Table Of ContentWHEN DOCTORS
GET SICK
WHEN DOCTORS
GET SICK
Edited by
HARVEY MANDELL, M.D.
The William W. Backus Hospital
Norwich, Connecticut
and
HOWARD SPIRO, M.D.
Yale University School of Medicine
New Haven, Connecticut
Springer Science+Business Media, LLC
Library of Congress Cataloging in Publication Data
When doctors get sick.
Includes bibliographies and index.
1. Physicians—Diseases. 2. Physicians—Psychology. 3. Sick—Psychology. I.
Mandell, Harvey N. II. Spiro, Howard M. (Howard Marget), 1924- . [DNLM: 1.
Patients—psychology. 2. Physician Impairment. 3. Physicians—psychology. W 21
W567]
R707.W49 1987 616'.008861 87-14104
ISBN 978-1-4899-2003-4
ISBN 978-1-4899-2003-4 ISBN 978-1-4899-2001-0 (eBook)
DOI 10.1007/978-1-4899-2001-0
First Printing—September 1987
Second Printing—July 1988
© Springer Science+Business Media New York 1988
Originally published by Plenum Press, New York in 1988
Softcover reprint of the hardcover 1st edition 1988
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
To
Marjorie Mandell
Marian Spiro
FOREWORD
When a doctor gets sick, his status changes. No longer is his role de
fined as deriving from doctus, i.e., learned, but as from patiens, the
present participle of the deponent verb, patior, i.e., to suffer, with all
the passive acceptance of pain the verb implies. From pass us, the past
participle, we get the word passion, with its wide gamut of emotional
allusions, ranging from animal lust to the sufferings of martyrs. It is
the connotation, not the denotation, of the word that defines the
change of status. When a doctor is sick enough to be admitted to a
hospital, he can no longer write orders; orders are written about him,
removing him from control of his own situation. One recalls a sonnet
from W.H. Auden's sequence, The Quest, which closes with the lines:
Unluckily they were their situation:
One should not give a poisoner medicine,
A conjuror fine apparatus,
Nor a rifle to a melancholic bore.
That is a reasonable expression of twentieth-century skepticism and ra
tionalism.
Almost all medical literature is written from the doctor's point of
view. Only a few medically trained writers-one thinks of Chekhov's
Ward Six-manage to incorporate the patient's response to his situa
tion. Patients' voices were not much in evidence until well into the
twentieth century, but an early example is John Donne's Devotions upon
Emergent Occasions (1624). Written over 350 years ago, it describes the
feelings, perhaps recollected in tranquility, of an articulate Jacobean
clergyman and writer with respect to an acute, febrile, life-threatening
illness that struck abruptly in December 1623, when he was 51 years
old.
Donne, ordained a priest in the Church of England in 1615, was
appointed Dean of St. Paul Cathedral in 1621. Two years later he was
suddenly taken ill. We know the onset was acute, because in the first
of the twenty-three Devotions he writes, "This minute I was well, and
am ill, this minute. I am surpriz'd with a sodaine change, and altera-
vii
viii FOREWORD
tion to the worse." But an exact diagnosis remains unknown. Various
writers have given such labels as "spotted fever," which merely indi
cates a skin eruption, "relapsing fever," which merely indicates that
the fever was intermittent, and "typhoid fever," which in those days
was not clearly distinguished from typhus fever. The last of these is
not improbable; James I's eldest son is supposed to have died of it in
1612, and London's drinking water was hardly free from fecal contami
nation. However, Donne's "spots" seem to have developed late in the
course of the disease and may well have been the petechiae of a rickett
sial infection rather than the rose spots of typhoid, which characteristi
cally appear late in the course of the disease. Establishing a precise
diagnosis is not essential. What is important is Donne's reaction to his
disease-how the patient felt. Apparently he made a few notes during
the acute phase and wrote the set of Devotions while convalescing in
the winter months of 1624. He comments:
he feels that a Fever doth not melt him like snow, but powr him out like
lead, like iron, like brasse melted in a furnace: It doth not only melt him,
but calcine him, reduce him to Atomes, and to ashes; not to water, but to
lime.
Donne seems to have been ambivalent about his physician; he had
little faith in the medications:
it may be that obvious and present Simples, easie to bee had, would cure
him; but the Apothecary is not so neere him, nor the Phisician so neere
him, as they are to other creatures.
He also complained of abandonment, suspecting that his physician
was afraid of contagion:
As Sicknes is the greatest misery, so the greatest misery of sickness, is
solitude; when the infectiousness of the disease deterrs them who should
assist, from coming; even the Phisician dares scarce come. Solitude is a
torment which is not threatned in hell it selfe .... When I am dead, and
my body might infect, they have a remedy, they may bury me; but when
I am but sick and might infect, they have no remedy but their absence,
and my solitude ... it is an Outlawry, and Excommunication upon the Pa
tient, and separats him from all offices not only of Civilitie, but of working
Charitie.
