Merely the patient

By SAMUEL W. LAMBERT, M.D.

It is an unusual privilege to look into the mind of a person afflicted with a serious illness and learn the point of view of a patient who, without losing confidence in his medical advisers, questions the when and the wherefore of his treatment.

In this book Mr. Henry H. Harper presents a graphic and realistic picture to the reader. It contains the confessions of a patient to whom the fact is very palpable that his progress from illness to health was not all that he had been persuaded to expect when he entered upon his medical and surgical adventure.

The majority of persons who have experienced only the minor discomforts of an appendectomy or a tonsillectomy may not fully appreciate the underlying importance of this masterpiece which Mr. Harper’s skillful pencil has drawn. Their idea of an operation will be confined to a preliminary period of worry and apprehension, an active horror of thirty-six or seventy-two hours of pain and distress, followed by a convalescence of two or three weeks of comfort, of visits by friends, of a world in which the recovered patient is the central object of attention. But Mr. Harper does not present such a commonplace picture; for his convalescence became a disease, and almost a fatal disease at that. One of the chief messages implied in his story is the tribute to his skillful surgeon, and a grateful remembrance of the care and untiring attention which pulled him through a serious blood poisoning, and of the radical method of treatment which became necessary to insure his recovery.

Moreover, the author has written a colorful and humorous description of his clinical and hospital experiences. There is a pertinent message for every past or prospective patient. After his return from the operating room he was subservient to the restraints of a convalescence from a major operation; he was observant of his symptoms and anxious to communicate his subjective feelings to his medical attendants. He did not exaggerate his discomforts. The post-operative message of this case portrays an interesting and exemplary lesson for every individual, and especially every surgical patient. It is not clear how much of this good behavior is due to overcoming the preliminary antagonism of a man trying to escape a surgical fate, and how much to the breaking down of a strong human will before the inexorable training of a professional habit of thought founded on an unbending scientific routine.

But the most important message in this story of a nephrectomy is perhaps unintentional: it is of importance to the physician himself, and here is a book which should be read by every member of the medical profession.

The lesson begins at the patient’s first encounter with a complete up-to-date routine health examination. His reactions during his journey through a modern clinic are far from placid, and not free from a resentment—expressed with playful seriousness—which any person, lay or professional, can easily understand. The author displays a keen appreciation of the humorous side of the modern system of diagnosticating disease in a scientific manner; although he does not admire the detail. Being a layman, he cannot be expected to follow the relation between the determination of the amount of free hydrochloric acid in a stomach that was digesting everything without known complaint, and a kidney which at times was the seat of a pain. Nor does he realize that he may make a better convalescence if a blood test is made which some scientist unknown to him, has determined can decide whether any ancestor has had hard luck with his diseases.

Mr. Harper describes his experiences from the unusual viewpoint of an invalid’s bed, giving the humorous impression that the joke is on him, without realizing that all these jokes, little and big, were training him to go to the operating room with a feeling of elation and courage for the outcome, and there to climb on the operating table unassisted.

But the physician can learn from this story what the author has taught, all unconsciously: he can learn to omit unnecessary examinations made purely for scientific curiosity or record alone, and not for diagnosis; also to listen considerately to the complaints of his patients; to appreciate that a patient’s feelings during convalescence may have more value in determining treatment than all the physical signs of disease or of well-being which he can discover by fingers, eyes and ears, or by instruments of greater or less precision; to beware the use of new and non-official remedies, even when endorsed by manufacturers of honest intent; to look twice at remedies which are patented for the personal profit of an exclusive chemist or sometimes, I regret to say, for pecuniary gain to some member of my profession.

The description of the night before the first operation is much to the point. The patient’s experience with the amateur hospital barber gives a vibrant touch of humor to the mystery of preparing for the operating room, which is so apt to develop into a hospital tradition even in the best of organizations; a mystery which is, as likely as not, to hinder the acquiring of a good morale by a patient. Mr. Harper discreetly leaves much to the imagination concerning the gruesome details of his stormy convalescence. But the oft-told tale of the normalcy and expected sequence of such events as a patient is supposed to experience and describe; the account of the bottles of castor oil he was obliged to consume; the tale of the nurse who “died” behind a screen in his room; the tale of the military rounds of hospital service which seem cold but which are necessary, and which really can have a soul hidden within them; the tale of the prognostic nurse who prophesied the death of the kidney patient in “Number 88;” the tale of the first removal of the surgical dressings after the operation; the tale of the visit of consolation (?) from the official head of a neighboring church, all lend vividness and color to the tragedy and the gaiety of what must have seemed to the author as “one thousand and one nights” of horror and mischance. But throughout the entire melange he seems never to have lost his sense of humor.

Mr. Harper has seen fit to quote my first impressions when I commented on this book shortly after reading the privately printed first edition. I am correctly quoted, for I believe that every young graduate must secure an appreciation of the discomforts of illness if he is to be successful in making his patients comfortable during their sojourn in bed, and their subsequent convalescence. The art of every physician should include much more than a mere cure for his patient. There is no school like experience, and a personal accident or a febrile disease requiring a stay in bed will do more to educate a physician than all the books that have been printed, or than any service he may carry on in a hospital.

The most engaging story of today is the hard luck medical story; and the human individual, especially among women, is so prone to recite his or her own, or the experience of others, that the ladies’ luncheon party in modern society has been well designated “an organ recital.”

Mr. Harper enters only one complaint against a member of my profession, and that a justifiable one: his account of the first post-operative dressing should be told to every young medical student as a warning and a threat for them to avoid such a brutal performance. He refrains from telling us about the disagreeable offices of the hospital orderly, and of the painfully embarrassing moments of daily routine which led one patient of my acquaintance to greet every knock on his door with the challenge, “Who goes there? Friend or enema?”

I feel a kindred claim to cherish this little book, for although I have never taken a general anaesthetic yet I have had typhoid fever once, and pneumonia twice. It was during one such convalescence that I composed during a wakeful night what I dared call a sonnet. I am no poet but my overwrought nerves, chagrin, temper or some unknown caprice, induced the Muse to urge me to give birth to this thought:

HELL IS NOT PAVED WITH GOOD INTENTIONS

I have since used these words to cheer up suffering humans who rebel at fate and the unnecessary crimes of brutal attendants, which are the results of doctors’ orders.

Mr. Harper has written of his remarkable experiences in a calm, humorous and analytical spirit. I recommend his story to professional and lay readers alike.