A Career in Medicine
I led the first decade of my career in perpetual enthusiasm for helping sick people. Each case was an emotional experience and my responses were spontaneous consistent with system I thinking. I neither measured my response nor its validity. I think my enthusiasm and commitment to do good were admirable but I do not think I was the best doctor I could hve been, Hence I also pissed off a lot of people and a lot of doctors.
I had a sort of friend mentor internist who referred me a hospitalized case of scalded skin syndrome . I stayed up all night with her and in the morning when the internist made rounds I greeted him and said thanks you Dr. ___ for trusting me to take care of this very difficult case., Ed, he said, at my age I am happy to give you all my difficult cases.
Sometime during this first decade period I was called to Holy Family Hospital around midnight to see a life threatening rash. When I got to the hospital around 1 AM the woman around age 33, with 3 children was in a coma and covered with vesicles consistent with herpes simplex. At first I was angry that I was called to see a terminal case (she had advanced Hodgkins Disease) at that hour in the morning. Then I assumed self righteous indignation as I considered the life of a 33 year old woman with 3 children and the necessity for her to live. Ultimately I called a former mentor, Nancy Esterly to ask if she had heard of anything to treat disseminated herpes simplex. She told me there was an ongoing study at the University of Chicago with a new drug that turned out to be acyclovir. I called the hospital to get her in the study but she did not meet the requirement for admission by a single day. Somewhat distraught I decided to falsify her chart in order to make her admissible to the study. I then called her husband who called her priest and they declined my offer to transfer her because she would die anyway. I became passionate and perhaps irrational as I pursued both men and appealed to them on behalf of her children that she deserved a chance to live. By 8AM they had relented and I called the University of Chicago to have her transferred. Ultimately she was and I heard nothing for 3 months. One day I received a phone call from a doctor at the University of Chicago. He inquired about who I was and confirmed that I had treated and transferred the patient to their care. He wanted to inform me that she had lived. He then asked if I had falsified the chart. I nervously confessed that I had and he responded "You are a very brave doctor". Then he explained that she lived in spite of the fact that she had received a placebo drug. Deflated, I expressed that I hadn't needed to send her after all. Not so he replied. The intense care she received at the University had saved her life and had she remained at the local hospital she would have perished.
As a poor student I did not spend the time necessary to learn the facts of medicine. Many if not most students knew more facts and would score better on tests. Perhaps my saving grace was empathy or sympathy for ill patients. As someone who moralized frequently adn had passion around political ideology though I vacillated as a student from left to right and only later in life to left again I was passionate about my beliefs, argumentative, and confrontational. My penchant to get angry with any figure who was powerful vis a vis me or for that matter did not support my opinion or whose opinion conflicted with mine aroused an emotional outburst that ight or might not be rational.
One night I was moonlighting in the ER of Central Dupage Hospital when I got a code blue announcement in the ICU. I ran up and there was a man in cardiac arrest. The nurse quickly told me he was 35 years old and had several children. I never inquired, to my memory, why he was in ICU, but had an immediate reaction that I would not let him die. As a child I believe in the 1950's was a popular TV show called BenCasey and in one episode he treated a man in cardiac arrest by injecting his heart with epinephrine. I had never seen the procedure performed as a physician. I asked the nurse for a cardiac needle and 1 cc of epinephrine. I inserted the needle and advanced it forward to the left of the sternum and upon withdrawing blood I injected the epi. The man revived within the minute to my recollection. By that time the cardiologist oncall arrived and examined the patient. He came to me and asked, do you know what the odds were of you injecting the heart? I said no. He said 1:1000. I was puzzled and pleased. The man died the next morning I believe of a bleeding aneurysm of the brain. As I think about the case I am confused how I had the chutzpah to inject someone's heart based solely on a TV show I had watched as a child. That emotional reaction, or over-reaction) characterized my career for better or worse. In retrospect was such a heroic measure justified in a man with a bleeding aneurysm, even more so by someone as unqualified as I was? I think not. I believe I have a genetic defect that dictates my emotional response dominating any intellectual response to my environment. While it has led me to help many people during my career it has caused me great harm and suffering at the hands of those I have offended. And at this time it has aused my to have performance anxiety which has not infrequently been incapacitating when attempting public speaking or situations where I interpret confrontation.
