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The Soul of Medicine-Tales from the Bedside-

This collection of anecdotes, written by Sherwin B. Nuland, portrays different doctors from an array of specialties that each write about their most memorable patient. The medicine spoken about in this book is from an earlier era, which shows the best and the worst moments of many surgeons and doctors. Each chapter in this book consists of a different unrelated story from the previous, yet all are recollections of Dr. Nuland’s peers while he was doing his residency in Yale-New Haven Hospital. In the book he disguises the hospital as “Canterbury”. The book cannot merely be summarized in one paragraph; therefore, it will be subdivided into chapter summaries.

Chapter Summaries

1.     The Surgeon's Tale

The patient’s Name was Jimmy Tyson. The 19-year-old boy arrived to the hospital with a 103 fever and an opaque left side chest x-ray. Jimmy had a hole in his Diaphragm from a previous incident with a blade which caused his transverse colon to perforate into the thoracic cavity. Jimmy spent a total of 3 months in the hospital recovering from the numerous surgeries and other treatments.

2.    The Family Physicians Tale

The patient’s name was Arlene Williams. She was a 32-year-old woman who visited her family physician for a 3-centimeter lump on her left breast. While doing the pelvic exam, they discovered she had an abnormally thick hymen. Performing the excision of the hymen did not take long, however when removing the breast lump, they found she had an aggressive form of cancer and would need a mastectomy. Within six months, her cancer metastasized, and she died a year later. A woman of her age and diagnosis would be subject to a less aggressive treatment and would have a longer life span with modern medicine.

3.    The Dermatologist's Tale

The Patient’s name was Joan Carson. She developed a rash on her upper eyelids which no doctor could seem to cure. She had tried all sorts of medicine, whether it be allopathic or orthodox medicine. She was then suggested that she should visit Canterbury. There, the source of her rashes was identified; she suffered from a rare type of dermatitis which flares up with CPB. This is an ingredient that is found in many shampoos and conditioners which also happened to be in her favorite shampoo.

4.     The Gastroenterologist's Tale

The patient’s name was Aaron Shultheis. He was an old man who was admitted to the hospital due to advanced osteoarthritis of his knees and hips. This patient was particularly special; he was a survivor of Auschwitz. Blood was found in his stool which then led to the discovery of a four-centimeter polyp near his anus. Although a cardiac workup was done before doing the procedure, Aaron died of cardiac arrest due to the surgery.

5.    The Obstetrician-Gynecologist's Tale

The patient’s name was Jean Tucker. She was an army wife that was pregnant for the first time. She was aware she had a defect in her reproductive organs, but no tests showed any results. When she went into labor, she was having unbearable pain which was very uncharacteristic of her since she always remained calm. When exanimated, it was discovered she had a double vagina which restricted her from being able to deliver a baby due to lack of stretching. By cutting the septum, she was able to dilate and successfully deliver the baby.

6.    The Ophthalmologist's Tale

The Patient’s name was Laura Taylor. She was the daughter of Harry Ransom, the officer in charge of the doctor’s unit at the Gunter Air Force base where he was stationed at. Laura was admitted to the hospital with severe abdominal pain. She showed symptoms of pregnancy, yet denied all suggestions. Mrs. Ransom was insulted the Doctor would suggest such a thing, and when she began to leave with her daughter, the baby began coming out and was successfully delivered afterwards. The Doctor was later assigned to move to the Landstuhl Air Force Base in Germany.

7.    The Cardiologist's Tale

The Patient’s name was Joe. He had first met Joe in 1982 when he was rushed to the hospital due to congestive heart failure. After having various procedures done, he had a balloon pump inserted into his aorta. However, even that was insufficient, and he required a coronary artery bypass graft. He was well until approximately fifteen years later where he was suffering from mild-to-moderate congestive heart failure. Additionally, he had a defibrillator installed in order to keep his heart beating. His doctor became very fond of Joe and was fascinated by all his stories he would always tell during their visits. During one visit, Joe was handed a blank prescription that said, "One set of Memoirs." Joe was thrilled and promised he would surprise the Doctor with what would be written in the book. Joe immediately began working on the book by dictating what he wanted written to his granddaughter. Joe finished the book and dedicated it to his Doctor, and by then he was ready to die. Neither of them wanted his cause of death to be due to his congestive heart failure, so they decided to arrange for Joe's defibrillator to be turned off. Joe died two hours prior to his appointment for his defibrillator to be turned off.

