Chapter VII: The Medical Mind

Article excerpt

Learning Medicine From a Master. In 1997, Dr. Joseph Stanton invited me to address the students and recent graduates of Harvard Medical School who were taking the restated Hippocratic Oath. Here is what I said: (80)

Dear Friends, I want to draw your attention to a sentence in the original Oath, which reads: I will pay the same respect to my master in the Science as to my parents. It is not so much a matter of respect any more, the forms of respect change with time and I think the present-day masters like to be treated as fellow students of medicine, and of course that's what we all are. But what in my opinion is still important, and what the Oath took for granted, is learning medicine from a master.

Let me tell you a story that my teacher, Dr. Jakubowski, told me many years ago. In 1915, as a young military doctor with the Russian army during World War I, he stayed with his regiment in a provincial town in Central Russia. While there, he was called to see a very sick twelve-year old girl who was running a fever of 40[degrees] C (104[degrees] F). Two doctors had seen her and couldn't find the cause. After a meticulous routine examination, neither could Dr. Jakubowski. But he remembered a lesson from his Paris student years, something his teacher in surgery had told him: "If a child comes back from school and does not complain of anything, but the next day falls ill with high fever, tap with your finger all long bones. Children are kicked by playmates at ball games, don't pay attention to the injury, and forget about it. Meanwhile, bacteria from the child's throat or teeth may settle in the injured bone and osteomyelitis develops." (81)

Dr. Jakubowski percussed the girl's bones inch by inch and found a very painful spot in the left shin. Within hours the surgeon at the local hospital chiseled out the infected piece of bone, and the child was cured. Tearful parents came to thank Dr. Jakubowski, and the father said: "Bob vas poslal" ("God has sent you"). Agnostic as he was, Jakubowski must have been moved by these words because I could see that even forty years after the event he had to subdue some emotion while telling this part of the story.

Since the day I heard it, I have inquired about possible trauma and percussed the bones in every case of unexplained fever. It paid off two years later, in a quite exceptional, I would even say, unheard of case. A distant relative of mine, Mr. S, was rushed 150 miles to my hospital in Lodz, Poland, with a fever of 103[degrees]-104[degrees] E He had been doing some repairs and fell from the roof of his house. He didn't break any bones and hurt nowhere, but two days after the fall the fever began.

Percussing his bones, I found in the right shin a spot that not only was painful, but there was even fluctuation indicating the presence of fluid. An area of rarefied bone was seen on the X-rays. I punctured the affected spot and drew thick green pus. The patient was transferred to the department of the excellent bone surgeon Dr. Wroblewski. Meanwhile, sensational news came from the lab: the pus swarmed with Salmonella typhi, the causative agent of typhoid fever!

The patient had typhoid fever during World War II. It turned out that he still was a carrier of the bacilli, stored in his gall bladder. Bone surgery had to be combined with a chloramphenicol cure.

About a year later, at a military hospital in Lodz, I saw a pale, sick lady of 34. She ran a hectic fever that alternated with profuse sweating. The patient's left forearm was swollen, and her spleen was palpable, soft on touch. Her white blood cell count was elevated to 32,000. It had been four days since her admission and she didn't have a diagnosis. The head of the department, Dr. H, a laboratory-minded theorist who was out of touch with clinical practice, never once examined the patient, but kept firing away disparate and improbable diagnoses that had no connection with the patient's problem. …