So many anecdotes. Working at Holy Family Hospital I was probably the only dermatologic hospitalist on staff or at least functioning as such. A patient came to me suffering from a severe case of pustular psoriasis with generalized erythroderma. The patient was a carpet salesman and owned his own business. I hospitalized him after which began a series of organ shutdowns that necessitated involvement of a variety of specialists including general surgery, nephrology, GI, and probably internal medicine. At one point he had a surgical emergency involving the bowel, perhaps necrosis, for which no surgeon would operate because the chance of surviving surgery was so slim. I prevailed upon a Syrian immigrant who became US citizen who was notoriously brave (recklas?). He consent to perform the surgery. The man was in a constant state of critical . Each night I had a meeting with his wife and I would explain which organ had or was failing. That night she would turn to her worldwide prayer group and they would pray for recovery of the organ and each morning I returned to the hospital expecting to find the man dead only to observe that the organ in question had again begun to function. Similarly he survived surgery when there was no reason to believe it was so. In the meantime his psoriasis cleared, I think because of systemic steroids. At the end of probably a month the patient left the hospital ambulatory and having lost much weight looking more fit. We had a discussion that he would have to reduce stress in his life and work less and in fact he did sell his business. I never saw him again and I presume that for at least a time he maintained remission.
GYNECOLOGIC DERMATOLOGY
So many memories but the bad ones stick out. A shame but bad memories are more powerful than good.
A 16 year old girl was referred by a gynecologist because of persistent infection. She was accompanied by her mother. I examined her with her mother in the room and concluded there was a good chance she had a mixed infection of gonorrhea sand chlamydia. The patient denied sexual experience. I asked th emotehrfd if I could speak with the girl alone and left trhe room while she got dressed. When I returned I told the girl that it was most likely she had a venereal disease and I had taken cultures. If she would give me the name of her contacts I would contact the boy for treatment. (which I did). Otherwise the State would contact ehr as a result of the culttures and she would have to give a detailed histoyr, I told hewr IO would not divulge any of this to her pareents. The girl gave me the name of a boy and I contacted the bpoy and he came in and I htink I gave him penicillin or some oral med probably teteracycline. I never saw the girl again. I assume she saw another doctor. The next day a man over 6 feet tall came into the waiting room and demanded to see me. I was nearby so I asked him what he wanted. He told me he was the girl's father and demanded I give him her diagnosis. I refused and he began to butt me with his chest. I turned to the receptionist and told her to call the police. I told him the girl and I had a confidential relationship and I would not communicte with him. I told him the polic would be there in another mionute and if he left immedicately I would not press charges. The amn left. Several months later I received notice that the girl was suing me for mental anguish. I discussed the case with my attorney and since I bore no ill will toward the patient but felt abused by her attorney I instructed my attorney to sue her attorney for malpractice. My attorney demurred but I insisted aand he did sue him. Several days later the attorney offered to drop his case if I would drop mine and I agreed. I have such a history of puting myself in uncomfortabel psotiitons whern I considered it a matter of principle. In retrospect I should have discussed the case with the mother. The cultruews should have been sent to the state where they would contact her. I shopuld not have been so self righteous. My system I thinking ususally supercedes rational judgement though my hear is in the right place.
I had a sort of friend mentor internist who referred me a hospitalized case of scalded skin syndrome . I stayed up all night with her and in the morning when the internist made rounds I greeted him and said thanks you Dr. ___ for trusting me to take care of this very difficult case., Ed, he said, at my age I am happy to give you all my difficult cases.
Sometime during this first decade period I was called to Holy Family Hospital around midnight to see a life threatening rash. When I got to the hospital around 1 AM the woman around age 33, with 3 children was in a coma and covered with vesicles consistent with herpes simplex. At first I was angry that I was called to see a terminal case (she had advanced Hodgkins Disease) at that hour in the morning. Then I assumed self righteous indignation as I considered the life of a 33 year old woman with 3 children and the necessity for her to live. Ultimately I called a former mentor, Nancy Esterly to ask if she had heard of anything to treat disseminated herpes simplex. She told me there was an ongoing study at the University of Chicago with a new drug that turned out to be acyclovir. I called the hospital to get her in the study but she did not meet the requirement for admission by a single day. Somewhat distraught I decided to falsify her chart in order to make her admissible to the study. I then called her husband who called her priest and they declined my offer to transfer her because she would die anyway. I became passionate and perhaps irrational as I pursued both men and appealed to them on behalf of her children that she deserved a chance to live. By 8AM they had relented and I called the University of Chicago to have her transferred. Ultimately she was and I heard nothing for 3 months. One day I received a phone call from a doctor at the University of Chicago. He inquired about who I was and confirmed that I had treated and transferred the patient to their care. He wanted to inform me that she had lived. He then asked if I had falsified the chart. I nervously confessed that I had and he responded "You are a very brave doctor". Then he explained that she lived in spite of the fact that she had received a placebo drug. Deflated, I expressed that I hadn't needed to send her after all. Not so he replied. The intense care she received at the University had saved her life and had she remained at the local hospital she would have perished.
As a poor student I did not spend the time necessary to learn the facts of medicine. Many if not most students knew more facts and would score better on tests. Perhaps my saving grace was empathy or sympathy for ill patients. As someone who moralized frequently adn had passion around political ideology though I vacillated as a student from left to right and only later in life to left again I was passionate about my beliefs, argumentative, and confrontational. My penchant to get angry with any figure who was powerful vis a vis me or for that matter did not support my opinion or whose opinion conflicted with mine aroused an emotional outburst that ight or might not be rational.
