Excerpt
From Anecdote to Antidote:
SECTION 3: “THINGS”
INTRODUCTION
Foreign cultures,
the intricacies of faith, the depth
and breadth of the human mind — as inscrutable as any
or all of these may be for some, the world of medicine can
seem just as byzantine and impenetrable to the uninitiated.
Maybe that’s why television shows like Quincy, ER, CSI,
and the like are so popular and so long-lived. The everyday
world of medicine generates more than enough fodder for both
screen writers and mystery buffs with its seemingly endless
false leads, hidden clues, and complex yet often invisible
network of relationships, causes, and effects, each leading
down a series of potential blind alleys.
As an example, I’m put in mind of a building
from my alma mater, the University of Rome. Near the ancient
campus compound, there is a large and impressive building
to the immediate right. It bears the name “The Institute
for Syphilis and Dermatology.”
Interesting combination, no? What could the
link possibly be between dermatology and history’s most
famous venereal disease? The pairing cracks open the door
to any number of jokes, but the fact that it is carved above
the entrance to a department building at one of the oldest
institutions of higher learning in the Western world leaves
many scratching their heads.
Before the antibiotic era, when syphilis was
rampant, the rashes caused by this disease were plentiful
and diverse beyond the initial skin ulcerations in the genital
area. Therefore, the presentation of any rash or skin lesion
always contained syphilis as part of the differential diagnosis;
it was so prevalent that it deserved equal billing with dermatology.
Even during my training in the early 1960s, we still saw the
many different varieties of skin rashes that were the results
of syphilis, as well as malformations in babies born to sufferers,
and even elderly people with telltale signs of prior disease.
I once examined, as part of a supervised group of medical
students, an elderly grandmother suffering from bronchitis
when the professor pointed out, very quietly, that one pupil
was pin-point while the other was dilated — a sign of
late-stage neurological syphilis. There was something in her
past that certainly no one would want to talk about to her
grandchildren.
Syphilis (in its tertiary stage) also causes
changes in personality and dementia. It has long been rumored
that Idi Amin, the ruthless former dictator of Uganda, was
treated for neurological syphilis in Israel while there for
a military training course, long before the fateful raid on
Entebbe. Though never proven, he was known to have a taste
for brothels and was treated for “social diseases”
several times as a young man in the British Colonial Army.
Perhaps tertiary syphilis was the reason he was so crazy.
I have taken this detour through the wonderful
world of syphilis to illustrate the number of hidden rooms
and secret passages in the great labyrinth of medicine, and
how so many seemingly unrelated things are somehow connected.
Since I’ve already introduced you to some of the “People”
with whom I’ve crossed paths, and taken you to some
of the more interesting “Places” I’ve been
(and shared the lessons I’ve learned from all of them
along the way), I’d like to teach you all a few “Things”
about practical medicine and health maintenance — some
more straight-ahead scientific, some philosophical, some coldly
practical, but all guaranteed to maintain your interest. I
really do feel, as I said in the first section, that the modern
doctor-patient relationship should be more of a partnership
and less of a dictatorship. To that end, I am quite glad to
see my patients becoming more informed about certain things,
thanks to the Internet and sites like WebMD and such.
Nevertheless, there’s a lot more out there
than can be found on WebMD and some things you will be worth
finding while others should be ignored or taken with the proper
number of salt grains. Almost every day the news blares mixed
messages from some new medical report or another, resulting
in a huge spate of patient visits just so they can come to
me and complain, “I thought dairy was good, now the
surgeon general tells me it’s bad. Which is it, doc?”
This is where knowledge of some medical
basics as well as of yourself can help you. When consulting
medical journals or popular web sites, it is important to
assess the information in the proper context and work out
a solution that feels right for you. In a way, it’s
a review and reinforcement of what I said before: our body
can usually tell us when something is wrong. I’d like
to hope that this third section helps us listen to our bodies
as closely as we do (or should) our doctors. Think of it as
a limited crash course of study through medical school.
Check out all three categories: “People”
– “Places”
– “Things”
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