When I began my medical education in 1958, I assumed my teachers would be limited to the men and women listed in descriptions of required courses and rotations. Like all dedicated teachers, each of them imparted formal instruction mixed with their personal experiences. My debt to them is incalculable.
As the years passed, I realized that many of my patients imparted other lessons not inscribed in texts, presented in lectures or delivered during clinical rounds. These were teachings of courage, devotion and determination. A sampler follows:
S.B. was assigned to me during a surgical rotation in my final year of medical school. An elderly lady from rural Maryland, she had suffered a severe, penetrating wound to her abdomen. Infection no longer responded to antibiotics. Multiple drains connected to bags. All of her nutrition was delivered intravenously. For eight weeks, I visited her twice daily to examine and plan her day's intake. We chatted throughout each visit. She realized that she would not recover. Her regret was that she would not see her grandchildren grow to adulthood. She showed me patience, kindness and a quiet courage as she approached the end of her days.
S.H. had suffered severe polio in childhood. Her growth was severely stunted. She spent years in an iron lung and then a portable respiratory device. I became her physician in her mid-life. She moved about with the aid of a motorized wheelchair which she could direct with a toggle switch. She emanated joy. She created delicate needlework with her pipe-cleaner-thin fingers. I never heard self-pity. By the time her office visit concluded, my spirits were raised by her abiding humor and wry observations of politicians. She inspired me for two decades before she died.
M.W. suffered widespread metastases from breast cancer at a time when there were few therapies beyond radiation. Her chest wall was an open wound from overly aggressive radiation. She had a young son and no other kinspeople. Willing herself to stay alive, she carefully arranged the adoption of her son by a family whom she deeply respected. Nearing the end of her life, she signed herself into a nursing home where she read Bertrand Russell's philosophical writings and anticipated weekend visits by her son and his adoptive parents.
R.M., a retired university educator, had cancer, which had spread to his skeleton. He avoided medication for pain because it dulled his intellect. As I approached his home near the end of his life, I observed through a window that he seemed to be conducting music with a pencil. Entering his home, I heard a classical recording that I could not name. He explained to me that he was selecting music for his memorial service. "Finally," he said, "people will have to listen to the music that I love."
A.M., the wife of R.M., was a physical therapist. Following the death of her husband and a daughter, she undertook several trips to post-war Vietnam to teach care of children who had lost limbs to land mines. She sought no publicity for her work.
M.M. had severe, hereditary elevation of her blood lipids at a time when there were limited therapies. University centers could offer no help. She was one of the most joyful people I ever met. She loved to sing, play the guitar and entertain children. After earning a degree in early childhood education, she could not find a job. Her "pre-existing" condition precluded health insurance offered by any employer. Finally, a school took a chance, hired her and added her to the school's insurance plan. She was able to pursue her dream for a few years before widespread vascular disease ended her life.
These life-lessons are not unique to me or to the health professions. Each of us has the opportunity to learn from our band of unofficial teachers if we take time to listen.
Contact Clif Cleaveland at ccleaveland@timesfreepress.com.