what Ill have to worry about everyday on the Job.

A father's letter to his internist son


Dear Dave,
Last September I attended the biennial congress of the British congress of the British Society of the History of Medicine in Newcastle-upon-Tyne, where I graduated 50 years ago.
After my presentation an elderly lady came over to me and asked, "Dr Jacoby, were you at Monkwearmouth Hospital?" I replied that I was and she said, "You treated me for diphtheria."
I immediately remembered her - my first patient on my first day as a real doctor, 1 July 1943. I had been called to the outpatient department from the house staff's quarters. I walked down the long corridor, with windows bricked up in case of bomb blasts, wearing a long white starched coat, my stethescope dangling around my neck in the most approved fashion. There was a diagnostic set in one pocket and a reflex hammer, tuning fork, and the handbook for new house officers, Pye's Surgical Handicraft, sticking out of the other. I was full of the self confidence of youth. I entered the outpatient waiting room and was directed to a small examination room and there was my patient - a nurse wearing a long white veil, as was customary.
She had a sore throat. I looked in her throat and I didn't see much. I knew all about how to treat brain abscesses, which in those days was to do nothing, because they were almost never diagnosed before death. I knew how to do major abdominal surgical operations, such as gastroenterostomies, at least in theory, although I would have killed the patient if I had attempted one. After all, I had been the fourth assistant many times when my surgical chief did thoracoplasties for empyema, a common operation in those days, Halstead radical mastectomies, and other equally bloody operations, such as abdominoperineal resections. I would be fighting the other student, the house officer, and the registrar for the right to dab the bleeding spot with gauze, before the surgeon deftly caught the spurter with a pair of artery forceps and tied it off. What I not been taught was how to treat a sore throat. I did not know what to do, so I prescribed a salt water gargle.
* "I immediately remembered her - my first patient on my first day as a real doctor."
Later in the morning I discussed the case with one of the other house officers who had graduated six months before me, so he knew everything. "George," he said, "if I were you I would do a throat culture and give her some sulfa." This was in the days before penicillin was available. I followed his suggestion and, to my amazement, the culture came back positive for diphtheria.
My patient was sent off to the fever hospital and later had to have a tracheotomy. After she recovered I saw her again and she told me that each morning the doctor used to greet her with the request to say "Sister Susie's sewing shirts for soldiers" or "Plum jam," both of which came out rather flat because her palate and pharynx had been paralysed. Her other recollection was being offered a tonsillectomy just before discharge. I remember noting that she had a dilated left pupil, from diphtheritic paralysis.
Fifty years later, as soon as a I realised who she was, I looked carefully at her face and declared, "You don't have an enlarged pupil any longer."
Now as a senior man in the profession, when you make rounds with your residents forgive them in their trespasses, which are many. Remember what happened to your father.

M G Jacoby