Autumn 2005
ARTICLES A case of glimmering gloom This patient, perhaps history's most famous invalid, was confined to bed for almost three decades with insomnia, anorexia, nausea, irritability, and depression. Since her death almost a century ago, historians and biographers have argued over the etiology of her illness. Some have suggested that it was an extraordinarily protracted case of brucellosis acquired during her service in the Crimea, others that it was simply a form of neurosis steeped in self-pity. Who was this famous patient, and what diagnosis best explains the full spectrum of her strange illness?
The mother of us all: Boston City and the Thorndike After the First World War, the Harvard Medical Unit at Boston City Hospital and its associated Thorndike lab reformed the way medicine was taught and practiced in municipal teaching hospitals. Medical training programs countrywide soon followed Boston's dictum that laboratory and clinical experience were indispensable to each other, and both necessary for the training of young physicians. One could bring science from the bedside to the lab bench and back again-and also serve the medically needy. The Boston City/Thorndike model was a caring and curious doctor who could enjoy the luxury of doing good. The house staff memoirs of the Harvard Medical Unit at Boston City Hospital at its zenith in the 1930s are tribute to doctors and patients alike. They are also the story of medicine before Medicare and Medicaid and penicillin.
Glory days: What price glory? Training of resident physicians is undergoing major needed alterations in the climate and work hours that have characterized house staff training for close to a century in medical institutions throughout the United States. Description of the Osler medical residency training program from Johns Hopkins in the 1960s puts into bold relief the strides that have been made recently in many programs. These innovations may avert the unrecognized or unacknowledged toll that was the trade-off for the total immersion in medical training that such programs demanded of their "iron" men.
PERSPECTIVES Lessons from the ICU I was to find the ICU very much educational on this day. "I heard he was being discharged tomorrow." Discharged? This patient was nowhere near discharge. Fresh from reading the patient's chart and with the strength of prognosis, morbidity and mortality post stroke, I felt confident in attacking. This was my second mistake. My first? Not identifying the guest. Now, I am better from having this experience. I have learned to introduce myself to patients and family members, to identify people in a hospital room, to go to the bedside first and ascertain the identity of patients. I have also learned to be more receptive to patient and family views and to understand the genesis and reasons for those views. And I do not rely solely on printed lists for the identity of patients in the various hospital rooms.
POETRY Scents The EKG Marching Band Pining When Parents Die My Trembling Aspen |
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