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 as 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. Unfortunately, Dr. Rosenzweig was a Jew and was subjected to torment by the general who actually had him stay at the Air Force Base in Montgomery 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 baby, which ended up sadly being stillborn (infant born dead). He could have spread this story around to get back at Colonel Ransom for every Jew and African American that he 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.

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 several 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’s 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 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 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 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 be 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. 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. It is not about what Dr. Kronberg did (helping Joe out), but this tale is remarkable because of 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.

Intra-Aortic Balloon Pump

The following table is the geriatrician’s (doctor for the elder’s) tale when he has referred a patient with the chief complaint of severe ankle pain with no associated trauma. Specifically, Dr. Curray was referred to 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 this finding 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 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 arthritis and clubbing disappearing within months of her surgery. 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 talk to the patient to find out what is truly wrong with 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. 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 part of Dr. Curray’s tale is about treating the patient, not the complaint, which is something I feel all doctors should be reminded of.

Clubbing of the Fingers

 

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, www.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, www.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, www.mamanatural.com/is-baby-breech/. Accessed 1 Sept. 2017.

IABP (Intra-Aortic Balloon Pump) Insertion. NMC Heartcare, www.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.