… uh … Mr.…”
“I’m Terry.”
“Okay, Terry … uh … would you please take your shirt off?”
“Sure.”
He reached over his shoulder and, in that special guy way pulled the back of the white tee up and over his head and then looked right at me.
I don’t know if my classmates in the amphitheater saw it, but I had one of those pit-of-the-stomach reactions when I spied the glistening, red-black, one-inch spot on Terry’s right shoulder. I moved closer to him, palpated it and then felt under his arms and around his neck. The enlarged lymph nodes were unmistakable.
“Terry, would you lie down?”
He stretched himself out on the cart, and I ran my fingers over the place in his abdomen where the liver would be. It wasn’t hard to find. It was twice normal size.
I helped him sit back up and turned to the professor.
“Terry has melanoma, and it’s spread to his lymph nodes and liver.”
The room went silent. Even as sophomores we knew what it meant. We had just completed a section on malignancies of the skin. This young man’s fate was sealed.
It is fairly easy to read a textbook and study photos and descriptions of different medical problems. It’s another story when the subject is alive, alert, and damned nice.
“Didn’t you forget something, Mr. Galen?”
Dr. Stemp raised his right eyebrow.
Terry whispered softly, so I think I was the only one to hear him.
“Listen to my chest, Doc.”
I quickly opened my bag, took out my stethoscope, and self-consciously strained my ears. The classical machine-shop rumble of a hole in the heart wall separating the two main chambers roared back at me.
“Terry has a VSD, Dr. Stemp, a ventricular septal defect.”
Stemp nodded, and I sat down.
In small groups, the rest of the class approached, examined the devil on Terry’s shoulder, and listened to the demon in his chest. After we finished we applauded the young man as an attendant wheeled him out of the room. When they reached the door, Terry sat up, forming the two fingers of his right hand in a V and yelling, “I’m going to lick this, guys!”
Stemp stared at the floor; the rest of us tried our best not to cry.
Other memories of those days march through my mind: more practical exams with microscope slides, unlabeled organs in jars, and fresh specimens delivered straight from the operating room or the morgue. Each bore the cryptic questions designed to tease and distract us. We didn’t just identify, we had to extrapolate: What would you expect this patient’s blood tests to show? What symptoms did he or she experience because this organ was not doing its job? And so on.
We learned something else: vigilance. At conferences we saw doctors called on the carpet and made to look like fools for missing what were obvious diagnoses to the pathologists once they had sliced open a deceased’s body. We witnessed even high and mighty specialists knocked down like bowling pins by the pathology reports. And indirectly we learned that cherished beliefs often have no basis in fact.
“Class, Mrs. Dayten was kind enough to share her problem with you today before her surgery.”
The general surgeon smiled benignly at the middle-aged woman sitting in the wheel chair. We had just studied breast tissue and the various tumors that could occur.
“Miss Sabo, would you do the honors?”
My classmate Judy hesitated then rose from her seat and approached the woman.
“Hello, Mrs. Dayten, I’m Judy. What seems to be your problem?”
She jumped back reflexively when the woman abruptly pulled open the top of her gown. Even from the back row we could see the corrugated surface on her left breast.
Paget’s disease of the breast. Insidious and misleading, it often appears as a skin rash like eczema and lulls the unaware into ignoring it until it becomes untreatable. Today’s health-savvy women are trained not to ignore even the slightest changes. Back then, neither the patient nor the medical professional were as enlightened.
Once more we stood in small groups around our patient and saw and felt the peau d’orange (orange-peel) roughness of the skin over the tumor.
Mrs. Dayten was to undergo a radical mastectomy in several hours. The women in the class held her hand.
We knew what would happen to her. Surgeons would remove not only the entire breast but also the lymph nodes under her arm and even some of the muscle tissue. That side of her chest would become a living skeleton.
Now, decades later, I shake my head in dismay. The procedure maimed those who underwent it and did little to prolong their survival.
What present-day treatments will become anathema under the scrutiny of future knowledge?
The year progressed and we marched through the various disciplines of the human body, studying each organ system with its unique chemistries, physiology, and anatomy, both visible and microscopic. And as we did so, we were introduced to the living personifications of what could go wrong.
“Note the dimensions of our patients’ chests and the way they breathe.”
We traveled by car to other institutions, including the local Veterans Administration hospital on the outskirts of Richmond. This time we saw first-hand the ravages of lifetime smoking, compliments of the countless free cartons of cigarettes given to soldiers during two world wars.
Two men, old before their time, sat in chairs, plastic tubes feeding oxygen from portable tanks into their mouths and noses. I stared at the two—so different and yet so alike. One looked like he had just been rescued from a concentration camp: thin and emaciated with flushed skin, his every attempt to breathe seemed a tiring effort. The other soldier, barrel-chested, wheezed and coughed and spat sputum (phlegm) into a cup by his side.
Seeing them took me back to my childhood, to my world in the tenements, when I was just a kid called Berto. To this day I retain vivid images of The Old Guys, three World War I vets who gathered at the shoe-repair shop of their legless war buddy, Harold Ruddy. That’s where I saw the devastation caused by the Germans’ use of mustard gas. Our neighbor, Tim Brown, lived a life of oxygen deprivation, drowning in a sea of air, because his lungs were almost non-existent.
But the men in that veteran’s hospital hadn’t been gassed—at least not by others.
They had unknowingly damaged themselves with decades of heavy smoking.
“Class, note the typical “blue-bloater” and “pink-puffer” habitus (body shape) of our patients.”
Dr. Marja Gortan was a lung specialist, a former refugee from Eastern Europe. Diminutive, almost doll-sized, she paced back and forth in front of us, her long white professor’s coat fluttering, as she pointed out the skin color and body shape of the thin emphysema patient and