8.    The Pediatric Cardiologist's Tale

The patient was a three-year-old girl named Patty Crawford. She suffered from Pulmonary stenosis, where her valve which separates the right side of the heart from her lungs was narrowing down. This caused her to have low oxygenation and stunted development. Dr. Krane was assigned to operate on Patty yet was always waiting for the perfect time to perform this complex surgery. He was infamous for avoiding operations by either hiding instruments or canceling an operation due to deviations in blood levels or faint rashes. The day of Patty’s surgery, the valvulotome was missing as many of the staff predicted. Jim Hartenberg, the chief of Pediatric Surgery, was furious and once he found the tool that was hidden in Dr. Krane’s desk he made Dr. Krane go operate. The surgery went smoothly, and Patty was able to live a normal, successful life.

9.    The Anesthesiologist's Tale

The patient of this tale was Morton Cantrell. He was a fifty-five years old man who visited the hospital after experiencing severe abdominal pain nausea after eating an unhealthy meal. When Dr. Mansfield checked him up, he discovered a couple of small stones which he suggested he could get surgery to remove. It was known that Dr. Mansfield suffered from a psychiatric condition, but nobody knew what it was. It had never before hindered his abilities to operate or displayed a change in his behavior until the day he had to operate on Morton Cantrell. When he stepped into the OR, he kissed the head nurse’s forehead and caressed her left breast. He proceeded to then make dirty jokes as he entered the scrub room. Seeing as he was a respectable Doctor, the nurse said nothing and did nothing concerning the matter. Once the operation began, he had cut into the patient’s stomach within a minute, had removed the gallbladder in approximately two, and had begun to cut into the stomach. He completely disregarded all small vessels he cut, which as a result just squirted blood everywhere. He managed to cut out a perfectly healthy section of the patient’s stomach and place it on a tray, and then proceeded to performing a transverse cut on the aorta. An orderly pinned him to the floor in order to prevent further harm to the patient. Morton Cantrell sued, which resulted in the Dr. Mansfield losing the lawsuits and his medical license. Cantrell became a multimillionaire and never suffered from any post-operative complications. This all was a result of Dr. Mansfield doing an “experiment” to see how he would act after pausing his bipolar disorder medication for three weeks while on vacation with his family.

10. The Neurosurgeon's Tale

The patient in this tale is a two-year-old boy who was rushed to the OR with a serious head injury after his mother’s boyfriend threw him against the wall out of anger. He had bruises all over his body and a tear in his rectum. There was nothing that could be done, his injuries were too severe.

The second patient in this chapter is Maryann Dugan. She was first seen by the doctor before she was born; she was diagnosed with massive hydrocephalus which results in a larger head due. This condition is also referred to as “water on the brain”. After her C-section was completed, she was rushed to surgery where a shunt was placed and various procedures in order to decrease the proportions of her skull were performed. Maryann, like most kids with congenital hydrocephalus, suffered from seizures and had to have her shunt revised but other than that her recovery was successful.

11. The Chest Surgeon's Tale

This tale begins with a fourteen-year-old patient suffering from patent ductus arteriosus, a condition where an artery which is supposed to only function during prenatal life to allow blood to pass through the lungs remains open after birth and allows too much blood to flow into lung tissue. A distinguishable feature of this condition is a very harsh murmur heard through a stethoscope. When operating the boy, Dr. Catledge grabbed the ductus with his bare hand and examined it. Carl Swenson, the chief of the thoracic section, was furious that Dr. Catledge had invaded the surgical area with unsterile, ungloved hands. Swenson proceeded to throwing hemostatic clamp to his face and then chasing him around the hospital. Dr. Catledge could not return to work there but had luckily acquired a job at a hospital in Northern Michigan. Years later, he would have to present Carl Swenson’s farewell speech at his retirement dinner.

