Anecdotes from my Public I

 

Fifty plus years of practicing medicine has provided me with a wealth of anecdotes--some educational,

some humorous, all interesting.  I would like to share a couple more of these with you today.

       I was told in medical school that the physician may occasionally have the role of priest thrust upon him.  This is a confession that I may have failed my greatest such opportunity.

       This man came to me with a great variety of important medical and surgical problems over a period of several decades.  Many of the problems were rather bizarre.  On one occasion, he fell off his tractor which kept going and dragged a harrow over him (not a disc harrow).  The surgeons sewed him up and otherwise put him back together on this occasion.  There were other freak accidents and puzzling illnesses.  Finally, he had a series of intestinal obstructions.  Consultants could find no disease.  His intestines just stopped working on short notice for no apparent reason.  After recovering from several of these episodes, he came back in worse condition than usual and died.

       Over a period of a few weeks after his departure, I did some soul searching about what I might have been able to do to help this patient.  Then I remembered a conversation that we had years before in which he described how he had been tried for arson but acquitted.  You know about those days when dying cheese factories conveniently burned.  He hadn’t flat out told me that he deserved to be acquitted.  Suddenly, I had this insight: that an unpunished criminal with a near normal conscience might (subconsciously?) sentence himself to various punishments.  Since then, I have frequently regretted that I didn’t have this insight during his life and perhaps accepted his confession or arranged for some other professional to take the confession.  It might have saved his life.  I am aware that if this was a failure on my part, it was a personal failure and not a professional one, but a failure nonetheless.  Years later, I still ponder this occasionally.  To myself, I call it the Queequeg syndrome after the South Sea islander in Moby Dick who said he was going to die and sat on the deck for several days without moving until he did die.

       All of my more recent Queequeg candidates have had good physical reasons for wanting release.  I have confined my professional activities to keeping them comfortable and have left their confessionals to other professionals.

        In school we are taught many surprising things, including at times, why they are surprising.  Many medical students are taught that when patients ask the doctor his or her religious affiliation, the short answer may not be best.  Frequently the patient’s question reflects anxiety about their illness and its outlook. So an answer that is directed toward addressing these feelings is more appropriate.

       A patient, who happened to be a nun, asked me the above question.  We had been having a conversation about our common interests as professionals in dealing with the public, and she had no major anxieties about a current illness.  Perhaps she liked me and hoped I was Roman Catholic.  In any event I used a virgin answer that popped into my head, “I’m a transcendental ecumenist”.  She considered this briefly and replied, “I think I am one of those too”.  This was quite a useful experience for both of us.  Looking back I believe that I had followed the precepts of my teachers at a higher dimension of reality.

        You may doubt the truth of this last story; but let me assure you my imagination is not that good.  This particular patient wanted very much to lose weight and repeatedly insisted with great conviction that the 1,000 calorie diet I had recommended was being followed very conscientiously.  After several encounters in this same vein it became clear to me that the patient was indeed eating the prescribed diet---in addition to all his regular meals!  Hence, the continued weight gain.  There must have been some element of magical thinking that made him see my diet as a ritual to enhance his own efforts.  Somehow I managed not to feel too guilty about my failure to foresee the possibility of his mistaking my “orders” to such an extent.

John A. Frantz, M.D.

May 12, 2002