Chapter 8
In General
Human understanding plays a large part in the practice of medicine. A sick patient does not know how much or how little skill a doctor has, and in fact the amount of skill is not questioned if the doctor has a sympathetic heart and real empathy. The old general practitioners were especially warm hearted and frequently guided their patients over some mighty rough spots just by their visits, their interest and to some extent, of course, their ability. There was not then the complaint that doctors were blind and deaf to the needs of the patient. They were not too wrapped up in their golf game, the stock market, and their own security. Now the complaint is that they are insensitive to the needs of the people and too selective as to whom they will serve. We may be losing those qualities of human understanding so aptly demonstrated by some of our forebears. After all, medicine has its art as well as its science, and it is just as important. We mustn’t become self-seeking, clock watchers and undo the reputation that has been built for doctors in the past years. Doctors have always been at the top of the list in popularity, and should remain that way.
It is important for a good mother or wife to have behind her a good husband. We often hear how important, even necessary a good woman is to a successful man, but we forget how important it is the other way around. How can a woman do any civic chores if she isn’t backed up by a good husband who will help her to do the dishes, clean the house and help out in general? The good Lord did not give every woman a helpful man to facilitate her duties while she does her church work, her PTA and the committee work she is obligated to do. Some of the training of the children is definitely a part of father’s obligation. How many times have I heard the expression, “Oh if I had only had more time for my family!”
Every man should make more time to spend with his family, for the benefits are unsurpassed, to him and to the children. With the eight-hour day, one can manage time with the family if he desires. After all, a fellow does what he wants to do, and lives as he wishes. He is able to control his activities so when a man says he has no time to spend with his family, I rather question his real desires.
The problems of marital counseling arise frequently and a physician has plenty of opportunity to give advice, but there is need to be very careful how he advises a patient, especially if only one member of the family is relating the story. For example, if a woman tells what a beast her husband is, how he mistreats her, and beats her, ignores her, etc., his first thought is to advise her to get a divorce. Life is too short to put up with such treatment. Then she may return to her husband, call him a brute and tell him the doctor advised her to get a divorce because he isn’t worth living with. She really makes it good. Then the doctor may be faced with a belligerent husband, perhaps a lawsuit, plus an unhappy wife. Fortunately I have never been involved in a case of this kind, but it is very easy to become so involved. Generally only one side of the story is presented, and some of the stories have been pathetic, almost unbelievable. Many are embellished, many are understated.
There was one instance where a young woman came in repeatedly with stories of ill treatment, and she had numerous bruises to accompany the story, as proof. I knew both Charlotte and Richard Cox for two or three years and Dick had some terrible asthmatic attacks for which I treated him. He was always a perfect gentleman in my office, while she always complained about his cruelty. They always came in separately to see me.
One Sunday morning about 2:30 the phone rang. I answered, for I was still up, having gotten in from another call.
“Dr. Harris, I wish you would come down right away. I think Dick is in pretty bad shape.”
Thinking of his asthmatic attacks, I grabbed my medical bag and rushed down. It was only a few blocks from home, so it didn’t take long. I found Dick in pretty bad shape, all right. She had shot him dead. There was no life at all when I arrived. I phoned the police and she was tried eventually, found guilty of manslaughter, and served one year in the women’s prison at Frontera. She was out within a year, for I saw her in the neighborhood. One never knows what kind of people he is dealing with, so I was doubly glad that I had kept my counsel during the years they were fighting.
Most of the problems of concern to women are sex, fear of pregnancy, too much or too little affection, money, failure of husband to show his appreciation, and in-laws. Most problems of concern to husbands are sex, money, too much or too little affection, inability to discuss problems with wife, failure of wife to express appreciation, and in-laws. Other items enter in, in fact, many of them, but such things as the inability to conceive are frequently the worry.
Any one of these items can be built up into a big thing and can result in divorce proceedings. Usually the big problems can he talked out and settled together, but the small, exasperating differences are the ones which cause the most trouble.
Then too, when a couple’s income is good, sometimes there is most difficulty. For example, the Robins were steady patients, coming in, baring their grievances time after time. Finally Mr. Robin was laid off by his employer, who sold out to another company. Mr. Robin was out of work, so they started cooperating. They didn’t seem to require medical care for a long time, they settled their difficulties and became very happy, working together like they did when first married. Mr. Robin soon found another job, and their problems were solved. I have noticed that other patients required much less medical care when their monetary coffers were low.
A nasty disposition is frequently due to personal problems, too, and at times there is a tendency to run to a doctor for consolation. Sometimes they pour out the whole story, exaggerating a bit, always making themselves the heroes. I have been forced to hear some very interesting stories, accompanied by some histrionic efforts. After getting it off his (or her) chest, the patient feels much better and is able to go his way greatly relieved.
