 57, which required a balloon pump in the aorta, but he eventually needed a coronary artery bypass graft for three vessels in order to move blood away from the clogged vessels. Moreover, he had another heart attack and even needed the implantation of a defibrillator when there was something wrong with his cardiac rhythm. Dr. Kronberg knew that Joe’s heart was failing, and he, as Joe’s friend, truly wanted to help him. Medication would not save him, so Dr. Kronberg gave him the “prescription” to write memoirs about his life. This idea gave Joe life, and he vigorously began to dictate his stories to his daughter-in-law for her to write. Making the memoirs gave Joe purpose to his actions and lifted his spirits so much so that he seemed like a younger man. When Joe finished his memoirs, Dr. Kronberg realized that he was finally ready to die, and he wanted him to die in a peaceful manner without suffering. Thus, Dr. Kronberg offered to turn off his defibrillator, which Joe agreed to, because it would have been a far less painful death than dying from congestive heart failure. This plan never came to fruition though with Joe passing peacefully in his sleep the day before the planned date. This tale is so remarkable because it represents that the doctor’s role is not just as a healer but also a caregiver. Dr. Kronberg was able to give Joe the power to do something that he loved in his final days, which was the best thing that he could do for him at that point. This tale is not about what Dr. Kronberg did (helping Joe out); it is about how Dr. Kronberg did it. Dr. Kronberg established such a positive patient-doctor relationship, so he understood how exactly he could help Joe in terms of palliative care. Even when Dr. Kronberg offered to turn off Joe’s defibrillator, it was an act of kindness that they mutually agreed on to prevent further pain. Dr. Kronberg is an inspiration of how to properly take care of patients and make their end of life period as purposeful and peaceful as it can be. This tale has something that every physician can learn from.

IABP

Intra-Aortic Balloon Pump

The following tale is the geriatrician’s (doctor for the elderly’s) tale when he was referred a patient with the chief complaint of severe ankle pain with no associated trauma. Specifically, Dr. Curray was referred Jean, a 58-year-old patient, from a family physician. The family physician had tried many different treatments with no success and was completely stumped by the case. When examining Jean, Dr. Curray noticed that she had some clubbing (nail rounds downwards so that it looks like a spoon) in her fingertips. While clubbing can be caused by celiac disease (damaged small intestine) or cirrhosis (scarring in the liver) among other conditions, the most common cause is lung cancer. When Dr. Curray noted the clubbing to Jean, she was surprised, not having noticed it herself because it had been happening gradually over the last year. Dr. Curray ordered a chest x-ray, which prompted him to order a CT scan of the chest region. This scan found a small cancer in the upper right lung. Even though the prognosis for lung cancer associated with arthritis symptoms and clubbing is poor, Jean recovered well after the surgery with both the arthritis and the clubbing disappearing within months of her surgery. In my opinion, the most amazing part of this tale is that Dr. Curray was so observant, noticing clubbing on a patient who was coming in for ankle pain. All too often, doctors do not take the time to take a full family history and to talk to the patient, relying too much on laboratory tests to make the diagnosis. This tale just reinforces the importance of treating each patient as a person, taking a moment to meticulously observe them and help them. Because of Dr. Curray’s observations, he was able to give a life-saving diagnosis of lung cancer, which the family physician had completely failed to do. I think the biggest takeaway from Dr. Curray’s tale is the importance of treating the patient not the complaint, which is something I feel all doctors should be reminded of.

Clubbing

Clubbing of the Fingers

These tales of doctors proved uniquely inspirational and educational, teaching terrific life lessons. Dr. Rozenwig, Dr. Kronberg, and Dr. Curray all exemplify the characteristics of a great doctor and what I, along with others, should emulate when we become doctors. Dr. Nuland masterfully conveys these tales in The Soul of Medicine: Tales from the Bedside complete with his own insightful narration on some of the most interesting patients and inspirational doctors in the US.

 

References

“Clubbing of the Fingers or Toes.” MedlinePlus, medlineplus.gov/ency/article/003282.htm. Accessed 1 Sept. 2017.

“Coronary Artery Bypass Graft.” NHS Choices, 28 Nov. 2016, nhs.uk/Conditions/Coronary-artery-bypass/Pages/Introduction.aspx. Accessed 1 Sept. 2017.

Diamond, Dan, editor. “What Health Care Has Lost—and Gained—Since the 1960s.” Advisory Board, 22 Mar. 2012, advisory.com/daily-briefing/2012/03/22/after-mad-men-what-healthcare-has-gained-and-lost-since-1960s. Accessed 1 Sept. 2017.

Footling Breech. Mama Natural, mamanatural.com/is-baby-breech/. Accessed 1 Sept. 2017.

IABP (Intra-Aortic Balloon Pump) Insertion. NMC Heartcare, nmcheartcare.ae/iabp-intra-aortic-balloon-pump-insertion/. Accessed 1 Sept. 2017.

Nails Journal. Nail Clubbing. 8 Jan. 2014. Fingernail Clubbing Causes, Symptoms and Pictures, nailsjournal.com/fingernail-clubbing-causes-symptoms-and-pictures/. Accessed 1 Sept. 2017.

Nuland, Sherwin B. The Soul of Medicine: Tales from the Bedside. Paperback ed., New York, Kaplan, 2010.

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