Page 18 - Volume 69, Number 4
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disease. Two days after that (the prodromal headache having evolved into full-blown influenza) I was sick with a 102° fever and unable to function. An Asian flu epidemic was spreading up the East Coast and I was one of its victims.
I was so debilitated that I dragged myself from my dorm room down to the small Health Service clinic in Vanderbilt Hall, which was being staffed that day by
Dr. Hermann Blumgart, the distinguished Professor and Physician-in-Chief Emeritus at the Beth Israel Hospital, then in his early 70’s. I was quite surprised to see someone of his stature there.1 He was a compact, dapper, well-dressed man in suit and bow tie, with a noticeable German accent. He was kind, gentle, and solicitous. From him on that day I learned a lesson about what it could mean for a patient to have a real doctor. After his evaluation, he looked at me and offered these words of compassion: “Why don’t you come into the hospital and let me take care of you.” It was an offer I couldn’t refuse.2
My education as a patient was about to begin. ... It has been interesting to see a hospital from a patient’s point of view now that I’ve seen things from the other side. The needle that takes blood does hurt going in. And one does surrender his self-respect and pride and almost everything else when he enters, and needs reassurance.
As a result of my illness, I was off the wards for 10 days, not returning until the day after Christmas. My first patient after returning was a 46 year-old woman with pneumonia. The next admission was a 52 year-old “chronic lunger” with a history of tuberculosis. I was up until 4 AM doing acid fast stains on her sputum samples to see if she had active TB. I was exhausted again, but getting used to the feeling.
A cold wave hit Boston the day after the New Year began. For over a week temperatures hovered between -10 and +10. The city was paralyzed by cold and snow.
It was so cold at the City that the patients were hypothermic and, because of a shortage of blankets, were wrapped in laundry bags, or whatever else was handy, to keep warm On Peabody 1 where it was as cold as 56 degrees, one patient brought in off the street had a
(body) temp of 80°. (He recovered but was readmitted a few days later with gangrenous feet.) A fellow with myxedema had to be moved because he couldn’t generate enough heat. It (the cold wave) was amusing and taken in the hardy pioneer spirit by almost everyone – people at the City aren’t used to (having) much and don’t expect much – but it’s really pretty deplorable.
I admitted an 83 year-old woman with chronic renal failure and hyperosmolar diabetic ketoacidosis and once again was up all night.
After 1100 units of insulin and 6-1/2 liters of fluid her diabetes seems under control, her mouth is closed and she is breathing normally; and she now grunts
and grimaces. She has a ways to go yet, though, and after ? hours of anuria, her renal status is far from clear. Her creatinine was 6, BUN 125. She’s been a good prep to work on and watch, though. I did my first femoral artery and vein sticks, and my first LP – a failure but I didn’t get shook. I had the fun of explaining all about her to 8 or 10 student nurses.
Dialysis was never a consideration. I’m not sure whether it was even available. She died a few days later from renal failure. I called her granddaughter, my first time calling a family member to report a death: “I think I broke the news gently enough,” but an autopsy was refused.
Hers was one of 3 patient deaths that occurred that day. One was an old alcoholic on the male ward: “I arrived on the scene in time to loan (the resident) my flashlight with which to demonstrate the patient was fixed and dilated.
I watched his EKG pattern slowly spread out and then disappear.” The other was a woman in her 60’s with tense ascites, splenomegaly, and a massive upper GI bleed. She had been transferred from another hospital because of the shortage of blood resulting from the cold wave.
I stayed and helped the team do iced saline lavage on her all night, in part because I couldn’t get my car out of the frigid, snow-covered parking lot. She exsanguinated.
I didn’t record this, but I have an indelible memory of the surgery chief resident sitting in a chair near the foot of the bed, watching if not this bleeding patient a similar one, but not lifting a finger to help. I found this unforgiveable.
The following week brought a flurry of cardiac arrests. A woman who had been admitted with pneumonia with a pCO2 of 80 a week earlier died despite a tracheostomy and being placed on a respirator. There was of course no ICU as we would think of one today, and no way to monitor her. A GI bleeder on the male ward, who surgery turned down for any kind of operation, died the next day. A woman with pulmonary edema, for which there was no effective treatment at the time, died. Two more patients on Peabody 2 were close to death. My last day on Peabody 2 was another day of death, bringing the total for the week to 8: 2 from pneumonia, 3 from diabetes or its complications; 2 from cardiac problems and 1 from bleeding varices.
Having nothing to compare this experience to, I looked for some bright spots in my 6 weeks on Peabody 2.
I admitted an 89 year-old lady in coma who responded to IV glucose in the storybook way that I didn’t believe happened. Her hypoglycemia was a surprise because she was not diabetic and not on insulin. But she came to with 50 grams of glucose.
1 Dr. Blumgart had been a pioneer in nuclear medicine and cardiol- ogy. In 1925, he did the first diagnostic procedure using radioactive indicators, essentially inventing the field of nuclear medicine.
2 Dr. Blumgart in his later years gave a lecture on the doctor-patient relationship, updating the earlier, famous talk given by Francis Weld Peabody (for whom the Peabody building at BCH was named) en- titled, The Care of the Patient. In his talk, Dr. Blumgart describes what he called “compassionate detachment” in patient interactions. NEJM 1964;270:449-456
Washtenaw County Medical Society BULLETIN OCTOBER / NOVEMBER / DECEMBER 2017

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