Some of our problems are present when the husband retires. “Wives’ ire, when husbands retire” is an old saying. Poor man, he has nothing to do, and hasn’t prepared for retirement, so he goes back to the plant to talk to the boys. But the boys haven’t any time to visit, and their interests are different, so he gravitates back home. He can only help his wife make so much jelly or jam, so she soon becomes fed up with having him around. In general, it takes most men about a year to get into the swing of retirement and learn to enjoy themselves.
Genetics have a great part to play with our conditions. In fact there are special studies in genetics now, in biology and in medical schools, and the study is becoming a specialty. I am reminded of a family in Oklahoma named Whipple. Mr. Whipple had three sons and six daughters. All bore a family resemblance, end each one weighed over 300 pounds. When they had refreshments on a hot summer afternoon, all eleven of them had a whole watermelon each, and they stayed with their melon until it was just a shell of its former self. It was indeed quite a picture, that family eating watermelon. We fellows called them the “Beef Trust” for it really represented a lot of weight. They must have done equally well at the table, at mealtime.
Then there were two surgical patients, brother and sister, who had similar conditions, not far apart. They presented with a pouching of the esophagus, due to a spasm of the cardia. The pouch on the woman held over a pint, and required surgery. The X-ray revealed a large diverticulum, with practically no filling of the stomach. We opened her up, opened the stomach and forcibly dilated the cardia (upper end of the stomach). A great many undigested green beans, and stewed carrots came down into the stomach. This operation was on Friday, and the wife said they had green beans and carrots on Tuesday.
In less than a month, the brother had a similar condition, also requiring surgery to dilate the cardia. These were the only cases like this I had ever seen. Both recovered promptly and were able to eat more green beans and carrots. Whether there was a genetic effect there, I don’t know as it is really a rather rare condition.
Another type of case that was very interesting, was that of ectopic, or tubal pregnancy. I saw three cases, all of pregnancy in the right tube, all within a period of a year, and there was never another case in my thirty years of practice. There have been several surgeons I talked to who had never seen one, or not more than one case. It just depends on where you happen to be at the right time.
There are many things in medicine that we do not understand, but one of the mysteries is the regression of cancer in a patient. The medical literature reviews many cases of cancer all diagnosed by biopsy as well as clinically which were far advanced, even in the inoperative stage. These have improved, ceased to spread and the patient had a rather long period of freedom from the symptoms. A recent study by Everson and Cole has brought to light 176 examples of very unexpected regression of “tumors.” It is true that some of these patients later died of their disease, but many enjoyed several unexpected months or even years of additional time to live. There seems to be evidence that some force hitherto undiscovered, exists in the body of man which is able to overcome cancerous conditions. Perhaps some method will be discovered accidentally to enhance this force and we can use it as a preventive measure.
How do we know that some individuals as children have not had early malignancies which have been arrested automatically through some force, or some treatment which we do not suspect? There is a great deal of experimental work being done, some very complicated, but a simple remedy maybe found which will make us all wonder, “Why didn’t I think of that myself?”
The ears are pretty handy gadgets to have and are used for other things than hearing. Frequently a very young child came in with foreign bodies in the ear, but there was a Boy Scout, about fourteen years old who had a bean pushed so far into an ear that he required an anesthetic to extract it. He was “performing” before the group of Scouts. He put the bean into one ear, to pull it out the other ear, and accidentally got it in too far. Then there was the man who came in with a note folded and placed in an ear. He very nonchalantly reached up, took the note out and reminded himself of the question his wife had told him to be sure to ask. Also, when we had streetcars for transportation, there was a chap who always carried a dime in his ear to have handy. It was easier than searching through his pockets.
One day a small boy was brought in to see me with a bean in his nose. His mother didn’t know how long it had been there. Her first knowledge of it was when the bean began to sprout. Not realizing what it was, she was quite perturbed and thought only the worst. As he was quite young, we immobilized him and extracted the object without difficulty.
In general, people are very clean, and especially the women are fastidious when coming for an examination. They are bathed, powdered, and perfumed for the doctor, and the doctor appreciates their thoughtfu1ness. Men frequently come straight from work, which is easily excused, but there were two women in particular I recall who had an antipathy to taking a bath. They always came in with a horrible B.O. plus a cheap perfume lavishly used. It made quite a combination, and was always the same, time after time. I frequent1y advised soaking in the tub for whatever condition they had.
There was one elderly gentleman who came in one day complaining of a headache. His blood pressure was quite high, apparently the cause of his headache of a few weeks standing. After I had outlined his diet, telling him what to avoid, and prescribing some antihypertensives, he very shyly confided, “Doctor, you are the first doctor I have been to in years. About seven years ago when I had my gallbladder out, the doctor told me not to take a bath. Do you suppose it would he all right now if I bathed?” I assured him that a good long soaking bath would be very good therapy, and that it might help to bring his pressure down. Water therapy was wonderful for him. He left the office happy.