This tale does not include a patient, but rather focuses on a resident. He was a married man who realized him, and his wife did not match well after he returned from war. This situation caused him to have flings with nurses working at the hospital. His main location for these flings was a place under construction in the hospital that was banned from entering. Hilda McIntire was the night nursing supervisor that had begun to catch on to the doctor’s late-night adventures in the construction place. One night, she entered the site with a flashlight pointed at the doctor and his conquest. She threatened him, saying she would have him fired but he was one step ahead. Instead, he visited the executive president of the hospital in the early morning to tell him that Ms. McIntire had been found in the banned construction area, which in fact was not her first time there and suggested she goes there to drink alcohol.

12. The Medical Student's Tale

This tale involved a young third year medical student named Chip and a patient called Peaches Pasqualoni. He came to the ER with severely swollen genitals. Although married, he spends his Friday nights at a whorehouse. During his last visit there, he received various nips which got him to the condition he was in. During surgery, cuts were made into the foreskin and slip drains were placed. Chip volunteered to change the drains for the patient every day, twice a day. He eventually was elected Alderman Pasqualoni, and with that position, he decided to shut down the whorehouse.

13. The Geriatrician's Tale

The patient’s name was Jean Michaels and she suffered from pain in the joints of her ankles. She was fifty-five years old, which is younger than most patients that are referred to this specialty. After doing a chest film, the found a small lung cancer that would be able to explain the clubbing she was experiencing in her fingertips and the arthritis symptoms. She had tried numerous treatments, yet none had seen to work until she arranged for the surgery with Sam Carstairs. After the surgery, she no longer suffered from arthritis pain and never had long cancer again.

The second tale in this chapter is about Franklin, a man in his sixties who suffered from Behcet. Behcet is a disease that causes ulcers in the mouth and genitals. He has received various treatments for his condition, such as numerous eye operations, chronic cortisone therapy, and anti-immune medication. Yet, none of these treatments seem to work. One day, Franklin came into the office after finding research that thalidomide can help with his condition. This medication caused child deformities in the 1960’s and was not FDA approved but after six months, the medication was able to be attained and Franklin’s ulcers were healing. Eventually, he was able to get off the steroids and live a happy life.

14. The Bronchoscopist's Tale

Botu Adunabadajo, or as named in his passport Reginald Farnsworth, was an African physician who was taken to London by Sir Russell in order to train African physicians with skills of Bronchoscopy they could take back home. The patient was a five-year-old girl who had flown to London for Sir Russel to remove a small foreign body from her left lung tissue. She had inhaled a metallic cap when trying to inflate a large rubber inflatable. During surgery, Sir Russel demonstrated how to remove the cap with forceps and a scope but when pulling upwards, the cap fell into the deep right lung. The cap could not be found this time, which required the team of doctors to open the little girl’s right chest and search for the foreign object. It was successfully removed, yet not ideal since she traveled to London specifically to for Sir Russel to perform this procedure as minimally invasive as possible.

15. The Internist's Tale

The patient in this tale was Harold Bernstein, a forty-five-year-old man who was moved to Canterbury hospital due to his condition of aseptic meningitis. This condition is usually infected virally, but other factors can contribute. The results of his spinal tap did not provide any solutions for Harold’s illness, which only seemed to worse every day. The doctors could not find a diagnosis but miraculously on the third week of being in the hospital Harold began getting better. This improvement was not due to anything the doctors did, and still remains a mystery because he never relapsed.

16. The Surgeons Second Tale

The Patient in this tale is Austin Carruthers, a man who came from a loving family. This tale is similar to the previous Surgeons tale, the first tale told in this book. The difference is that the first patient, Jimmy Tyson, came from a troubled background. Both patients, however, received damage to the diaphragm. He arrived at the hospital with what he assumed was a dislocated shoulder. What he remembered from his injury was being slammed on to the floor and landing on his left rib cage. The doctor sat him down and assured him he had his spleen removed, which had been cracked in the fall. The hematoma was pushing against his diaphragm. The surgery had no complications. Austin’s father was the Vice president of Pan-Am, that out of gratitude, sent the doctor the plane tickets for London he requested.

