Night Train to Lisbon

Night Train to Lisbon

 

Night Train to Lisbon by Pascal Mercier (Grove Press, 2004)

I first read this page-turning thriller several years ago. I was attracted to re-read it because of its fine plot, historical setting, and character development. It kept me up several nights and re-reading it was a joy.

The Colors of Pride

First published in the Hektoen International Medical Journal. Hektoen International Journal is published by the Hektoen Institute of Medicine.

To view the story online visit the Article Here.

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In August 1978 we moved to Los Angeles. The van had barely left when Zan padded across our cul-de-sac, shirtless in knee-length shorts, concealing a bulging large mass he called “my benign sliding inguinal hernia.” At sixty-five, he was a tall, stocky man with a crop of wavy white hair.

In fragmented pieces, revealed casually and interspersed with daily political news, Zan gradually painted his life as a gentleman farmer in Orange County. In a moment of bravado he said, “I’ve had it for so many years and it hasn’t bothered me, it’ll probably be all right, Doc.” After a swig of his beer, he added, “If you’re willing to fix it I’ll let you do it someday. I don’t trust doctors, but you’re different.”

Eventually Zan made an appointment.  His hernia reached his left knee. Elsa, my resident, had not seen anything like it—I had, in India. He lay back. I successfully reduced it.

“An operation will fix your problem.”

“It doesn’t show,” he argued. “Why fix it?”

“If you aren’t willing to fix it under controlled conditions, will you be willing when it’s strangulated and a life-threatening emergency?”

His operation was my first of the day. Backing my car out of our driveway, I failed to note signs of inactivity across the street, riveted by news that Iranian Revolutionary Guards had stormed our embassy and taken fifty-two hostages.

My usual surgical team, including my scrub nurse, and the operating room (OR) were ready.  We hung around in our blues, expecting Zan at any moment. We continued to wait.  I grew frustrated, believing Zan would turn up, then incensed at being let down.Still smarting, by 9:30 I called for my next case. My team disbanded and a different nursing team turned over the OR while Mr. Nazari was wheeled in. A new scrub technician what was unknown to me at the time kept irritating me by asking numerous questions about what instruments and sutures I was going to use. It was more efficient and safer to work with my familiar team.

Continue reading The Colors of Pride

The LeRoy Catastrophe: A story of death, determination, and the importance of nutrition in medicine.

“To this day, I wonder whether his death certificate truly reflected the cause of death: ‘physician-induced’ malnutrition.”  – from The LeRoy catastrophe

Below is the abstract of this article as published by The Columbia Medical Review. It can be viewed in full here. The Review has recently launched a place for thought leaders to convene and develop action-oriented agendas to combat contemporary and anticipated social issues in medicine.

Abstract

In August 1976, a young man named LeRoy fell from a ledge, fracturing his femur. Major internal bleeding was suspected. During a laparotomy, the trauma team ensured that all internal organs were intact and the orthopedic team set his fracture. Thirty days later, LeRoy died. He had eaten little; each day he only received three liters of glucose, the equivalent of 510 calories, intravenously. The glucose was insufficient to meet his nutritional needs, and he lost over 20% of his body weight during his hospital stay. The cause of death was due to “physician-induced” malnutrition. Meanwhile, a paper around the same time documented that the prevalence of malnutrition in Boston hospitals was 44% and that malnutrition itself was a predictor of higher complication and death rates.

Continue reading The LeRoy Catastrophe: A story of death, determination, and the importance of nutrition in medicine.