There was the case of a family who had a greatly under-nourished boy, about four years old. Really he was a pitiful case, before we had so much welfare. He was being fed an almost strictly carbohydrate diet, he had a very definite avitaminosis, and was in a really bad condition. The family was very poor, obviously barely eking out an existence. I treated him free, and gave them ten dollars to buy the boy some good substantial food.
The family didn’t return. One day, I saw the father on the boulevard, and asked him how the boy was getting along, and why they didn’t bring him back in to see me.
“Oh, he’s doing all right, I reckon. I took that ten dollars you gave us and took him to a good doctor.”
During the war the many “little people” were found to be very valuable for aircraft work. There were many of them living in the neighborhood of my office, and finally they were able to earn a few dollars by working in the small, hard-to-get-to sections of planes, in the various factories. They were very clever, and very pleasant. They learned to do their work very quickly and were really indispensable in crawling into the small parts of the planes to connect wires and do the various little jobs that were necessary. Several of these people were my patients, and I really enjoyed them. They were not neurotic, never complained unless they had a good reason and always were quite polite. They had their own organizations and attended the meetings very faithfully.
It was interesting to visit in their homes. Although they were very mature people, many in their thirties and forties, they were quite small, three to four feet tall. Their homes were equipped with children’s furniture, including small chairs and tables. Everything was on a smaller scale. There was never an ordinary sized chair for me to sit in when I made a house call. The folks were talkative, friendly, and nearly every one had bad joints. The joints bothered them quite a bit, but they always brushed it aside, by saying, “We all have bad joints. We have to expect them to hurt some.”
They played their part in winning the war. I have often wondered if they still are employed in the building of planes, or if some other method has been found to replace them.
One has to be in relatively good condition to be a patient in the hospital now. The greatest complaint is the early awakening of the patients to check the temperature, and to take an early bath. (As one patient said, “I don’t know why I am having a bath. I’m not going anywhere.”) Then there is the long wait for breakfast, the competition for the bedpan or bathroom, the Bennett machine, the lab technician poke a vein, then the Electrocardiograph. Every time a patient gets comfortable, along comes another disturbance—medication, laxatives or enemas, X-Rays, and hypodermics. The only real rest one gets is during visiting hours, and then there is always someone who comes to visit, sits on the bed and eats the fruit and candy. Someone always volunteers, “My aunt Emma had that and she died,” or “Uncle Elmer had your condition, and he lived about three weeks.” Finally the patient drops off to sleep, when along comes a nurse to wake him up to take his sleeping pill. During the night, someone falls out of bed or a bed pan drops on the floor with a clatter. The night nurses have a gripe and just enough is heard of their conversation to be disturbing. Something goes on all night long in a hospital. No wonder a young fellow who was put in a ward to be prepared for surgery, said, “Are all these people going to sleep in my room tonight?” Then comes morning, and the early temperature check, and the bath, prevent a fellow from developing the sleeping habit.
Then there is another type of individual to sympathize with. There was a delightful young woman, a school teacher who was of such a temperament that every time an opportunity arose to go somewhere, or do something that she really wanted to do, she looked forward to it with such enthusiasm that she invariably became ill and couldn’t go. She missed out on many school functions she wished to attend but always was ready to present plays and recitals by her class, and do the necessary class work.
She was unmarried. One time her fiancé’s family wanted her to accompany them for a weekend, and the idea appealed to her greatly. Preparations were made, a special outfit was bought for the occasion and everyone looked forward with glee to the trip. Right at the last minute she became ill and could not go.
She later married, but on many a trip she became ill at the last minute, and could not participate. Finally, I told her husband to plan his outings without telling her about it, then spring it on her at the last minute. The trick worked, but she became quite perturbed because there was no notice to make preparations, and as everyone knows, the planning and preparations for a trip are half the enjoyment. But this poor woman had to be unwarned in order for her to enjoy herself. After a few years, however, after three children, she overcame the tendency to become ill. She had to have notice in order to prepare her children. She indicated to me that her stomach became so upset that she vomited all her meals. She simply could not eat, and became nervous. I have never known anyone else with this weakness to this extent.
There was a dear old couple that had been married for over fifty years. I had occasion to make several house calls on one or the other, and for some reason I always had to wait in the breakfast room while preparations were made for me to see the patient who was in the back bedroom. I noticed the tea cups were turned over in the saucers each time, and a bit of liquid tea in the saucer. Being nosey, I turned over the cup and there were remains of the tea in it. They saw no reason to wash dishes so often, I later learned, because the tea tasted just as good, they said. They also kept their Christmas cards on the mantle until after Easter, because they looked so pretty and reminded them of their joyous Christmas they had had. They took them down with reluctance about the fourth of July.