“Life is short, and the art long; the occasion fleeting, experience fallacious, and judgment difficult.”
|Photo by National Cancer Institute on Unsplash.|
The Soul of Medicine is a slender (200-page) book by surgeon-author Sherwin B. Nuland. It contains twenty-one essays, each one based on a “tale” told to Nuland by either a medical student (one), or by physicians in family medicine, obstetrics-gynecology, anesthesiology, urology, neurology, internal medicine, pediatrics, or surgery, as well as in subspeciality branches of the last three.
These tales, which run between four and (exceptionally) twenty pages, describe the surprises, joys, and disappointments that arise in the doctor-patient relationship. There are unexpected deaths, unexplainable recoveries, and ethical dilemmas. An anesthesiologist feels guilty because she did not think enough of a surgeon’s erratic behavior in the operating room—the surgeon had stopped taking medication for his bipolar illness—to alert the other members of the team and cancel the surgery.
Another physician, a surgeon, describes his ruthlessness in lying and manipulating to climb the ladder of academic medicine. Some tales tell (but not boastfully) of well-thought-out diagnoses based on an infrequent co-occurrence of findings, or of having seen or read about a similar problem decades ago. About half of the tales have an added commentary by the narrator, that is, Nuland speaking in his own voice. He talks about the value, still important, of the physical examination, not just to obtain clinical information, but also for a reassuring physical contact with the patient, “a laying on of hands.” The commentaries variously give the history of transplantations, women in medicine, medical schools’ restrictive quotas, and the history of the diagnosis and treatment of certain cancers.
This writer was surprised that there was no commentary after “The Medical Student’s Tale,” written by a now-practicing physician about a clinical experience while a student. Working with a resident to treat a young man with a sexually acquired genital infection, the student spoke to the patient in a highly judgmental way and interacted with him in an unnecessarily cruel fashion.
This writer has not practiced medicine for ten years, but the book brought back some of the comfort—and sadness—that comes with the practice of medicine. It is good to know that there are still many thoughtful, introspective, empathetic doctors practicing medicine.
The Soul of Medicine: Tales from the Bedside
Sherwin B. Nuland
New York: Kaplan Publishing, 2009
HOWARD FISCHER, M.D., was a professor of pediatrics at Wayne State University School of Medicine, Detroit, Michigan.