Fanfare for the Common Malady

After several decades of medical practice and an eclectic education in the science and art of healthcare, this physician/philosopher can truly say "I've seen it all." Of course, strictly speaking, that's not true, since Harrison's Textbook of Internal Medicine is several thousand pages long--there's enough pathology to last a lifetime, so to speak. Would you like to hear about some of the esoteric and exotic things I've seen? Of course, you would.

In 1965 I was a teenage volunteer at Maimonides Medical Center, working as a clerk in the dialysis unit. When the brilliant nephrologist in charge (Dr. Donald Snyder) learned that I wanted to be a physician, he took it upon himself to teach me how to take a blood pressure. In those days, we used a sphygmomanometer, an antiquated device with a column of mercury and an inflatable cuff. After listening to Dr. Snyder's careful instruction, I was told to take the blood pressure of the first patient to come into his clinic. "Pump it all the way up" he added. I did what I was told and recorded a blood pressure of 300 over 130. "You'll never see that again" Dr. Snyder remarked, and he certainly was correct. Fortunately, after dialysis, the patient's blood pressure normalized.

As long we're on the subject of astronomical elevation of vital signs, might I also mention the fastest respiratory rate I ever witnessed? 24 times per minute, due to an aspirin overdose. Or the most rapid heart rate? 240 beats per minute, part of a "thyroid storm," fortunately a rarity. Normal blood glucose is approximately 80-100; my all-time record was approximately 2700 (due to a hyperglycemic, hyperosmolar coma). The most spectacular and frightening cardiac arrhythmia I witnessed was torsade des pointes, an out-of-control spiraling of the EKG that looks like a DNA double-helix.

Lest you think that these startling experiences were merely passive observations, allow me to tell you about the first clinical skill I ever performed. Most medical students begin their hospital training by learning how to obtain a blood sample or start an intravenous infusion. This lucky student, during his first overnight shift, happened to walk by a room where attempted CPR was unsuccessful but the supervisory professor still wanted the interns to learn an extremely dramatic last resort--administering adrenalin through an eight-inch intracardiac needle. If you've seen John Travolta and Eric Stoltz perform this procedure on Uma Thurman in Pulp Fiction, you know what it looks like. If you haven't, I won't upset your stomach. The professor pointed to me, said "Let him do it", and I did what I was told--several days before I learned how to attach EKG electrodes.

Rare infectious diseases? How about tularemia, an extremely rare bacterial infection a Brooklynite caught from his pet rabbit? Or disseminated meningococcemia? "You'll never see this again" I was correctly told in 1977. Scarlet fever? I never saw it--I had it! Even on a vacation in Morocco, medical rarities fascinated me: I followed a leper around the Marrakech marketplace, stunned at his characteristic facial features and what I refer to as "the terrible power of illness". This was also evident on the single occasion I saw a patient with neurofibromatosis (incorrectly called the "Elephant Man's disease") and another individual with dextrocardia (not really an illness, since organs that develop as "mirror images" usually function normally.)

Why discuss these extraordinarily rare conditions? Perhaps to gain a sense of perspective on common maladies such as hypertension, diabetes, and heart disease. These chronic illnesses are most definitely debilitating and life-shortening, yet many people minimize their "terrible power" because they are so prevalent. Being overweight or obese invites over 20 serious illnesses into your body, and even one can change your life plans drastically. Medical rarities seem exotic and interesting, like tropical orchids or spectacular comets. Common illnesses, no matter how mundane they may seem to you, are the real problem, especially when you have the power to diminish or avoid them.