Faculty Bibliography

Ofri reviews The Body in the Library: A Literary Anthology of Modern Medicine edited by Iain Bamforth

Over the next few days, [Bill Porter] sobered up, but still looked shriveled and malnourished -- the classic cirrhotic. Despite his weakness, though, there was a sprinkling of Southern charm. Porter beguiled the staff in his weather-beaten voice with tales of being a ranch hand, a pharmacist, a bank teller -- all of which Dr. [Kamal Singh] found amusing, but hard to believe. Except the part about doing time for embezzlement. But alcoholics confabulate, often grandiosely, so when Porter said he was a world-famous writer, Dr. Singh knew that the alcohol had caused some permanent damage to the brain. Over the next week, Dr. Singh found that the days in the hospital were slightly less dreary. Porter's anecdotes were entertaining -- like the one about fleeing to Honduras to avoid the embezzlement trial -- and Dr. Singh felt almost inspired. Most alcoholics were lost causes, but just maybe he could get Porter into rehab. Dr. Singh poked his head into Porter's room before heading home on Dec. 24. Porter was barely visible beneath the sheets. ''Procure me a Christmas present, doc,'' Porter croaked, with a feeble wave of his stick. ''Impart a medicine to make me strong.''

He watched, amused, as I untangled the cellphones, chargers, headsets and microphones, plugging the various wires into their respective attachments. When I placed one ungainly headset on him, another on me, Mr. M. giggled, his white teeth flashing from his round face. We looked like telephone operators from the 1950's, or maybe diplomats at the United Nations. Using the small-print guide, I followed the six steps until I had to enter the desired language code. Spanish, Mandarin, Cantonese, Bengali. No French! Off with the headsets, wires and cellphones. I gestured what I hope indicated patience, as I resorted to the last and most expensive option, AT&T. Whatever one may think about AT&T, it has the best network of multilingual employees. In two minutes, a French-accented voice came through, and I sighed with relief. For the rest of our visit, we chatted happily, if a bit awkwardly, in our second languages. I learned that he'd studied Spanish at a university in Congo, and I told him that I'd studied in Mexico. He told me how he had immigrated from Africa two years ago, but first lived in Canada. I myself had lived in Canada, and we found more things in common. We laughed over our mutual difficulty with the street- slang Spanish in New York. And then we were able to review his medical issues and treatment, and I could be confident that he understood

Carmen came to my clinic because of a scalp condition. She was 37 years old, slender, casually but fashionably dressed, with the broad bill of a red baseball cap obscuring her face. During the course of my questioning, Carmen mentioned offhandedly that she had been having aches and pains on her left knee, her right shoulder, the back of her head and her stomach. She described pins-and-needles sensations in these areas for the past six months. Carmen smiled a tight smile, and we talked for a few minutes about general steps to maintain good health: Pap smears, balanced diet, exercise

Recently a memo was sent to all of the physicians in our department by a hospital administrator, a doctor who'd recently taken on a new role. The memo reminded us that mammograms were one of the 'performance indicators' that regulatory agencies use to monitor our hospital's quality of care. 'We realize that the controversial data regarding mammograms for women aged 40-50 are not resolved,' the memo said. 'However, we urge you to order this important screening test for all your patients over the age of 40.' I looked at my patient and wondered if, in the remaining minute of our time, I could do justice to this complicated issue. Could I adequately explain her risk? Could I explain that the oft-mentioned 1-in-8 number is really a lifetime cumulative risk of breast cancer that applies only to women in their 80s who haven't died of anything else? The statistic for women in their 40s is closer to 1 in 67. For women in their 50s, one life will be saved for every 2,500 mammograms. But for women in their 40s, it can take 5,000 to 10,000 mammograms to save a life. And for those women in their 40s, there will be many 'false positives': unnecessary biopsies with their attendant cost, risks and anxiety. Could I explain all that in one minute? Evidence-based medicine is a complicated issue. Meant to ensure more rigorous and consistent science, it often induces more confusion than clarity. In some ways, evidence-based medicine is more about treating populations than individual people. If it takes 5,000 mammograms to save one life, then the value of mammograms depends on who you ask. For that one person whose life was saved, the mammogram was nothing short of the messiah. For the other 4,999, it didn't change much in their lives, and maybe it was an annoyance or an unnecessary expense. And then there will be a few people who were actually harmed in some way by the procedure

The most thought-provoking stories, for me, were from the students whose issues were either invisible or rarely talked about in public discourse: the student who is a recovering alcoholic; the student in remission from obsessive-compulsive disorder; the student who is taking 6 instead of 4 years to complete medical training because of frequent flares of sickle-cell disease; the obese student who tries to retain her smile when she discovers that the school doesn't make scrubs or laboratory coats large enough to fit her; the single parent who knows that if she accepts a scholarship, she will jeopardise her chances of getting government benefits for her young child; the poverty-line student who is too proud, or too ashamed, to check off "financially disadvantaged" on the application forms, and has to take care not to get grease on his hands as he changes into his interview suit in the bathroom of his uncle's auto repair shop; the Muslim woman who knows that one item of clothing-her laboratory coat-will make others look at her with respect, while another-her headscarf-will cause many to look at her with suspicion; the devout Christian student who is ashamed because she does not defend her religion when her superiors make derogatory comments; and the Vietnamese refugee, the Mexican "wetback", the grandchild of four Holocaust survivors, and the Native American raised in downtown Los Angeles who all struggle with identity and legacy in a world rife with stereotypes about who doctors (and who Americans) should be

The blood pressure reading was printed at the top of Bernice Ruger's chart in blaring red ink, with three exclamation points added for emphasis. 200/110!!! This was my first time meeting with Ruger (not her real name), but I could tell we'd be spending a lot of time talking about hypertension, and how it causes strokes and heart attacks, and the urgency of treating such dangerously high numbers. Her chart listed at least three blood pressure pills, which -- from the numbers -- I assumed she wasn't taking. So I steeled myself for a talk about medication compliance.