One night I was moonlighting in the ER of Central Dupage Hospital when I got a code blue announcement in the ICU. I ran up and there was a man in cardiac arrest. The nurse quickly told me he was 35 years old and had several children. I never inquired, to my memory, why he was in ICU, but had an immediate reaction that I would not let him die. As a child I believe in the 1950's was a popular TV show called BenCasey and in one episode he treated a man in cardiac arrest by injecting his heart with epinephrine. I had never seen the procedure performed as a physician. I asked the nurse for a cardiac needle and 1 cc of epinephrine. I inserted the needle and advanced it forward to the left of the sternum and upon withdrawing blood I injected the epi. The man revived within the minute to my recollection. By that time the cardiologist oncall arrived and examined the patient. He came to me and asked, do you know what the odds were of you injecting the heart? I said no. He said 1:1000. I was puzzled and pleased. The man died the next morning I believe of a bleeding aneurysm of the brain. As I think about the case I am confused how I had the chutzpah to inject someone's heart based solely on a TV show I had watched as a child. That emotional reaction, or over-reaction) characterized my career for better or worse. In retrospect was such a heroic measure justified in a man with a bleeding aneurysm, even more so by someone as unqualified as I was? I think not. I believe I have a genetic defect that dictates my emotional response dominating any intellectual response to my environment. While it has led me to help many people during my career it has caused me great harm and suffering at the hands of those I have offended. And at this time it has aused my to have performance anxiety which has not infrequently been incapacitating when attempting public speaking or situations where I interpret confrontation.
So many anecdotes. Working at Holy Family Hospital I was probably the only dermatologic hospitalist on staff or at least functioning as such. A patient came to me suffering from a severe case of pustular psoriasis with generalized erythroderma. The patient was a carpet salesman and owned his own business. I hospitalized him after which began a series of organ shutdowns that necessitated involvement of a variety of specialists including general surgery, nephrology, GI, and probably internal medicine. At one point he had a surgical emergency involving the bowel, perhaps necrosis, for which no surgeon would operate because the chance of surviving surgery was so slim. I prevailed upon a Syrian immigrant who became US citizen who was notoriously brave (recklas?). He consent to perform the surgery. The man was in a constant state of critical . Each night I had a meeting with his wife and I would explain which organ had or was failing. That night she would turn to her worldwide prayer group and they would pray for recovery of the organ and each morning I returned to the hospital expecting to find the man dead only to observe that the organ in question had again begun to function. Similarly he survived surgery when there was no reason to believe it was so. In the meantime his psoriasis cleared, I think because of systemic steroids. At the end of probably a month the patient left the hospital ambulatory and having lost much weight looking more fit. We had a discussion that he would have to reduce stress in his life and work less and in fact he did sell his business. I never saw him again and I presume that for at least a time he maintained remission.
GYNECOLOGIC DERMATOLOGY
So many memories but the bad ones stick out. A shame but bad memories are more powerful than good.
A 16 year old girl was referred by a gynecologist because of persistent infection. She was accompanied by her mother. I examined her with her mother in the room and concluded there was a good chance she had a mixed infection of gonorrhea sand chlamydia. The patient denied sexual experience. I asked th emotehrfd if I could speak with the girl alone and left trhe room while she got dressed. When I returned I told the girl that it was most likely she had a venereal disease and I had taken cultures. If she would give me the name of her contacts I would contact the boy for treatment. (which I did). Otherwise the State would contact ehr as a result of the culttures and she would have to give a detailed histoyr, I told hewr IO would not divulge any of this to her pareents. The girl gave me the name of a boy and I contacted the bpoy and he came in and I htink I gave him penicillin or some oral med probably teteracycline. I never saw the girl again. I assume she saw another doctor. The next day a man over 6 feet tall came into the waiting room and demanded to see me. I was nearby so I asked him what he wanted. He told me he was the girl's father and demanded I give him her diagnosis. I refused and he began to butt me with his chest. I turned to the receptionist and told her to call the police. I told him the girl and I had a confidential relationship and I would not communicte with him. I told him the polic would be there in another mionute and if he left immedicately I would not press charges. The amn left. Several months later I received notice that the girl was suing me for mental anguish. I discussed the case with my attorney and since I bore no ill will toward the patient but felt abused by her attorney I instructed my attorney to sue her attorney for malpractice. My attorney demurred but I insisted aand he did sue him. Several days later the attorney offered to drop his case if I would drop mine and I agreed. I have such a history of puting myself in uncomfortabel psotiitons whern I considered it a matter of principle. In retrospect I should have discussed the case with the mother. The cultruews should have been sent to the state where they would contact her. I shopuld not have been so self righteous. My system I thinking ususally supercedes rational judgement though my hear is in the right place.
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