Donne's Devotions contain many other passages a physician might
well read to his advantage, especially to prepare himself for the time
when he too will suffer from the ills to which the flesh is heir, but the
climax is in the familiar passage in the seventeenth Devotion:
Perchance he for whom this Bell tolls, may be so ill, as that he known not
it tolls for him .... No man is an nand, intire of it selfe ... any mans death
diminishes me, because I am involved in Mankind; And therefore never
send to see for whom the bell tolls; It tolls for thee.
FOREWORD ix
Donne's emphasis on the interdependence of making is not only one
of the roots of medical care, why we minister to the sick, but also the
root of any civilized society, and the day may yet come when, as a later
poet wrote: "AUe Menschen werden Bruder.
II
For the present we have a book by some fifty doctors, each describ
ing a sickness of his own. It would be easy to dismiss such a compila
tion as anecdotal but, in fact, what we know about medicine is the sum
total of cases we have studied, and each one adds its increment to our
knowledge. That is partly because each case is unique-"an nand intire
of it selfe"-yet all share in a common humanity. As individuals, each
doctor's experience is unique and so is his insight. Assembled, they
provide a rich variety of medical experience as seen through the eyes of
patients trained in medicine, and in this way we learn from the ex
periences of others.
WILLIAM B. OBER, M.D.
Director Emeritus
Department of Pathology
Hackensack Medical Center
Hackensack, New Jersey
PREFACE
Doctors get sick even as other people do. We doctors have no magical
immunity to ward off devils or germs, whichever you think causes dis
ease. People may not know that we ever get sick because we tend to
work just the same unless the illness is significantly debilitating. We
physicians are in general a hardy lot and few of us stay home with the
flu. This may not be good epidemiology but it helps to foster our su
perman and superwoman egos.
Most of us doctors are not neurotic about our health. Medical
school and the years of internship, residency, and fellowship may lead
us to the conclusion that if we can survive these programs we may just
be immortal.
You will seldom find us admitted to a hospital or even having out
patient work unless we are very sick. Most of our medical "care" con
sists of a telephone call to a colleague, or a hospital corridor or doctors'
parking lot consultation. Doctors' reactions to health measures other
wise seem to be, in general, rational and sensible rather than hysterical
or obsessive. Few doctors smoke cigarettes and most, at least the
young ones, seem always to be playing tennis or skiing. Running and
jogging occupy the leisure time of many. Obesity at morbid levels ap
pears to be less frequent among physicians than in the general public.
Most doctors know about illness only from their patients and jour
nals and texts. Physicians who say the patient "has a low pain thresh
old" have probably not had the same disorder that is causing "the low
pain threshold" patient to howl with agony at the passage of his ure
teral stone. We have never heard a physician who has had a kidney
stone or a "disc" belittle a patient's description of severity of pain. We
have never known a migrainous doctor to make light of the discomfort
of headache. How many physicians know firsthand the anxiety that ac
companies the wait for a doctor's call with a report of a biopsy?
This leads inevitably to the question: Should doctors be sick with a
painful or debilitating illness themselves before being permitted to take
care of patients? Not very practical, and not likely to attract many
volunteers even if the answer is yes.
xi
xii PREFACE
We have shared both an abiding interest in physician behavior and
an extraordinary delight in being published. Although one of us has
had cancer surgery and the other no more challenging procedures than
root canal and colonoscopy without anesthesia, we have often thought
that physicians and others might be interested in reading about physi
cians who have become patients with serious diseases. This is, after all,
a unique group of patients who have found in their experiences much
to learn and much to teach.
We asked a few physicians who had been seriously sick if they
would be interested in writing about their illness for a collection we
hoped to publish. We asked the prospective authors how they discov
ered they were sick, how they chose their physicians and their hospi
tals, what it was like to be a patient and what the experience did to
them as physicians and human beings.
The initial response was so promising that we began to search for
physician-patients with increasing vigor, using acquaintances all over
the United States and Canada and keeping a careful eye on the occa
sional anonymous pieces in the lilncet and the British Medical Journal, in
which physicians in the United Kingdom described their illnesses.
The editors brought different viewpoints to the project. One of us,
the cancerous one, is an obscure New England country doctor. He has
spent his career in a community hospital, where the emphasis must al
ways be on the practical management of patients who are acutely ill.
The other is an amiable if peripatetic academic teacher and clinician
among whose duties are thinking and ruminating. The collaboration
has been amicable, and each editor is prepared to blame the other for
any matters of concept or style that may irritate readers.
Since every physician cannot have every disease and since male
obstetricians can never know firsthand the pain of labor and no female
urologist can ever experience the pain and terror of torsion of the tes
tis, we thought physicians might benefit, if not prosper, from the ill
nesses of their colleagues as related by those colleagues.
HARVEY MANDELL, M.D.
HOWARD SPIRO, M.D.
