A Bleg.


I have a new book out on Kindle that is now published. It is called “War Stories: 50 Years in Medicine.”

I’ve been working on this for 20 years and kept having to revise it as I would put it down and then go back to it after ten years. I finally decided to rework it and publish it two years ago. My students were reading the draft on my laptop while I was editing so maybe it will be interesting.

It is a memoir of patients. They are all patients’ stories that I have tried to describe accurately and to describe what we did then. Sometimes I screwed up and I tell those, too. Sometimes we did the best we could and we now know better. Some of these cases are still hard to explain.

Two of them, in the chapter on Melanoma, are about young women who developed major melanoma metastases years after the primary was excised but when they had become pregnant. The melanoma went wild in pregnancy, in one case ten years later. In the other, three years after I had removed the primary, she developed extensive metastases while pregnant. She refused abortion and I thought it would cost her her life. In both cases the melanoma vanished after pregnancy ended. In one case, the woman, last I heard, was free of melanoma 25 years later. The other was free ten years later. The medical literature says pregnancy has no effect on melanoma. Neither ever became pregnant again.

Another case is an example of the only supernatural near-death experience I have ever heard.

The book starts when I began medical school in 1961 and describes experiences with patients, including my summer working with schizophrenic men in 1962. I have a series of stories about patients I saw as a student and sometimes intersperse stories from later that are about similar cases and events. One that is amusing, I guess, is about my very first pelvic exam, on a 40 year old prostitute who had just gotten out of prison and enjoyed it thoroughly. I had a dozen student nurses as witnesses. I do have some biography in it but try to keep it to minimum.

After the first eight chapters, I go on to residency and then finally to private practice. I continued to teach and there are a few of those stories. There is a chapter on ethics including my thoughts on euthanasia and “benign neglect.” Toward the end of my career, I started and ran a trauma center in our community hospital. I also did a fair amount of testifying in court in both trauma cases and some civil cases where I testified for plaintiffs and for defense. I consider it a compliment that Kaiser Permanente had me testify for their defense even though I had also testified against them.

Anyway, the book is on Kindle and I hope somebody is interested. It has some similarity to my medical history book, which I plan to do a Kindle version of once this one is launched. In this one, I spend some time explaining the diseases in a way that I used to explain to patients and I still do to students. Without some basic understanding, most of these stories would not make sense and I hope the explanations are not too dull. If so, all comments are welcome. If anyone likes it, feel free to post a review on Amazon. Two reviewers from the first book in 2004 told me to let them know if I did another one and I have contacted them.

If anyone wants to discuss the book here, feel free to add comments.

16 thoughts on “A Bleg.”

  1. I really like that log home in the ad on the site. The only negative is two stories. I am getting old.

  2. I am so behinkd on my reading list but I put it on my “wish list” so as not to forget. That is interesting about the melanoma and pregnancy. Those stories always interest me as we don’t know as much as we think we do.

    Also interested in the miraculous recoveries for which there is no medical explanation.

  3. “Also interested in the miraculous recoveries for which there is no medical explanation.”

    Here is one that is kind of fun.

    Many of our patients and their families were grateful for what we tried to do and sometimes, they were grateful even when we screwed up. One night a young man came in with a compound leg fracture and was comatose. That was before CAT scans and we didn’t know what head injury he might have so we called the neurosurgeons. Some neurosurgery residents were good guys and some were not. We got one of the jerks that night. He examined the patient and told us he was brain dead. We should call the transplant team and tell them they could harvest his organs, in those days kidneys and corneas. First, of course, I had to ask his family and I talked to his mother, who was there on the admitting ward. She was very nice and said, “I know you boys at the County would do everything you could. If you say there is no chance for him to survive, then yes you can have his kidneys.”

    At that point, I called the transplant fellow, named Glenn, and told him he had a donor. Glenn came in and went through his regular routine, which consisted of drawing blood for tissue typing and other studies at Paul Terasaki’s lab at UCLA, starting a high volume IV fluid regime to be sure his kidneys stayed working well and then left to make arrangements. It would take several hours to do the tissue typing at Terasaki’s lab. I went back upstairs to Main Surgery to do my cases that were waiting. It was morning before I got to the admitting ward and found out what was happening with our “donor.” He was awake and wanted breakfast ! So much for the neurosurgeon’s prognosis.

    What had apparently happened was that this young man had bled out from his compound fracture plus maybe some amateur pharmacology and his coma was not from head injury. When Glenn ran a lot of IV fluid into him, his blood pressure came up and he woke up ! Obviously he was going to need surgery to deal with his fracture, so no breakfast and now I had to call his mother who had gone home. She didn’t bat an eye. She said, “I knew you boys at the County would not give up even if I said you could have his kidneys ! You kept working on him and you saved his life ! Thank you !”

    Another triumph.

  4. Darn you! My pending reading list probably exceeds my best-guess predicted lifespan, but heck if your volume isn’t purchased and moved to the head of the line…

  5. “Some neurosurgery residents were good guys and some were not.”

    Politics and Prosperity is a blog I always check out with mostly conservative/libertarian themes.

    Lately they’ve been having a series on empathy and how it relates to altruism, among other things. This latest installment discusses the tradeoff between kindness and competence in surgeons and to beware of the ones too empathetic.

  6. Bought it, it’s great. Will have some comments on it.

    Also you probably want to encourage people (who like it) to review it out on Amazon too because that helps it rise up in the rankings there.

    Do love the log house too, although I am looking for a bit more of a “Dwell” vibe. But what a lot of gorgeous land it is on!

  7. Grurray, that second link is interesting.

    “Compassion, communication, and collaboration are now strongly emphasized during training.”

    I call this the “feminization” of medical training especially medical school. For some reason my students keep giving me high marks on the anonymous evaluations and every year, when I have threatened to quit teaching, I go back for one more year. They seem to like the no BS approach.

    After I retired and a new department took over the Surgery service, they didn’t want me teaching residents anymore. I had done so for 20 years. I agreed as my skills would evaporate rapidly as new things came along.

    I had an anesthesiologist friend tell me that I was the only “Type B” surgeon he had ever met. I didn’t get excited. Some of the nurses told me they would rather do a major trauma case with me because I didn’t yell or swear.

    There is a folklore among surgeons who brag about how hard they work and how tough their cases are. I have a lot of those stories in the book but most of the time I was always aware that I was not the one talking the chances. The patient was the one on the high wire. I have always believed that the patient was the one making the decision and there are stories in there about that too. I let a couple of people die who told me they wanted to do so or who refused surgery that would save their lives.

    I fear that level of independence may be gone.

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