Page 19 - Volume 69, Number 4
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As I was getting her worked up, my 83 year old with upper respiratory problems suddenly became aphasic and perseverating in her speech – snap! – just like that. It seems a pretty clear case of stroke, probably from the fibrillating left atrium.
On the last day of my rotation on Peabody 2 I wrote detailed off-service notes on my patients and had a disagreement with the assistant resident over discharg- ing my patient who had had a possible pulmonary embolism. [The diagnosis was purely clinical – there were no lung scans or CT’s that would confirm the diagnosis or rule it out.] She had evidence (what kind,
I don’t record) of hepatosplenomegaly, but her liver function, as measured by BSP excretion, was normal.3 Her reticulocyte count was slightly elevated, not enough to say she had hemolysis, but not normal either. My reflection on trying to write her discharge summary was:
Life is always like this at 2 AM. Some things are just never clear-cut, and my natural inclinations are quite different from those who have been around longer. Dick Cashion, the assistant resident and a good man, protested that I couldn’t just send her home without a diagnosis. I said, she feels fine and she wants to go home and if she stays much longer she’ll begin to think she sick. He pointed out that hepatosplenomegaly doesn’t just happen.
I don’t record who won the argument, but the example shows the extraordinary amount of responsibility rested on the student’s shoulders in that setting. It also highlights the fact that once patients left the hospital, they often had no other reliable source of care.
Part II of this story will appear in the January 2018 issue of the Bulletin
3 The bromsulphalein excretion test was a now-obsolete test of hepatic function performed by injecting BSP intravenously and measuring the residual dye in the bloodstream after 45 minutes.
The Power of the Home Visit
(Continued from page16)
door. He was surprised but clearly pleased, and invited me into the living room. There sat my patient in front of the TV, oxygen off, eating handfuls of potato chips out of a family-sized bag! She froze when she saw me. After saying hello, I explained that I happened to be in the neighborhood and thought I would stop by to see how she was doing. Then I said, “Oh, my goodness, Ethel*, where is your oxygen? It’s really bad for you to be without it! No wonder you have been having problems! And those potato chips are so salty, they are like poison for you!” I listened to her heart and lungs, and marveled out loud that she sounded OK so far. Then I reinforced that if we were going to keep her healthy she would have
50 Years
By Stephen G. Landau, MD
My medical career began around age four when I decided to become a Doctor. In high school I was briefly sidetracked by thoughts of being a photographer but soon realized that unlike medicine, photography could be pursued as a hobby as well as a profession. I got my MD at the University of Michigan Medical School (UMMS) and did a straight medicine internship at Beth Israel Hospital, Boston, which later built an ICU and became famous not just as a Harvard teaching hospital, but also as the actual HOUSE OF GOD. I recall to this day making rounds with the supposedly fictional but all too real “attendings” later portrayed in the novel.
I did Psychiatry at University of Colorado and later did research at NIMH in Bethesda for two years in USPHS before returning to UMMS and setting up the Emergency Psychiatry Service at University Hospital. I later taught in the outpatient department and started a private practice.
Over the years, research areas have included medical education, average evoked response in schizophrenia and bipolar disorder, and the association between layoff and depressive illness.
I served as an examiner for the American Board of Psychiatry and Neurology. I was on the Oakland County Community Mental Health Services Board during a period of time that I practiced in that area. Throughout the years, direct patient care has always provided the most professional satisfaction in my life followed closely by teaching and the fellowship of my colleagues.
Since retiring in 2010, I have learned to enjoy life and leisure on a QD rather than a PRN basis. I attend classes at the University of Michigan in areas totally unrelated to a premedical curriculum. My writing since retirement has consisted mainly of fart-joke laden short stories for my granddaughter; to date none have appeared in a refereed journal. I am however, considering submission of “Santa and the Jet Propelled Reindeer” to an appropriate journal if I can find one.
to help me help her by following my recommendations! Wide-eyed and embarrassed at having had her transgressions discovered, she agreed to do so. Her husband later told me his wife had been so shocked that I would take the time to come to her home that she got serious about taking better care of herself!
Requiring patients to come to the office is more efficient than paying a visit to a patient’s home. Home visits can help you appreciate and solve problems while also teaching things that cannot be done any other way. I hope Primary Care physicians will always include home visits as a tool in their toolbox!
*Not her real name.
Volume 69 • Number 4 Washtenaw County Medical Society BULLETIN 19

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