Wednesday, April 2, 2008

David Grob, M.D.

Last week I received the news that my greatest teacher, Dr. David Grob, had passed away. We first met in the mid-1970's when I was a medical student at Maimonides Hospital and he was the Director of Medical Education, as well as the chairman of the Department of Internal Medicine.

Dr. Grob was an internationally renowned expert in myasthenia gravis as well as a professor with impeccable academic credentials. To me, however, he was simply the most inspiring healer and teacher of a lifetime. Dr. Grob charted my entire academic pathway after medical school, giving me priceless opportunities to learn clinical medicine on the wards of Maimonides Hospital. From 1978 onwards for five years, I was immersed in patient care as an extern, intern, and resident, spending approximately 108 hours per week mastering the diagnostic and technical skills needed to help critically ill patients.

What made learning from Dr. Grob so very memorable was not merely his orderly and encyclopedic knowledge of the basic health sciences--in addition, he seemed to present medicine as a holy art, marveling at the intricacies of the human body and showing enormous empathy for the suffering individual. At times, while he was examining patients with the manual dexterity of a piano virtuoso, he would close his eyes, as if communing with Hippocrates or healing spirits.

One session of morning rounds in the intensive care unit featured five patients with myasthenia gravis, each one with a different set of signs, symptoms, and response to therapy. He instilled in us that day a great respect for the infinite mysteries of the human body, wherein even an extremely rare disease can unfold in multiple, different ways.

A brilliant practitioner of physical diagnosis, a lost art in itself, Dr. Grob would map out the outline of a patient's liver by percussing the surface of the abdomen, then draw an outline on the bemused person himself (patients enjoyed this as much as the students, by the way). On other occasions, he would lie a pencil down on the left ribcage directly over the "point of maximum impression" [where the heartbeat is most easily felt] and we would watch the pencil bobbing up and down with every heartbeat.

In another impressive display of physical diagnosis, Dr. Grob showed me how to "feel" atrial fibrillation, a sensation resembling a "bag of worms" writhing under my hands. Who else would have taught us how to estimate a blood pressure by touching the wrist artery? I still use this skill almost every day, and several times in Cabrini Emergency Room it was actually of crucial importance.

I hope that you too will have your life enriched and ennobled by brilliant teachers and mentors. Dr. Grob represents to me a Golden Age of healthcare--the technology and information were not as extensive as they are today, but the empathy, sense of wonder, and ability to inspire will last me a lifetime. Thank you, Dr. David Grob. Hail and farewell!