The Days of the Giants

NB: I first published this as The Road Taken, in a hospital newsletter, some years ago, but I've had occasion to remember these events recently.

When I was fourteen, my good friend suggested the worst thing about being a doctor would be that all my friends would be doctors, or at the very least, I’d have to spend a lot of time hanging out with doctors.

Actually, in retrospect, that has proved to be one of the best things about medicine—not that all my friends are doctors, but the doctors I met along the way turned out to be one of the best things about medicine.


Take the neurologist, Kathleen F. , for example. When I was a third year medical student, I was lucky enough to draw Dr. Kathleen  as my resident for the six week neurology rotation. She had been one of the four women in her medical school class of one hundred and she was the only woman I ever heard of who landed a neurology residency in a department headed by a very famous chief of Neurology who thought women would always be mothers first and doctors second, and never as committed to the profession as men, and so he refused to appoint a woman to his faculty.

But even he had to give Kathleen a spot in his residency program--not because there was any political force in those days which would have motivated him, but he gave her a residency spot because she was a stellar medical student. He was the co-author of the classic textbook, Stupor and Coma, the Chief of Neurology, but if he believed in the idea of meritocracy, he had to give Kathleen a residency, even if he would ultimately refuse her a faculty position.

The first thing which struck me about her was how fragile she looked: Five feet five, no more than one hundred pounds, very blonde hair and skin and eyes so light blue they were almost white. I could well imagine her in her plaid Catholic school skirt and patent leather shoes, but she wore a white skirt and short white jacket, pockets stuffed with reflux hammer, tuning fork, ophthalmoscope, packets of coffee for testing the olfactory nerve--Kathleen tested each and every cranial nerve in every patient—stethoscope, and the notebook in which she kept the names and numbers of patients she would call in for admission to the neurology ward.

She was all business, but she was a hummingbird among the bears on that ward.


Life on the neurology ward was rigidly punctual: The four medical students arrived at six a.m. to draw bloods on the forty patients; Kathleen  arrived at six-fifteen and did teaching rounds from six-thirty until seven fifteen; then the students fanned out on the ward to do patient chores until ten a.m. when the Chief arrived to do his harrowing, teach-by-humiliation rounds. The rest of the day went downhill from there.


On the days she was on call, I shadowed her doing consults on the wards, in the emergency room, wherever her beeper took us. One night, well after midnight, we were called to the ER to see a seventy year old man who had become demented over the prior three weeks, started falling a lot and taken to bed.


It was a pro forma consult: Nobody expected Kathleen  to do more than take a quick look and reject him for the neurology ward, which was for neurologically interesting cases, not for garden variety cases of dementia, which went to the general medical wards. But Kathleen kept jerking his foot with her hand and kept looking at his tongue, wriggling in his mouth. I was leaning with my back against the wall, nodding off, when I heard her say, “Do you know what this is?”

I had to admit I did not and she informed me it was myoclonus and I should go home and read up on it for morning rounds, which were now only about five hours away. She admitted the patient to the neurology ward with Jacob-Creutzfield disease, which she had diagnosed at one a.m., in a dark ER stall, by physical exam and history alone, picked him out of all the other demented old “gomers,” filling the ER.


The next morning, the Chief of Neurology examined the patient on rounds and had to agree the patient had Jacob-Creutzfield and he moved on to the next patient, as if there were nothing remarkable about this. Of course, medical students came from all over the hospital to see the patient,--interns and residents, too. Her dark hours diagnosis added to Kathleen's  local renown, but she never showed any sign of special pride about it. She treated her coup as casually as the Chief had.


Later that week I had to present a case to the Chief, a patient with a parietal lobe tumor. Kathleen  prepared me rigorously, so I could point out all the findings and she warned me the one thing which was not explained by the tumor was the patient’s significant memory deficit and we went over how to handle that part of the case in the presentation. The Chief listened intently with the expression he reserved for student presentations, which made him look as if he was smelling something nasty, but he did not interrupt me, nor did he castigate me as being unworthy of taking up space in the highly select medical school, nor did he grunt or snort. I kept pausing, waiting for his slings and arrows, which never came.

Finally, he asked about the memory deficit, just as Kathleen had warned me he would and I answered exactly as she had prepared me to answer and the Chief turned to Kathleen  and the other residents and said, “This presentation is just a little too perfect. Did any of you tell this student what to say? Did any of you prepare him for this?” He was looking directly at Kathleen.


She met his glare and said, simply and directly, “No, sir, we did not.”


Later I pulled her aside and said, “How many Hail Mary’s are you going to have to say this Sunday? I presume bearing false witness is still a sin.”


She said, “The Chief is not a normal person. The best thing to do is to do your work and stay away from him.”


Our next on call night, we got called down to the pediatric ward to see a fourteen month old in the pediatric ICU.

We were met by the Chief Resident in Pediatrics, the junior resident and two medical students and they all had a stricken look I hadn’t often seen among housestaff at that hospital. I understood, when they told the story: A twenty year old single mother had her child by one hand and a bag of groceries in the other, and she walked up the three flights of stairs to her apartment, holding the kid with one hand the groceries with the other. She lived in one of those apartment buildings with an Alfred Hitchcock type stairwell, where you could look down over the banisters four flights, right down to the cement landing in the basement. The mother had eggs in the grocery bag and rather than setting down that bag, she let go of her child’s hand, reached in her pocketbook for her keys, turned to unlock the door and in the time it took to get the key in the lock, her child managed to squirm through the banister rails and plunge four flights down, head first, to the cement landing.


We were being called to say if there was any brain activity or to pronounce him brain dead.


I watched over Kathleen's shoulder as she examined the rag doll child, as she went through all the tests with which I was now familiar, Babinski’s and so forth, but what I found myself looking at was not the child, but Kathleen's  ears, which had gone quite crimson. She had her hair up that night, and you could see her ears. Kathleen was the mother of a child about this kid’s age. She went over him methodically, as she always did, but after about five minutes, she reached in her pocket and got out a tissue and wiped her eyes and blew her nose. Then she finished examining the baby.


I followed her out to meet the residents in the ICU and she told them she would see the mother in the conference room, alone. She dismissed the residents and the students and headed into the conference room and sensing I was still with her, she turned around and said, “I’ll do this alone. Hold my beeper. Answer any pages. Wait for me.”

This was the first and only time she did not allow me to stay with her. I was just a happy, but I also knew she was sparing me something nobody had much stomach for. And she was thinking of the mother. She was in there a long time. Then she came out, totally composed, and we got in an elevator and I handed her back her beeper and reported there were no more consults to see, for which I was grateful, because it was now approaching two a.m. So we stood in the elevator together staring at the overhead numbers and I said, “You okay?”


“Yes,” she said. “Don’t be late for rounds.”


I suppose I could have gone into some other sort of work, and there would have been rewards, and talented, intelligent people. But if I had, I never would have been instructed by Kathleen, never seen her grace under fire and tried to emulate it.

And I would not have met all those whom I met later, who sailed with her, guided by the same stars she followed, those people who combined toughness, rigor and kindness who call themselves doctor.