17. The Nephrologist's Tale

The patient from this story is named Lou Rizzo. This is a patient that was very close to the doctor depicted in this tale, seeing as he treated him for fifteen years. Lou was born with type I diabetes that caused him to go into kidney failure. He required a transplant at the age of seventeen, but his life really changed after receiving a pancreas transplant. However, seven years later, his pancreas began to fail. His case was presented among several Doctors in an amphitheater, where the next steps for his treatment was discussed. All the doctors were convinced the best plan of action would be to not a second transplant. However, Lou decided to speak in front of all the medical staff that was present and shared with them how difficult it was to live with his illness. He asked for them to attempt a second transplant. His wish was granted, and he received the transplant as well as various medications to avoid rejecting it. Shortly afterwards, his condition began worsening he was going into kidney failure, congestive heart failure, and was being considered for a cardiac transplant. Apart from all of this, he suffered from a hemorrhagic stroke which ultimately led to his respirator being turned off.

18. The Neurologist's Tale

The patient’s name in this tale was Janice Carpenter, a forty-one-year-old woman suffered from Lou Gehrig’s disease. However, she ended up living twice the life expectancy that was predicted. During her stay at the California Hospital, she spoke to senior medical students and they were all awed by the conversations they had with her. She eventually became quadriplegic and could not speak or move her muscles, but technology was developed so she could communicate through Morse code. Despite her condition, when asked how she felt about life in her condition, she replied saying she loved life and considered it a gift

The other patient in this tale was named Kate Mueller. She met her husband, Walter, at a young age and remained in love with him throughout her life. They were both very happy and in love with their idealistic American home and family. At the age of eighty, Kate died from a cerebral hemorrhage. Walter was distraught and for months would only speak about Kate or stare at pictures of her, reminiscing. A year after her death, he suffered a transient ischemic attack which caused him to have hallucinations. He would hallucinate about Kate. When recommended a medication that would stop these hallucinations, he rejected them, preferring to be able to see his beloved wife Kate.

19. The Urologist's Tale

The patient of this tale is Igor Gronski, the first patient in Canterbury to receive a Kidney transplant. He was able to receive the kidney from a Canterbury junior who was sadly declared brain dead after a car accident. After his transplant, he received cortisone injections in order to prevent rejection. However, there wasn’t a standardized dose to administer to patients. Igor died within days of the surgery due to an overdose in cortisone.

20. The Pediatrician's Tale

The patient in this tale is a four-year-old boy with congenital hydrocephalus. His condition was said to be “arrested” which meant he did not require a shunt. His mother was very concerned with his condition and acted in a manner that almost tiptoeing around him, fearing the worst. She would take him in for routine visits every three months where they would measure his head, ask a few questions, and then send him off. After the doctor reassured his mother, they agreed for the little boy to not come as frequently; only regular checkups were necessary.

21. The Narrator's Tale

The last tale is different from any other tale told in this book. Rather than speaking of the most memorable patient, this tale is about the most memorable doctor the narrator has had the pleasure of meeting. Danny Farber enlisted to be a medical officer for the Army Air Force. He would treat those who were wounded, but Danny wanted to experience seeing how these wounds were acquired in order to be able to understand them and treat then better. He then was brought to a raid in Strasbourg but on the way back, the aircraft he was in was hit and therefore crashed. There were only two survivors from the crash, him and a crew member. After being treated in a military hospital in Spain, he was discharged in 1945 and immediately returned back to complete his medical residency in Anesthesiology. He opened a department of Anesthesiology at Columbia and also became the chief. Throughout his lifetime, he earned various awards and honorary titles due to his achievements. He died of a cerebral hemorrhage at age eighty-seven.

References:

Nuland, S. B. (2009). The soul of medicine: tales from the bedside. New York, NY: Kaplan.